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Yu Matsuo,1 Yu Monden,1 Kensuke Sasaki,1 Hodaka Akune,1 Shuntaro Ikeda,1 Daiki Ishio,1 Kenta Murotani,2 Koji Nagafuji,3 Shigeo Yoshida1 1Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan; 2Biostatistics Center, Kurume University, Kurume, Japan; 3Department of Hematology and Oncology, Kurume University School of Medicine, Kurume, JapanCorrespondence: Yu Matsuo, Department of Ophthalmology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan, Tel +81 942 31 7574 ; Fax +81 942 37 0324, Email matsuo_yuu@med.kurume-u.ac.jpPurpose: To report the outcomes of different therapies in patients with conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma.Patients and Methods: This retrospective study included patients diagnosed with conjunctival MALT lymphoma between August 2000 and April 2022. Patients were classified into three groups according to their treatment: an observation group, a radiation therapy (RT) group, and a rituximab group (rituximab with or without chemotherapy). We analyzed overall survival (OS), overall, local, and systemic relapse-free survival (RFS), and adverse events after treatment.Results: This study included 15 patients (22 eyes). The 10-year OS was 100%. The 2-, 5-, and 10-year overall RFS rates were 80.1%, 41.2%, and 41.2% in all patients, respectively. The 2- and 5-year local RFS rates in the observation group were 100% and 0%, respectively. The 2-, 5-, and 10-year local RFS rates were 87%, 87%, and 87% in the RT group and 83%, 67%, and 67% in the rituximab group, respectively. The 2- and 5-year systemic RFS rates in the observation group were both 100%, and the 2-, 5-, and 10-year systemic RFS rates were 92%, 55%, and 55% in the RT group, and 100%, 60%, and 60% in the rituximab group, respectively. After RT, 53.3% of the eyes developed cataracts and 75% of these were treated with cataract surgery. In addition, 53.3% of the eyes developed dry eyes and were treated with eye drops. Rituximab with or without chemotherapy resulted in some systemic adverse events, but these improved following symptomatic therapies.Conclusion: RT resulted in good local control of conjunctival MALT lymphoma; however, systemic relapse may occur during long-term follow-up. Local and/or systemic relapse may also occur during long-term follow-up in patients treated by observation or rituximab with or without chemotherapy. Patients with conjunctival MALT lymphoma should be followed-up carefully for as long as possible after treatment.Keywords: conjunctival mucosa-associated lymphoid tissue lymphoma, overall survival, relapse-free survival

Yu Monden, Chikako Nagashima, Noriko Yokote, Fumi Hotokezaka, Satoshi Maeda, Kensuke Sasaki, Ryoji Yamakawa, Shigeo Yoshida Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, JapanCorrespondence: Yu MondenDepartment of Ophthalmology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830 0011, JapanTel +81-942-317574Fax +81-942-370324Email you@med.kurume-u.ac.jpPurpose: The aim of this study was to evaluate the clinical outcomes of management of recurrent pterygium with severe symblepharon using mitomycin C, double amniotic membrane transplantation, cryopreserved limbal allograft, and a conjunctival flap.Patients and Methods: This retrospective case series included 10 eyes of 10 patients with recurrent pterygium with severe symblepharon. Eight patients have diplopia in primary gaze. All patients underwent pterygium excision, application of mitomycin C (MMC), double amniotic membrane transplantation (AMT), cryopreserved limbal allograft (CLA) transplantation, and placement of a conjunctival flap. Outcome measures were visual acuity, astigmatism, and recurrence. Recurrence was defined as the presence of fibrovascular proliferative tissue crossing the limbus.Results: The patients’ mean age was 73.8 years. The mean follow-up period was 3.0 years. The mean preoperative and postoperative best-corrected visual acuities (logMAR conversion) were 0.43 and 0.30, respectively. The mean preoperative and postoperative astigmatism were – 3.89 diopters and – 1.54 diopters, respectively, and there was a significant difference. No recurrence occurred in any of the eyes. Symblepharon was released in all eyes. Diplopia in primary gaze was resolved in all eyes.Conclusion: Management of recurrent pterygium with severe symblepharon using MMC, double AMT, CLA, and a conjunctival flap was an effective treatment.Keywords: pterygium, symblepharon, limbal allograft, amnion, mitomycin C

Yu Monden, Fumi Hotokezaka, Ryoji Yamakawa Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan Purpose: The aim of this study was to evaluate the clinical outcomes of surgery for recurrent pterygia using mitomycin C (MMC), double amniotic membrane transplantation (AMT), and a large conjunctival flap.Patients and methods: This retrospective case series included 31 eyes in 31 patients with recurrent pterygia. All patients underwent pterygium excision, application of MMC, double AMT, and placement of a large conjunctival flap. Outcome measures were visual acuity, astigmatism, and recurrence. Recurrence was defined as the presence of fibrovascular proliferative tissue crossing the limbus.Results: The patients’ mean age was 68.2 years. The mean follow-up period was 3.6 years. The mean preoperative and postoperative best-corrected visual acuities (logMAR conversion) were 0.23 and 0.13, respectively. There was a significant difference between the mean preoperative (−3.85 D) and postoperative (−2.22 D) astigmatism. The recurrence rate was 3.2% (1/31 cases).Conclusion: Surgical pterygium excision with application of MMC, double AMT, and placement of a large conjunctival flap was an effective treatment for recurrent pterygia. Keywords: pterygium, amnion, MMC

Yu Monden,1 Shohaku Yamamoto,1 Ryoji Yamakawa,1 Atsuko Sunada,2 Seishi Asari,3 Koichi Makimura,4 Yoshitsugu Inoue5 1Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, 2Laboratory for Clinical Investigation, 3Department of Infection Control and Prevention, Osaka University Hospital, Osaka, 4Teikyo University Institute of Medical Mycology, Tokyo, 5Division of Ophthalmology and Visual Sciences, Tottori University Faculty of Medicine, Tottori, Japan Purpose: To report the isolation of Pestalotiopsis clavispora from the cornea of a patient with recurrent keratitis. Case report: A 73-year-old male gardener presented with conjunctival injection and an oval infiltrate with feathery margins in the temporal half of the cornea in the right eye. His ocular history in the right eye included cataract surgery, five episodes of herpes simplex keratitis, three glaucoma surgeries, and bullous keratopathy. He had been treated with corticosteroids for years. Light microscopy of corneal scrapings revealed a filamentous fungus, and fungal keratitis was diagnosed. Treatment with topical voriconazole and pimaricin ointment was commenced. One month later, the infiltrate resolved. The antifungal agents were discontinued 7 months later, and keratitis relapsed 4 days after the discontinuation. The fungus was isolated and identified by molecular techniques as P. clavispora. Based on the results of antifungal susceptibility testing, treatment with topical and intravenous micafungin was initiated. The corneal infiltrate resolved 1 month after the relapse. Conclusion: Molecular identification of the pathogen, and antifungal susceptibility testing, are useful in treating patients with fungal keratitis caused by a rare human pathogen. Keywords: fungal keratitis, Pestalotiopsis clavispora, plant pathogen, molecular identification, antifungal susceptibility test

Rika Kamada,1 Yu Monden,1 Koji Uehara,1 Ryoji Yamakawa,1 Kazuko Nishimura21Department of Ophthalmology, Kurume University School of Medicine, Kurume, Fukuoka, 2Medical Mycology Research Center, Chiba University and First Laboratories Co, Ltd, Kawasaki, Kanagawa, JapanAbstract: A rare case of fungal keratitis caused by Plectosporium tabacinum is reported. A 78-year-old female gardener presented with conjunctivitis and an oval infiltrate with irregular margins in the nasal half of the cornea in the right eye. Light microscopy of corneal scrapings revealed a filamentous fungus, and a diagnosis of fungal keratitis was made. The patient was admitted into our hospital on February 19, 2008. Treatment with topical miconazole, topical fluconazole, pimaricin ointment, intravenous miconazole, and corneal debridement was commenced. One week later, the infiltrate improved, but the central part of the infiltrate was still deep. Topical fluconazole was switched to topical voriconazole, and intravenous miconazole was switched to intravenous voriconazole. One month after admission, the causative organism was identified by morphology and molecular biological analysis as Plectosporium tabacinum. The corneal infiltrate resolved 3 months after admission. A stromal scar persisted for 3 months after the patient was discharged. This is the first detailed report of fungal keratitis caused by P. tabacinum. Voriconazole was effective in treating this refractory keratitis.Keywords: fungal keratitis, Plectosporium tabacinum, voriconazole, filamentous fungi

Yu Monden,1 Minoru Sugita,1 Ryoji Yamakawa,1 Kazuko Nishimura,21Department of Ophthalmology, Kurume University School of Medicine, Kurume, Fukuoka, Japan; 2Medical Mycology Research Center, Chiba University and First Laboratories Co Ltd, Kawasaki, Kanagawa, JapanBackground: Paecilomyces lilacinus is a saprobic fungus that occasionally causes keratitis in infected patients. Voriconazole, a triazole antifungal agent, is often administered to treat P. lilacinus keratitis, because it is resistant to many antifungal agents. However, some patients may not require voriconazole. Here, we report our experience of treating this infection and compare outcomes between patients treated with or without voriconazole.Subjects: We retrospectively reviewed four cases of infectious keratitis caused by P. lilacinus and compared treatment course and outcomes among the four cases.Observations: P. lilacinus was isolated from corneal cultures in all four cases. Three cases developed corneal perforation and underwent keratoplasty. Voriconazole was given in two cases with severe and refractory infection. Both required long-term treatment despite the effectiveness of voriconazole. They also had a medical history of diabetes and corticosteroid therapy. In two cases that were not treated with voriconazole, the eye conditions improved with a short treatment period (2–3 weeks). Neither of these cases had a medical history of diabetes, nor had they used corticosteroids.Conclusion: Although voriconazole is the most useful antifungal agent for treating P. lilacinus keratitis, this infection can be resolved by other treatments. Voriconazole should be offered to patients with diabetes and/or prior corticosteroid use.Keywords: Paecilomyces lilacinus, voriconazole, diabetes, corticosteroids