Search

Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2005.08.032 Byline: Takashi Kojima (a), Murat Dogru (a), Reiko Ishida (a), Eiki Goto (a), Yukihiro Matsumoto (b), Kazuo Tsubota (a) Abstract: To evaluate the efficacy of a thermo sensitive punctum plug, the Smart Plugacents, in the treatment of dry eyes. Author Affiliation: (a) Department of Ophthalmology, Keio University, Tokyo, Japan (b) Department of Ophthalmology, Tokyo Dental College, Chiba, Japan Article History: Accepted 15 August 2005 Article Note: (footnote) This study was supported by grants from the Japanese Ministry of Education and Science Tokyo, Japan and Hightech Research Center at Tokyo Dental College, Chiba, Japan.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2008.07.012 Byline: Minako Kaido (a)(b), Reiko Ishida (a), Murat Dogru (b), Kazuo Tsubota (a) Abstract: To evaluate the intracanalicular migration rate during plug insertion with a new plug insertion technique compared with a standard technique. Author Affiliation: (a) Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan (b) Johnson & Johnson Ocular Surface Visual Optics Department, Keio University School of Medicine, Tokyo, Japan Article History: Accepted 3 July 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2007.04.006 Byline: Atsuro Uchida (a), Miki Uchino (a)(b), Eiki Goto (a)(c), Eri Hosaka (a)(c), Yuko Kasuya (c), Kazumi Fukagawa (a)(b), Murat Dogru (a)(d), Yoko Ogawa (a), Kazuo Tsubota (a)(d) Abstract: To compare noninvasive tear meniscus height (NI-TMH) using a tear interference device in normal subjects and dry eye patients with Sjogren syndrome (SS), and to investigate the applicability of this new method before and after the punctal occlusion procedure. Author Affiliation: (a) Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan (b) Tokyo Dry Eye Center in Iidabashi Eye Clinic, Tokyo, Japan (c) Department of Ophthalmology, School of Dental Medicine, Tsurumi University, Yokohama, Japan (d) Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan. Article History: Accepted 4 April 2007

For the last 20 years, a great amount of evidence has accumulated through epidemiological studies that most of the dry eye disease encountered in daily life, especially in video display terminal (VDT) workers, involves short tear film breakup time (TFBUT) type dry eye, a category characterized by severe symptoms but minimal clinical signs other than short TFBUT. An unstable tear film also affects the visual function, possibly due to the increase of higher order aberrations. Based on the change in the understanding of the types, symptoms, and signs of dry eye disease, the Asia Dry Eye Society agreed to the following definition of dry eye: “Dry eye is a multifactorial disease characterized by unstable tear film causing a variety of symptoms and/or visual impairment, potentially accompanied by ocular surface damage.” The definition stresses instability of the tear film as well as the importance of visual impairment, highlighting an essential role for TFBUT assessment. This paper discusses the concept of Tear Film Oriented Therapy (TFOT), which evolved from the definition of dry eye, emphasizing the importance of a stable tear film.

To evaluate the relationship between the severity of ocular and systemic pain.

On a global scale, the quantity of biomass waste is steadily increasing, particularly in densely populated urban areas. The electricity and heat energy generation from biomass gasification is a viable sustainable process and substitutes fossil fuels, which can decrease greenhouse gas emissions, in particular, reduce carbon dioxide gas. In this work, sugarcane bagasse as a biomass fuel was considered for combustible gas generation by utilizing an intensified downdraft-throated gasifier. The study showed that sugarcane bagasse has a calorific value of around 17.7 MJ/kg and can be densified in the form of briquettes, which is found to be an appropriate feedstock for gasification in a downdraft gasifier generating an average of 2.05 N m3of produced gas per kilogram of bagasse with a calorific value between 3.30 and 4.56 MJ/N m3. Biomass feed rates for the gasifier varied between 2.87 and 7.44 kg/h were utilized in the experiments. The produced combustible gas mixtures were determined as CO, H2, CH4, C2H2, C2H4, and C2H6, which constitute 25–27% v/v of the entire produced gas. The volume of produced synthetic gas (syngas) ranged from 2.05 to 2.16 N m3/kg of bagasse gasified. Above 99% transformation of solid carbon in the bagasse to product gas was accomplished by utilizing the intensive gasification system; however, it is required to apply a gas clean-up process to mitigate against any possible harmful impacts.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2004.09.037 Byline: Tatsuya Onguchi (a)(b), Yoji Takano (b), Murat Dogru (b), Kazuo Tsubota (b), Jun Shimazaki (a) Abstract: To evaluate the influence of amniotic membrane on intraocular pressure (IOP) measurement with the Tono-Pen. Author Affiliation: (a) Department of Ophthalmology, Tokyo Dental College, Ichikawa, Chiba 272-8513, Japan (b) Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Article History: Accepted 14 September 2004

The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.

Ocular surface mucosa is the first-line ocular tissue to be exposed to environmental stress. We evaluated tear functions and keratoconjunctival epithelial alterations after sidestream cigarette smoke (SCS) exposure and tried to clarify the role of the transcription factor nuclear factor erythroid 2–related factor 2 (Nfe2l2, also known as Nrf2), on the ocular surface. In wild-type and Nrf2−/−mice, tear volume did not change after SCS exposure. Tear film breakup time (tear stability) in Nrf2−/−mice was significantly shorter than that in wild-type mice after SCS exposure. Vital staining scores, including fluorescein and Rose Bengal staining, showed significantly higher values in Nrf2−/−mice than in wild-type mice after SCS exposure. Excessive oxidative stress accumulation was detected in Nrf2−/−mice after SCS exposure using immunohistochemical analysis. Immunohistochemical analysis also revealed decreased mucin 1 (Muc1) and Muc5ac staining in Nrf2−/−mice after SCS exposure. mRNA expression levels of Muc1, Muc4, and Muc5ac and of SAM-pointed domain epithelial-specific transcription factor in Nrf2−/−mice were lower than those in wild-type mice after SCS exposure. Mean tear IL-6 concentrations increased significantly in Nrf2−/−mice after SCS exposure. In conclusion, SCS exposure induced decreased tear stability, ocular surface damage, and altered conjunctival phenotype in Nrf2−/−mice. Nrf2 could play an important role in protection of the ocular surface against SCS exposure.

Recent advances in ocular surface reconstruction for patients with severe ocular surface diseases have significantly improved the prognosis of patients with vision-impairing corneal abnormalities. The history of cultivated epithelial sheet transplantation is short, and debate on the current approaches for these procedures is continuing. Limbal stem cell transplantation, including conjunctivolimbal autograft and keratolimbal allograft, has brought opportunities for vision improvement. In addition, the use of cultivated limbal epithelial transplantation from both allogeneic and autologous sources has provided further options for immediate postoperative epithelialization of the corneal surface. Finally, cultivated oral mucosal epithelial transplantation, which allows autologous transplantation for patients with bilateral limbal stem cell deficiency, has provided the best overall midterm and long-term results. Its biggest advantages are the absence of rejection reactions and the reduction of postoperative complications associated with steroid therapy. However, a solitary surgical approach is not sufficient for obtaining a good clinical outcome. To maximize the possibility of success using these procedures, it is important to preoperatively enhance aggressive treatment of the ocular surface, especially with factors that facilitate moisture retention. In this review article, we also discuss our clinical experience in relation to these surgical procedures.

IMPORTANCE: There are limited reports on the relationship between mucin 5AC (MUC5AC) concentrations in tears, working hours, and the frequency of ocular symptoms in visual display terminal (VDT) users. This investigation evaluated these relationships among patients with dry eye disease (DED) and individuals serving as controls. OBJECTIVE: To determine the relationship between MUC5AC concentration in the tears of VDT users based on the diagnosis of DED and frequency of ocular symptoms. DESIGN, SETTING, AND PARTICIPANTS: An institutional, cross-sectional study was conducted. Participants included 96 young and middle-aged Japanese office workers. Both eyes of 96 volunteers (60 men and 36 women) were studied. Participants working in a company that used VDTs completed questionnaires about their working hours and the frequency of ocular symptoms. Dry eye disease was diagnosed as definite or probable, or it was not present. Tear fluid was collected from the inferior fornix after instillation of 50 μL of sterilized saline. The MUC5AC concentration was normalized to tear protein content and expressed as MUC5AC (nanograms) per tear protein (milligrams). The differences in MUC5AC concentration between DED groups, between VDT working hours (short, intermediate, and long), and between symptomatic and asymptomatic groups were evaluated with 95% CIs based on nonparametric Hodges-Lehmann determination. MAIN OUTCOMES AND MEASURES: Ocular surface evaluation, prevalence of DED, and MUC5AC concentration. RESULTS: The prevalence of definite and probable DED was 9% (n = 9) and 57% (n = 55), respectively. The mean MUC5AC concentration was lower in the tears of VDT users with definite DED than in those with no DED (P = .02; Hodges-Lehmann estimator, −2.17; 95% CI, −4.67 to −0.30). The mean MUC5AC concentration in tears was lower in the group that worked longer hours than in the group that worked shorter hours (P = .049; estimated difference, −1.65; 95% CI, −3.12 to 0.00). Furthermore, MUC5AC concentration was lower in participants with symptomatic eye strain than in asymptomatic individuals (P = .001; estimated difference, −1.71; 95% CI, −2.86 to −0.63). CONCLUSIONS AND RELEVANCE: The data obtained in the present study suggest that office workers with prolonged VDT use, as well as those with an increased frequency of eye strain, have a low MUC5AC concentration in their tears. Furthermore, MUC5AC concentration in the tears of patients with DED may be lower than that in individuals without DED.

Introduction:Dry eye is a visually disabling disease encountered in many countries with a wide variation of treatment practices all over the world. On that front, the 2007 Report of the International Dry Eye WorkShop (DEWS) reviewed the current knowledge on all aspects of dry-eye disease (DED), in an evidence-based manner, and outlined the trends and recommendations in the treatment of DED on the basis of disease severity.Areas covered:This review mainly focuses on treatments for DED based on severity as recommended in the DEWS report, particularly artificial eye drops, hyaluronate sodium eye drops, autologous serum, anti-inflammatory eye drops including cyclosporine and steroids, and mucin secretagogues. New dry-eye treatment modalities in current trials outlined on the clinicaltrial.gov site are also outlined.Expert opinion:Further investigations into the mechanism of action of the new mucin and tear secretagogues which have been suggested to have anti-inflammatory properties will enrich our understanding in relation to relevant ocular surface responses after treatment with these new agents.

IMPORTANCE A validated questionnaire that assesses symptoms and the effect of dry eye disease (DED) on the patient’s daily life is needed to evaluate the condition. OBJECTIVE To develop and validate the Dry Eye–Related Quality-of-Life Score (DEQS) questionnaire in Japan. DESIGN, SETTING, AND PARTICIPANTS Development and evaluation of the DEQS questionnaire were conducted in 4 phases: (1) item generation, (2) pilot study to assess content and face validity, (3) preliminary psychometric validation study to examine factor structure and reduce the number of items, and (4) final psychometric validation with 224 participants (203 with DED and 21 serving as controls). Participants completed the DEQS questionnaire, the Short Form-8, and the National Eye Institute Visual Function Questionnaire-25. To evaluate reproducibility and responsiveness, individuals with DED completed the DEQS questionnaire twice. MAIN OUTCOMES AND MEASURES Internal consistency, reproducibility, discriminant validity, concurrent validity, and responsiveness. RESULTS Items were generated from a literature review, and 35 items were selected for the draft version. In the pilot study, 11 items were deleted; furthermore, 9 items were deleted based on the results of item analysis and factor analysis in the preliminary validation study. The final 15-item DEQS questionnaire consisted of an Overall Summary scale and 2 multi-item subscales: Impact on Daily Life and Bothersome Ocular Symptoms. The psychometric analysis revealed that the DEQS questionnaire has good internal consistency, test-retest reliability, discriminant validity, and responsiveness to change. The DEQS questionnaire correlated well with the mental component of the Short Form-8 and showed strong correlations with 4 subscales (Ocular Pain, Near Vision, Distance Vision, and Mental Health) of the National Eye Institute Visual Function Questionnaire-25. CONCLUSIONS AND RELEVANCE The DEQS questionnaire is valid and reliable for evaluating the multifaceted effect of DED on the patient’s daily life, including mental health, and it can be used easily in routine clinical practice.

To investigate conventional visual acuity (VA) and changes therein over time in older drivers.

PURPOSE:To study the effect of pupil size on the relationship between refractive astigmatism and uncorrected distance visual acuity (UDVA) and pseudoaccommodation in pseudophakic eyes.METHODS:Thirty-six eyes from 36 patients who underwent phacoemulsification and intraocular lens (IOL) implantation were included. All eyes were divided into two groups based on the presence of postoperative with-the-rule astigmatism or against-the-rule astigmatism. Uncorrected and corrected distance visual acuity (CDVA), refractive astigmatism, subjective accommodation amplitude, and pupil sizes under photopic and mesopic conditions were measured 1 month postoperatively. The effects of pupil size on the relationship between refractive astigmatism and UDVA were investigated.RESULTS:Against-the-rule astigmatism had a moderate but significant negative linear correlation with UDVA irrespective of the pupil size (RAgainst-the-rule astigmatism had a moderate but significant negative linear correlation with UDVA irrespective of the pupil size (R2=0.60, P<.01). A moderate but significant negative linear correlation was found when the pupil diameter exceeded 2.9 mm in eyes with with-the-rule astigmatism (R2=0.46, P=.04). Refractive astigmatism was not significantly correlated with pseudoaccommodation regardless of the pupil diameter in either group.CONCLUSIONS:The results of the current study suggest that pupil size may have an impact on postoperative UDVA in eyes having against the-rule astigmatism and in eyes with a large pupil diameter and with-the-rule astigmatism.

An imbalance between free radical generation and radical scavenging antioxidant systems results in oxidative stress, which has been associated with cell injury observed in many age-related diseases. The superoxide dismutase (SOD) family is a major antioxidant system, and deficiency of Cu,Zn-superoxide dismutase-1 (Sod1) in mice leads to many different phenotypes that resemble accelerated aging. In this study we examined the morphologic features and the secretory functions of the lacrimal glands in Sod1−/−mice. Lacrimal glands showed atrophy of acinar units; fibrosis; infiltration with CD4+T cells, monocytes, and neutrophils; increased staining with both 4-hydroxy-2-nonenal and 8-hydroxy-2′-deoxyguanosine; increases in apoptotic cells; and the presence of the epithelial-mesenchymal transition in senescent Sod1−/−mice. Electron microscopy findings revealed evidence of epithelial-mesenchymal transition, presence of swollen and degenerated mitochondria, and the presence of apoptotic cell death in the lacrimal glands of senescent Sod1−/−mice. These alterations were also associated with the accumulation of secretory vesicles in acinar epithelial cells, decreased production of both stimulated and nonstimulated tears, and a decline in total protein secretion from the lacrimal glands. Our results suggest that Sod1−/−mice may be a good model system in which to study the mechanism of reactive oxygen species–mediated lacrimal gland alterations.

To evaluate the tear meniscus changes after punctal occlusion in dry eye patients using Visante optical coherence tomography (OCT) in a prospective controlled study.

To evaluate the efficacy of surgical treatment for conjunctivochalasis using the Tear Film Stability Analysis System.

Introduction:Based on data from the largest studies of dry eye to date –– the Women's Health Study (WHS) and the Physicians' Health Study (PHS) –– and other studies, it has been estimated that about 3.23 million women and 1.68 million men, for a total of 4.91 million Americans aged ≥≥ 50 years, have dry eye. Tens of millions more have less severe symptoms and probably a more episodic manifestation of the disease that is notable only during contact with some adverse contributing factor(s), such as low humidity or contact lens wear. Dry eye disease is a common yet frequently under-recognized public health problem whose etiology and management challenge clinicians and researchers involved in this field.Areas covered:Advances in the understanding of the disease have been made over the past 10 years in areas of epidemiology, pathogenesis, clinical manifestation, and possible therapy. Historical aspects and recent information in relation to the use of artificial tear substitutes and anti-inflammatory agents in dry eye disease, including topical cyclosporin and corticosteroids, autologous serum, tetracyclines and systemic immunosuppressants, are covered in this review. The reader will gain insight into the recent views on the pharmacological menu of treatments for dry eyes following the recommendations of the 2007 International Dry Eye Workshop.Expert opinion:Dry eye is a visually disabling disease, the treatment of which needs tailoring according to the type and severity of dry eye disease.

To prospectively investigate the effects of passive cigarette smoke exposure on the ocular surface and tear film in soft contact lens (SCL) wearers.

Differential expression of chemokine genes were investigated in various types of ocular surface cells.

The purpose of this study is to report the features of dry eye and ocular surface disease in an unusual case of ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome.

To evaluate the efficacy of punctum plug insertion on tear and dynamic visual function in dry eye patients with short break-up time (s-BUT) of the tears.

To evaluate the efficacy of a new Orgahexa eye warmer mask for patients with simple meibomian gland dysfunction (MGD) in a prospective comparative study.

The purpose of this study is to assess the features of dry eye disease in a Japanese elderly population.

Optical aberrations and visual disturbances are associated with dry eye, although visual impairment is often not detected by conventional visual acuity testing. The newly developed functional visual acuity (FVA) device allows continuous dynamic evaluation of distance visual acuity and assessment of the effect of natural tear film status on dynamic visual function. Similarly, to detect corneal surface irregularities during sustained eye opening in dry eye subjects, a new tear stability analysis system (TSAS) has been developed. Both FVA and TSAS measurement systems seem to be effective tools in the assessment of dynamic visual acuity changes in dry eye and normal subjects. Both methods were also found to be helpful in the evaluation of the outcome of management of dry eye disease. FVA testing has been suggested to be an important indication of an individual's performance in relation to certain daily activities, such as driving, reading and working at a video display terminal. This review provides illustrations of results obtained from FVA and TSAS systems.

We present the first child case of pseudomembranous conjunctivitis accompanied by an extensive corneal ulcer with acute graft-versus-host disease (GVHD) after cord blood stem cell transplantation (CBSCT). The histopathology of the pseudomembrane and the ocular changes following its excision were investigated specifically. One week after the excision of pseudomembrane, the extensive corneal epithelial defects had totally disappeared. Pseudomembrane excision may be an effective method of treatment in corneal epithelial defects observed after GVHD.

Purpose We compared the efficacy of a new nonsteroidal antiinflammatory drug (NSAID) eye drop, 0.1% bromfenac sodium (Bromfenac), with that of an antiallergic agent, 0.1% pemirolast potassium (Pemirolast), in the treatment of seasonal allergic conjunctivitis in Japanese patients. Methods Twenty-two subjects with seasonal allergic conjunctivitis were enrolled in the study. One eye was treated with Bromfenac eye drops and the contralateral eye was treated with Pemirolast eye drops for 1 week. Subjective ocular symptoms and objective ocular signs evaluated by slit-lamp examination were scored and recorded before and after treatment. Results Both drugs significantly decreased ocular signs after 1 week, but not symptoms. No significant differences in subjective symptoms or objective signs were observed between the two drugs. Ten patients (45.5%) selected Bromfenac as more effective, nine patients (40.9%) selected Pemirolast, and three patients found no difference in efficacy between the two drugs. Conclusion Bromfenac sodium is as safe and effective for the treatment of allergic conjunctivitis as pemirolast potassium. Jpn J Ophthalmol 2004;48:587–590 © Japanese Ophthalmological Society 2004

To describe the tear function and ocular surface disorders in a patient with ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome. Routine ophthalmic examinations were performed, including slit-lamp biomicroscopy, anterior segment photography including transillumination photos of the lids, Schirmer tests I and II, tear film break-up time (BUT) assessment, corneal fluorescein staining, DR-1 tear film lipid layer interferometry, and tear evaporation rate measurements. Slit-lamp examination revealed conjunctival hyperemia, superficial punctate keratopathy, and corneal leucoma with neovascularization. Although the Schirmer test values were within normal limits, the BUT value was 0 s in both eyes. Transillumination of the lids showed the absence of meibomian glandular structures. DR-1 tear film lipid layer interferometry results were dry eye grade 5 with an irregular tear film, areas of corneal surface exposure, and several dry spots. The tear evaporation rate was elevated and was measured as 6.98 × 10−7g/cm2per second (normal, 4.1 ± 1.4 × 10−7g/cm2per second). The ocular surface disorder and shortened BUT in EEC syndrome were attributed to the absence of meibomian glands, leading to lipid layer deficiency in the tear film with a concomitant increase in tear evaporation.

Over the past decade, numerous advances have been made in relation to dry eye diagnostic markers, technologies, and treatment options. The mainstay of treatment of dry eye is the use of artificial tear solutions and punctum plugs. A goal is the development of agents that provide symptomatic treatment and, at the same time, improve ocular surface keratinization. It is the authors' opinion that the functional visual acuity tester and the new tear stability analysis system will be widely used to improve diagnosis and evaluate treatment outcomes in KCS. Advances in treatment will utilize anti-inflammatory agents, immune suppressants such as Cyclosporin A and FK-506, growth hormones, androgens, topical mucins and ocular surface stimulating drugs, like INS365. Although aqueous-deficient dry eye is most commonly not associated with Sjogren syndrome (SS), aqueous-deficient dry eye is often most severe in patients with SS; thus, this article focuses mainly on SS-associated dry eye.

Purpose To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma. Methods Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV®) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue®) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth®, Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration. Results The final best spectacle-corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow-up. The mean follow-up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy. Conclusions Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.

Purpose:To describe the ocular surface disorders of 362 patients with severe active atopic dermatitis (AD) treated in the Ophthalmology Department of Kobe University Hospital and Kobe Rosai Hospital Eye Clinics during the period 1994–1996.