Award type：Award from Japanese society, conference, symposium, etc.  Country：Japan

【目的】全身麻酔下での小児斜視手術において，術後嘔吐に関連する因子を検討する．
【方法】2016年12月から2021年4月にあいち小児保健医療総合センターにて全身麻酔下で斜視手術を行った18歳未満の患者を対象に，診療録から後ろ向きに術後嘔吐の有無，麻酔方法，病名，手術術式，筋移動量等を抽出し，術後嘔吐に関連する因子を評価するため，術者をランダム効果とした多階層混合効果ロジスティック回帰分析を施行した．また，外斜視で両外直筋後転術のみを行った群で，筋移動量と術後嘔吐の関連についても同様に解析した．脳合併症既往，21トリソミー，先天眼振，デスフルラン麻酔症例は除外した．　
【結果】解析した症例は1024例，男児480例，女児544例で，術後嘔吐は80例(7.8％)で認めた．外斜視714例，内斜視242例，交代性上斜位159例，右上斜視85例，左上斜視69例であり，手術した外眼筋毎の症例数は外直筋638例，内直筋295例，上直筋179例，下直筋7例，下斜筋311例であった．可能性のある交絡因子を調整後，下斜筋，内直筋，上直筋操作は術後嘔吐増加と関連した（オッズ比; 2.43 [1.33-4.44], P=0.004; 2.42 [1.02-5.70], P=0.044; 2.71 [1.34-5.51], P=0.006）．術前上斜視の有無と術後嘔吐発症に有意な関連を認めなかった (オッズ比; 1.17 [0.61-2.24], P=0.64)．また，外斜視で両外直筋後転術のみを行った群での，筋移動量と術後嘔吐発症に有意な関連を認めなかった(オッズ比0.96 [0.74-1.24], P=0.73）．
【結論】下斜筋，内直筋，上直筋操作は術後嘔吐発症の増加と関連したが，術前眼位や筋移動量は術後嘔吐発症増加と関連しなかった．

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1410214934

CiNii Research

Language：English   Publisher：PLoS ONE  

Purpose To determine the factors significantly associated with the amplitudes and implicit times of the flicker electroretinograms (ERGs) recorded with the RETeval system by analyzing the comprehensive data obtained during a health checkup screening. Methods Flicker ERGs were recorded with the RETeval system from 373 individuals who had a normal fundus and optical coherence tomography images. The sex, age, anthropometric, ophthalmologic, and hematologic data were collected from all participants who were 40- to 89- years-of-age. Univariable and multivariable linear mixed effects regression analyses were performed to identify factors that were significantly associated with the implicit times and amplitudes of the RETeval flicker ERGs. Results Univariable linear mixed effects regression analysis showed significant correlations between the implicit times and the best-corrected visual acuity, the age, the axial length, the blood sugar level, and the blood urea nitrogen level. Analyses by multivariable linear mixed effects regression identified that the axial length (β = 0.28), the age (β = 0.24), and the blood sugar level (β = 0.092) were three independent factors that were significantly correlated with the implicit times of the RETeval flicker ERGs. Univariable linear mixed effects regression analysis also showed significant correlations between the amplitudes of the RETeval flicker ERGs and the age, the platelet count, and the creatinine level. Multivariable linear mixed effects regression models identified the age (β = -0.092), the platelet count (β = 0.099), and the creatinine level (β = -0.12) as three independent factors that were significantly correlated with the amplitudes of the RETeval flicker ERGs. However, the smoking habits, body mass index, and the blood pressure were not significantly correlated with either the implicit times or amplitudes of the RETeval flicker ERGs. Conclusions Our results indicate that the age and some ophthalmologic and hematologic findings but not the anthropometric findings were significantly associated with the implicit times and amplitudes of the RETeval flicker ERGs. Thus, clinicians should remember these factors when analyzing the RETeval flicker ERGs.

DOI： 10.1371/journal.pone.0284686

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：JAPANESE ASSOCIATION OF CERTIFIED ORTHOPTISTS  

<p> <b>【Purpose】</b> Electroretinography using skin electrodes HE-2000 (HE-2000) manufactured by Tomey Corporation is a cutting-edge device that can simultaneously record electroretinogram (ERG) for both eyes. In this study, its usefulness in recording ERG in children with congenital nystagmus was reported.</p><p> <b>【Subjects and Methods】</b>The subjects were 10 children (20 eyes) with congenital nystagmus who had visited the outpatient clinic at Aichi Children's Health Medical Center between June and July 2021. In the test, the pupils were dilated and the subject was given 20 minutes for dark adaptation before the rod and flash ERGs were recorded. After 10 minutes uninterrupted light adaptation, the cone and flicker ERGs were recorded. An ophthalmologist determined whether a typical ERG waveform was recorded under each condition.</p><p> <b>【Results】</b>The rod and flash ERGs were successfully recorded in all the subjects (20 eyes, 100%), and the cone and flicker ERGs were successfully recorded in 9 (18 eyes, 90%) subjects. Two subjects had difficulty opening their eyelids due to photophobia, but one of them could overcome the difficulty with the examiner's comforting and finally recording was achieved smoothly.</p><p> <b>【Conclusions】</b>Our results revealed that HE-2000 can achieve a high success rate of recording ERG in children with congenital nystagmus and is useful for the evaluation of retinal function. Moreover, it is important that the examiner previously explains about the recording procedure in consideration of the patient's age and development to help ease the patient and obtain results smoothly.</p>

DOI： 10.4263/jorthoptic.53f117

CiNii Research

Event date： 2023.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：仙台   Country：Japan  

選択特別講義　斜視の基本
斜視は有病率2-4%程度の比較的多くみられる疾患であり、整容面のみならず視機能に大きな影響を及ぼす。視覚が発達する小児期に斜視がみられる場合には、両眼視機能発達に影響を与えたり、弱視を生じる可能性がある。そのため斜視の原因となる疾患に応じて治療が必要であり、これらについて解説する。また、成人では頭蓋内疾患や全身疾患の症状の一つとして後天的に斜視を生じることがあり、斜視から他の疾患が見つかることもある。このような後天性斜視の代表的な疾患について解説し、複視を生じた場合の治療についても解説する。