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To determine the risk factors and unique characteristics of keratoconus (KC) progression after penetrating keratoplasty (PK), anterior segment optical coherence tomography parameters were statistically analyzed in comparison with eyes undergoing PK for other diseases as a control. Ninety-one eyes maintaining clear PK grafts for over 10 years were divided into 2 groups according to the primary indication for PK (KC vs Others groups). Corneal thinning indicators (inferior host thinnest corneal thickness/central corneal thickness [IHT/CCT], inferior graft thinnest corneal thickness/CCT [IGT/CCT]), were smaller whereas anterior chamber depth, and steepest corneal power (Ks), and maximum corneal power (Kmax) were larger in the KC group with statistical significance. Graft size, Kmax and Ks correlated with IHT/CCT and IGT/CCT in the KC group. These correlations were not detected in controls. Graft size and postoperative period were selected by multivariate regression analysis as factors for corneal ectatic changes in the KC group. In conclusion, KC eyes long after PK show inferior graft and host corneal thinning, and corneal protrusion. Corneal power parameters such as Kmax or Ks can be used to monitor KC progression after PK. A small graft might lead to KC progression after PK.

Fuchs endothelial corneal dystrophy (FECD) is a leading cause of corneal endothelial (CE) degeneration resulting in impaired visual acuity. It is a genetically complex and age-related disorder, with higher incidence in females. In this study, we established a nongenetic FECD animal model based on the physiologic outcome of CE susceptibility to oxidative stress by demonstrating that corneal exposure to ultraviolet A (UVA) recapitulates the morphological and molecular changes of FECD. Targeted irradiation of mouse corneas with UVA induced reactive oxygen species (ROS) production in the aqueous humor, and caused greater CE cell loss, including loss of ZO-1 junctional contacts and corneal edema, in female than male mice, characteristic of late-onset FECD. UVA irradiation caused greater mitochondrial DNA (mtDNA) and nuclear DNA (nDNA) damage in female mice, indicative of the sex-driven differential response of the CE to UVA, thus accounting for more severe phenotype in females. The sex-dependent effect of UVA was driven by the activation of estrogen-metabolizing enzyme CYP1B1 and formation of reactive estrogen metabolites and estrogen-DNA adducts in female but not male mice. Supplementation of N-acetylcysteine (NAC), a scavenger of reactive oxygen species (ROS), diminished the morphological and molecular changes induced by UVA in vivo. This study investigates the molecular mechanisms of environmental factors in FECD pathogenesis and demonstrates a strong link between UVA-induced estrogen metabolism and increased susceptibility of females for FECD development.

Purpose To compare 5-year clinical results of non-Descemet stripping automated endothelial keratoplasty (nDSAEK) and DSAEK. Methods A retrospective chart review involving patients with non-Fuchs-type bullous keratoplasty who underwent nDSAEK or DSAEK 5 years before the review was performed on demographics, graft survival rate, endothelial cell density (ECD), best-corrected visual acuity (BCVA), and complications. Results Fifty eyes (nDSAEK 28, DSAEK 22) were included in this study. Common indications for surgery were bullous keratopathy due to glaucoma, cataract surgeries, or laser iridotomy. The graft survival rates in nDSAEK and DSAEK eyes at 1, 3, and 5 years were 0.75 and 0.86, 0.67 and 0.81, and 0.59 and 0.74, respectively. The mean donor ECDs of nDSAEK and DSAEK eyes were 2638 and 2503 cells/mm, respectively; these decreased to 1654 and 1406, 1503 and 1218, and 1108 and 1020 cells/mm at 1, 3, and 5 years, respectively. The mean preoperative BCVAs of nDSAEK and DSAEK eyes were 1.08 and 1.11 LogMAR, respectively; these improved to 0.238 and 0.190, 0.126 and 0.157, and 0.097 and 0.070 LogMAR at 1, 3, and 5 years, respectively. The most common complication was intraocular pressure elevation. There were no statistically significant differences between nDSAEK and DSAEK in graft survival rates, changes in ECD and BCVA, or the occurrence of postoperative complications, with the exception of the change in ECD at 2 years (1173 and 1193 cells/mm, P = 0.0159). Conclusions Our 5-year clinical results of nDSAEK and DSAEK did not show significant differences at almost all points.

This study investigated a rabbit model of autologous simple oral mucosal epithelium transplantation (SOMET) for limbal stem cell deficiency (LSCD). LSCD was created in the SOMET group and the Control group. In the SOMET group, oral mucosa harvested from the buccal region was treated with dispase, cut into small pieces, and placed on the exposed corneal stroma without using graft sutures, amniotic membrane, and/or glue. A soft contact lens was positioned and tarsorrhaphy was performed in both groups. Postoperative corneal neovascularization and fluorescein staining scores were evaluated by slit lamp microscopy in both groups. At 2 weeks postoperatively, eyes were excised and subjected to immunohistochemical staining for CK3, CK13, CK15, and p63. In the SOMET group, transplantation of oral mucosa led to complete recovery of LSCD, as indicated by low neovascularization scores, low fluorescein staining scores, and detection of stratified K3/K13-positive cells on the stroma at 2 weeks after surgery. In contrast, corneal epithelial defects persisted in the Control group at 2 weeks. SOMET achieved re-epithelialization of the corneal surface in this rabbit LSCD model. It is a simple technique that does not require culture and could be a promising option for ocular surface reconstruction in bilateral LSCD.

We aimed to investigate the cell density and morphology of the corneal endothelium in ophthalmologically healthy young Japanese, given the lack of normative data in literature. This observational study included eyes without ophthalmologic diseases, besides refractive errors, examined between 1996 and 2015 at Miyata Eye Hospital. Eyes with a history of ophthalmologic diseases or contact lens usage were excluded. Correlation of corneal endothelial cell density (ECD), coefficient of variation (CV), appearance rate of hexagonal cells (6A), and cell area with age were examined. Multivariate linear regression analysis was performed to determine the predictors of corneal parameters. We included 16842 eyes of 8421 individuals (19.6 ± 8.7 years). ECD was 3109.0 ± 303.7 cells/mm2 and significantly reduced with age (p

Purpose: To compare the clinical characteristics of acute hydrops between eyes with recurrent keratoconus and eyes with treatment-naive keratoconus.Methods: Six eyes with acute hydrops caused by recurrent keratoconus (recurrent group) and 29 eyes with acute hydrops due to treatment-naive keratoconus (naive group) were included. We collected data from anterior-segment optical coherence tomography (AS-OCT), corneal topography and medical records. With AS-OCT, we investigated the location of Descemet's membrane break, the length and frequency of Descemet's membrane detachment, and the speed of corneal thinning before acute hydrops.Results: Descemet's membrane breaks were detectable in 6 cases in the recurrent group (100%) and 7 cases in the naive group (70%). Distance from the break to the central line was 2-3 mm in the recurrent group, and less than 1 mm in the naive group (p < .001). Detachment length was significantly greater in the recurrent group than in the naive group (p = .003). Steep corneal power values tended to increase before acute hydrops in the recurrent group, but the difference between groups was not significant (observation period; 6.03 ± 2.67, 7.36 ± 5.53 years, respectively). Penetrating keratoplasty was required in 5 cases (83%) in the recurrent group, and 8 cases (28%) in the naive group (p = .02).Conclusions: Acute hydrops due to recurrent keratoconus occurred around graft-host junctions and was more severe than that in eyes with treatment-naive keratoconus. Severity assessment of Descemet's membrane detachment using AS-OCT provided clues not only for diagnosis, but also for predicting prognosis.

Background Cytomegalovirus (CMV) has been known to cause unilateral corneal endotheliitis with keratic precipitates and localized corneal edema, iridocyclitis, and secondary glaucoma. CMV endotheliitis is diagnosed based on clinical manifestations and viral examination using qualitative polymerase chain reaction (PCR) of the aqueous humor. Case presentation An 80-year-old woman was referred to our department for bullous keratopathy. Pigmented keratic precipitates were found in the right eye without significant anterior chamber inflammation. After 8 months there was inflammation relapse with mutton fat keratic precipitates and PCR on aqueous humor was performed, with negative results for CMV, herpes simplex virus, and varicella zoster virus. Keratic precipitates disappeared with steroid instillation, and Descemet-stripping automated endothelial keratoplasty (DSAEK) was performed for the right eye. CMV-DNA was positive at 6.0 × 102 copies/ GAPDH 105 copies in real time PCR of corneal endothelial specimen removed during DSAEK with negative results for all the other human herpes viruses. After diagnosis of CMV corneal endotheliitis, treatment with systemic and topical ganciclovir was initiated and there was resolution of symptoms. No recurrence of iridocyclitis or corneal endotheliitis was observed at 6 months follow up. Conclusions This case report suggests that PCR should be performed using the endothelium removed during DSAEK for bullous keratopathy of an unknown cause, even if PCR for aqueous humor yields negative results.

PURPOSE We aimed to assess the corneal refractive changes induced by ptosis surgery in patients with acquired ptosis using Fourier harmonic analysis. METHODS This retrospective observational study enrolled consecutive patients who underwent levator aponeurotic surgery for acquired ptosis at the Department of Ophthalmology in the University of Tokyo Hospital from May 2016 to January 2018. Best corrected visual acuity, central corneal thickness, average keratometric corneal power (AvgK), corneal astigmatism, and topographic data using Fourier analysis were analyzed preoperatively and 6 months postoperatively. RESULTS Thirty-two eyes of 32 patients (age, 72.6 ± 8.5 years) were included in this study. There were no significant differences in best corrected visual acuity and central corneal thickness. However, there were significant decreases in anterior AvgK, anterior corneal astigmatism, and posterior corneal astigmatism 6 months postoperatively (all, P < 0.001). Fourier harmonic analysis showed that the anterior spherical component significantly decreased 6 months postoperatively (P < 0.001). There were no significant differences in other components of the anterior and posterior cornea. There was a significant negative correlation between preoperative posterior AvgK and changes in posterior AvgK (r = -0.891, P < 0.001) and between preoperative posterior corneal astigmatism and changes in posterior corneal astigmatism at 6 months (r = -0.858, P < 0.001). CONCLUSIONS Anterior and posterior corneal keratometry and posterior corneal astigmatism significantly changed 6 months after ptosis surgery for acquired ptosis.

The aim of this observational study was to examine the characteristics of anterior and posterior corneal topography in keratoconic eyes more than 30 years after penetrating keratoplasty (PK). Patients who maintained clear grafts for more than 30 years after PK were included and divided into the keratoconus (KC) group or other diseases (Others) group, based on the primary indication. Twenty-six eyes of 26 patients were included. The KC group and the Others group included 14 eyes and 12 eyes, respectively. The KC group participants were younger at the time of surgery (P = 0.03). No differences were found in best-spectacle-corrected visual acuity, keratometric power, and central-corneal-thickness. Based on corneal topography using Fourier harmonic analyses, regular astigmatism in the anterior cornea was significantly larger (P = 0.047) and the spherical component in the posterior cornea was significantly lower (P = 0.01) in the KC group. The area under the receiver operating characteristic curve of the spherical component, regular astigmatism, asymmetry component, and higher-order irregularity were 66.07%, 63.10%, 57.14%, and 59.23%, respectively, in the anterior cornea and 80.65%, 52.98%, 63.10%, and 63.99%, respectively, in the posterior cornea. Our results suggested that Fourier harmonic analysis of corneal topography could be useful for patients with KC long after PK.

To determine the characteristics and risk factors of recurrent keratoconus (KC) after penetrating keratoplasty (PK). We enrolled patients who had maintained clear grafts for at least 10 years after PK based on their medical records. Patients were divided into the KC group or Others group based on the primary indication for PK. Each case was reviewed for clinically observed corneal ectasia. Steepest keratometric power (Ks), cylinder (CYL), and difference between Ks and minimum keratometric power (MinK) were analyzed in patients that underwent corneal topography more than three times after the 5th postoperative year. One hundred one eyes of 82 patients were enrolled. The KC group comprised 50 eyes and the Others group comprised 51 eyes (herpes [n = 22], corneal leukoma [n = 12], and other [n = 17]). The mean period after PK was 27.2 years in the KC group and 26.0 years in the Others group. Recurrent KCs were observed in 18 eyes of 14 patients (36%), all of whom were in the KC group (p = 0.0001). Six of these eyes underwent PK again and all the grafts showed keratoconic changes histopathologically. The mean Ks during the whole observation period was 52.5 diopters (D) in the KC group and 49.2 D in the Others group (p

To investigate the clinical results of Descemet stripping automated endothelial keratoplasty (DSAEK) for failed penetrating keratoplasty (PK) and the influence of the graft-host junction (GHJ) on the graft survival rate.Data were retrospectively collected on patient demographics, visual outcomes, complications, and graft survival rate for 17 eyes of 16 patients who underwent DSAEK for failed PK. The graft survival rate was compared between the eyes when divided into a bump group and a well-aligned group according to the shape of the GHJ detected on anterior segment optical coherence tomography.The most common indication for initial PK was bullous keratopathy after glaucoma surgery (35.3%). Seven eyes (41.2%) were classified into the bump group and 10 eyes (58.8%) into the well-aligned group. The mean best-ever documented visual acuity (BDVA) after DSAEK was 0.33 logMAR. Postoperatively, almost 70% of eyes achieved a BDVA that was within 0.2 logMAR of their preoperative BDVA. Graft detachment occurred in 29.4% of eyes and primary graft failure in 17.6%. All primary failures occurred in the bump group. The cumulative graft survival rate was 82.3% at 1 year, 73.2% at 2 years, and 58.6% at 3 years. Graft failure was more likely in eyes in the bump group than in those in the well-aligned group (P = 0.037, Wilcoxon test).DSAEK for failed PK had a favorable outcome in this study. However, the GHJ should be assessed carefully before performing the procedure.

Human corneal endothelial cells (HCEnCs) are terminally differentiated cells that have limited regenerative potential. The large numbers of mitochondria in HCEnCs are critical for pump and barrier function required for corneal hydration and transparency. Fuchs Endothelial Corneal Dystrophy (FECD) is a highly prevalent late-onset oxidative stress disorder characterized by progressive loss of HCEnCs. We previously reported increased mitochondrial fragmentation and reduced ATP and mtDNA copy number in FECD. Herein, carbonyl cyanide m-chlorophenyl hydrazone (CCCP)-induced mitochondrial depolarization decreased mitochondrial mass and Mfn2 levels, which were rescued with mitophagy blocker, bafilomycin, in FECD. Moreover, electron transport chain complex (I, V) decrease in FECD indicated deficient mitochondrial bioenergetics. Transmission electron microscopy of FECD tissues displayed an increased number of autophagic vacuoles containing degenerated and swollen mitochondria with cristolysis. An elevation of LC3-II and LAMP1 and downregulation of Mfn2 in mitochondrial fractions suggested that loss of fusion capacity targets fragmented mitochondria to the pre-autophagic pool and upregulates mitophagy. CCCP-induced mitochondrial fragmentation leads to Mfn2 and LC3 co-localization without activation of proteosome, suggesting a novel Mfn2 degradation pathway via mitophagy. These data indicate constitutive activation of mitophagy results in reduction of mitochondrial mass and abrogates cellular bioenergetics during degeneration of post-mitotic cells of ocular tissue.

Background/aims To evaluate the clinical results of accelerated transepithelial corneal cross-linking (CXL) in Japanese patients with progressive keratoconus (KCN). Methods Thirty eyes of 19 patients (16 male, 3 female patients) with progressive KCN were included. The mean age was 24.9±7.0 (range 16–38) years. All patients received ultraviolet A radiation for 3 min at an irradiance of 30 mW/cm 2 . Patients were followed up on the first day, at 1 week and 2 weeks, and at 1 month, 3 months, 6 months and 12 months postoperatively. Clinical examinations included measures of uncorrected visual acuity, best corrected visual acuity (BCVA), average keratometry (AveK), maximum keratometry (Kmax), central corneal thickness, thinnest corneal thickness (TCT), endothelial cell density, intraocular pressure and non-mydriatic indirect fundus examination. Patients were asked to report any pain or discomfort at each visit. Results There were no intraoperative or postoperative complications. All 30 eyes finished the follow-up. After 12 months, there was a significant decrease in Kmax (p Conclusions There were no complications associated with accelerated transepithelial corneal CXL, and the clinical outcomes were appraisable in a 12-month follow-up. Trial registration number UMIN000009372.

Mutations in transforming growth factor-beta-induced (TGFBI) gene cause clinically distinct types of corneal dystrophies. To delineate the mechanisms driving these dystrophies, we focused on the R124C mutation in TGFBI that causes lattice corneal dystrophy type1 (LCD1) and generated novel transgenic mice harbouring a single amino acid substitution of arginine 124 with cysteine in TGFBI via ssODN-mediated base-pair substitution using CRISPR/Cas9 technology. Eighty percent of homozygous and 9.1% of heterozygous TGFBI-R124C mice developed a corneal opacity at 40 weeks of age. Hematoxylin and eosin and Masson trichrome staining showed eosinophilic deposits in subepithelial corneal stroma that stained negative for Congo-red. Although amyloid deposition was not observed in TGFBI-R124C mice, irregular amorphous deposits were clearly observed via transmission electron microscopy near the basement membrane. Interestingly, we found that the corneal deposition of TGFBI protein (TGFBIp) was significantly increased in homozygous TGFBI-R124C mice, suggesting a pathogenic role for the mutant protein accumulation. Furthermore, as observed in the LCD1 patients, corneal epithelial wound healing was significantly delayed in TGFBI-R124C mice. In conclusion, our novel mouse model of TGFBI-R124C corneal dystrophy reproduces features of the human disease. This mouse model will help delineate the pathogenic mechanisms of human corneal dystrophy.

To evaluate central corneal thickness (CCT) and corneal volume (CV) in healthy eyes using swept source anterior segment optical coherence tomography (SS-AS-OCT) and other devices.Thirty-three healthy right eyes of 33 subjects were investigated. CCT was measured with SS-AS-OCT, rotating Scheimpflug camera, ultrasonic pachymetry and specular microscopy. CV was determined within a diameter of 10 mm at the center using SS-AS-OCT and Scheimpflug camera.Mean CCT was 523.5 ± 25.2 μm by SS-AS-OCT, 523.9 ± 26.1 μm by Scheimpflug camera, 532.1 ± 26.6 μm by ultrasonic pachymetry, and 525.5 ± 33.5 μm by specular microscopy. The CCTs measured with SS-AS-OCT, Scheimpflug camera and specular microscopy were significantly thinner than those measured with ultrasonic pachymeter (p0.001). The mean CV within a diameter of 10 mm at the center was 57.2 ± 3.0 mm(3) by SS-AS-OCT and 59.4 ± 2.9 mm(3) by Scheimpflug camera. Scheimpflug measurements of CV were statistically larger than SS-AS-OCT measurements (p = 0.0008). Statistically significant correlation was found between the CCT and CV measurements of each imaging devices (p0.0001, r = 0.527, and p0.0001, r = 0.749, respectively).SS-AS-OCT enables the measurements of CCT and CV, demonstrating agreement with other devices. CV in addition to CCT measurement may serve as a practical parameter of the corneal endothelial pump function.

Measurement of total tear immunoglobulin E (IgE) is useful for the diagnosis of allergic conjunctivitis, but it is still unknown whether measurement of total tear IgE is useful for assessment of the severity of allergic conjunctivitis. We evaluated the relation between the total IgE level in tears and objective signs of allergic conjunctivitis.A prospective, nonrandomized, and cross-sectional study was conducted in 84 patients with allergic conjunctivitis (allergic group) and 80 age- and sex-matched healthy control subjects (control group). The total tear IgE score was obtained with the Allerwatch(®) test (0, 1, and 2), and ten severity scores (0, 1, 2, 3) were determined for objective ocular findings of the palpebral and bulbar conjunctiva, as well as limbal and corneal lesions.The scores for total tear IgE and each of the objective ocular findings were higher in the allergic group than in the control group (all p0.01). The total tear IgE score was correlated with the severity of each clinical feature of allergic conjunctivitis (p0.01), except for corneal epithelial damage in the allergic group. Multivariate analysis revealed that the severity of giant papillae was the most important indicator of the total tear IgE score (odds ratio = 1.33, p0.00001).The total tear IgE score was correlated with the scores for objective signs of allergic conjunctivitis. This rapid test for total IgE in tear fluid is easy to perform and could be used to assess the severity of allergic conjunctivitis on an outpatient basis.

PURPOSE To examine iridotrabecular contact (ITC) as a peripheral anterior synechia (PAS) of patients who underwent penetrating keratoplasty (PKP) using anterior segment Fourier-domain optical coherence tomography (OCT). METHODS Retrospective, observational case series. ITC, ITC index, and ITC area of 60 eyes of 52 patients who underwent PKP at the Department of Ophthalmology in the University of Tokyo Hospital (mean follow-up time 102.8 ± 116.1 months postoperation) were calculated using the angle analysis mode of a commercially available anterior segment Fourier-domain OCT system (CASIA; TOMEY, Nagoya, Japan). We analyzed the occurrence of ITC, ITC index, and ITC area with preoperative diagnosis, lens status, operation method, operation frequency, graft size, and intraocular pressure elevation. RESULTS ITC was observed in 28 (46.7%) of 60 eyes. Average ITC index was 14.0%, and average ITC area was 5.97 mm. ITC was significantly associated with eyes with bullous keratopathy, infectious keratitis, pseudophakia, PKP with cataract operation, several PKP operations, and large graft size. CONCLUSIONS Anterior segment Fourier-domain OCT is a useful and innovative tool that enables us to observe the anterior chamber angle and examine ITC as PAS of eyes with corneal opacity, even after PKP.

Purpose: This study compared the post-cataract surgery anti-inflammatory effects of topical treatment with 0.1% bromfenac, 0.1% betamethasone or both on postoperative anterior chamber inflammation and corneal swelling. Methods: Seventy-two patients with no eye disease other than cataract were enrolled in a prospective, randomized study to undergo phacoemulsification combined with intraocular lens implantation. After cataract surgery, patients were randomized to treatment with bromfenac, betamethasone or both agents. Twenty-five eyes were assigned to bromfenac, 23 to betamethasone and 24 to the combined treatment group. Inflammatory reactions in the anterior chamber were measured with laser flare photometry preoperatively and at 1 and 3 days, 1 and 2 weeks, and 1 and 2 months postoperatively. Intraocular pressure (IOP) and corneal thickness were measured at the same time-points. Best corrected visual acuity (BCVA) was measured preoperatively and at 2 days, 1 and 2 weeks, and 1 and 2 months postoperatively. Specular microscope endothelial photography of the central region of the cornea was performed preoperatively and at 3 months after surgery. Results: There were no significant differences among the bromfenac, betamethasone and combined treatment groups in BCVA, IOP, aqueous flare or corneal thickness. Cystoid macular oedema was present in one eye treated with betamethasone. Conclusions: There were no significant differences in anti-inflammatory effects among the three treatments. These findings suggest that bromfenac is as effective as betamethasone in minimizing inflammatory reactions after cataract surgery.

PURPOSE: To compare the results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) over a 4-year follow-up. SETTING: Miyata Eye Hospital, Miyazaki, Japan. METHODS:This comparative retrospective study comprised 22 eyes (22 patients) that had PRK and 18 eyes (18 patients) that had LASIK. To be included, the patient had to have completed a 4-year follow-up. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), percentage ofeyes withinG0.5diopter (D)ofthetargetedrefraction, centralcornealthickness, andthe anterior and posterior corneal elevations were compared between the PRK and LASIK groups. RESULTS: The mean UCVA was significantly better in the LASIK group than in the PRK group at 6 months (P Z .0043) and 1 year (P Z .0044). At 2 years, there was no significant difference in the mean UCVA between the 2 groups. The mean BSCVA was significantly better in the LASIK group than in the PRK group at 6 months (P

To compare postoperative performance and stability of 6.0-mm optic single- and 3-piece acrylic foldable intraocular lenses (IOLs).Prospective, randomized, self-controlled trial.Eighty eyes of 40 patients with bilateral senile cataracts.Phacoemulsification and IOL implantation were performed. One eye of a patient was randomly assigned to the SA60AT single-piece IOL, and the contralateral eye was allocated to the MA60AC 3-piece IOL.Best-corrected visual acuity (BCVA), spherical equivalent, aqueous flare intensity, anterior chamber depth, amount of IOL decentration and tilt, area of anterior capsule opening, and degree of posterior capsule opacification (PCO) were measured 2 days, 1 week, and 1, 3, 6, and 12 months after surgery. Specular microscopy was performed at 12 months postoperatively.In the SA60AT group, the anterior chamber depth did not show significant changes after surgery (P0.05; paired t test), and the refraction remained highly stable throughout the 1-year study period. The MA60AC group showed significant shallowing of the anterior chamber (P0.05) and a myopic shift (P0.05) up to 1 month after surgery. There were no significant differences between the 2 groups (P0.05) in BCVA, aqueous flare intensity, the amount of IOL decentration, IOL tilt, area of anterior capsule opening, and degree of PCO throughout the 12-month follow-up period.Both the SA60AT single-piece and MA60AC 3-piece lenses showed a minimum amount of decentration, tilt, anterior capsule contraction, and PCO. Although the MA60AC showed significant forward shift and myopic refractive changes after surgery, the SA60AT displayed little axial movement associated with highly stable refraction after surgery. This feature of the SA60AT should facilitate earlier spectacle prescription and quicker visual/social rehabilitation of patients after cataract surgery.

Fourier harmonic analysis can decompose videokeratography data into spherical power, regular astigmatism, and irregular astigmatism (asymmetry and higher-order irregularity). The aim of this study was to evaluate whether determination of cylinder power by Fourier analysis facilitates measurements of visual acuity and refraction in eyes after penetrating keratoplasty.Cross-sectional study.Sixty-six eyes of 56 subjects who had undergone penetrating keratoplasty.Spectacle-corrected visual acuity was measured in 2 ways: by the conventional and the Fourier methods. In the conventional method, the refraction was determined subjectively by reference to the measurement results of the autokeratometer and autorefractometer. In the Fourier method, the magnitude and axis of regular astigmatism were calculated by Fourier analysis of the videokeratography data, and spherical lenses were adjusted until best spectacle-corrected visual acuity was attained.Logarithm of the minimum angle of resolution (logMAR) visual acuity and refraction used for correction.The spectacle-corrected visual acuity obtained with the Fourier method (logMAR, 0.23+/-0.32; Snellen equivalent, 20/34) was significantly better than that attained with the conventional method (logMAR, 0.31+/-0.29; Snellen equivalent, 20/41; P0.001, paired t test). The cylinder power used for spectacle-corrected visual acuity measurements was significantly lower with the Fourier method (-2.41+/-1.26 diopters [D]) than with the conventional method (-3.53+/-1.64 D; P0.001). The spherical equivalent at the final refraction was not different between groups (P = 0.207).Fourier analysis of videokeratography data significantly facilitates determination of refraction and measurement of best spectacle-corrected visual acuity in eyes with corneal irregular astigmatism, such as eyes that have undergone penetrating keratoplasty.

Several recent studies have reported post-laser in situ keratomileusis (LASIK) complications related to a steroid-induced increase in intraocular pressure, including interface fluid and elevated intraocular pressure-induced interlamellar stromal keratitis.We examined two cases of interlamellar flap edema due to steroid-induced ocular hypertension after uneventful laser in situ keratomileusis.Oral acetazolamide and discontinuance of topical steroids were effective for treating interlamellar stromal edema in both cases.A rise in intraocular pressure should be considered a cause of interlamellar stromal edema after LASIK.

A new commercial immunochromatographic test (Allerwatch) has recently been developed for determining total immunoglobulin E (IgE). We previously reported on the use of this kit for analyzing tear fluid samples collected during the spring. In this study, we examined the relationship between the total IgE level in tears and the specific serum IgE levels in patients with autumnal allergic conjunctivitis.A prospective, nonrandomized cross-sectional study was conducted in 36 patients with autumnal allergic conjunctivitis (autumnal allergic group), in 32 age-matched and sex-matched healthy control subjects (control group), and in 10 patients with epidemic keratoconjunctivitis. Total tear IgE score was determined in all subjects using the Allerwatch test (0, 1, and 2), whereas the serum levels of total IgE and specific IgE for 12 inhaled allergens were measured using the Phadezym PRIST and CAP-RAST systems, respectively.Positivity rates for total tear IgE were significantly higher in the autumnal allergic group as compared with the control and epidemic keratoconjunctivitis groups (88.9% vs. 0.0% vs. 0.0%, P0.00001). In the autumnal allergic group, there was a significant correlation between the total tear IgE score and the log-transformed total serum IgE level (r = 0.84). Significant correlations were also seen with the IgE serum levels for Dermatophagoides pteronyssinus (r = 0.53), house dust (r = 0.51), acarus (r = 0.49), cedar pollen (r = 0.33), and mugwort (r = 0.33). Multivariate logistic regression analysis showed that the only significant predictor of the total tear IgE score was the log-transformed total serum IgE level (odds ratio = 2.76, P0.00001).The correlation between the Allerwatch total tear IgE score and the specific IgE serum levels against house dust mites suggests that house dust mite allergens might be the primary cause of allergic conjunctivitis during autumn in Japan. The Allerwatch methodology can provide rapid measurements of total IgE in the tear fluid, which makes it possible to easily diagnose allergic conjunctivitis in an outpatient setting.

Purpose To investigate the influence of cycloplegia with topical atropine on higher-order aberrations (HOAs) of the eye in children. Design Prospective, noncomparative study. Participants Twenty-three eyes of 23 subjects (11 boys and 12 girls) with hyperopia, ranging in age from 3 to 12 years (average, 5.74 years), were enrolled in this study. Methods Refraction and wavefront aberration were evaluated before and after cycloplegia with topical instillation of 1% atropine solution administered twice daily for 1 week. Ocular and corneal HOAs were measured simultaneously, and individual Zernike components were analyzed for a 6-mm pupil up to the 6th order. All these parameters were compared before and after cycloplegia. Main Outcome Measures Ocular and corneal HOAs before and after cycloplegia. Results Cycloplegia with topical atropine significantly increased spherical equivalent refraction from +1.92±1.53 diopters (D) to +3.10±1.61 D ( P t test). Ocular HOAs significantly increased from 0.282±0.086 μm to 0.316±0.087 μm for coma-like aberrations ( P = 0.02), from 0.169±0.058 μm to 0.192±0.076 μm for spherical-like aberrations ( P = 0.02), and from 0.333±0.093 μm to 0.377±0.095 μm for total HOAs ( P = 0.01). Corneal HOAs did not change after cycloplegia. As for individual Zernike components, significant changes were found in C 3 1 and C 4 0 after cycloplegia ( P 4 0 were correlated significantly with those in spherical equivalent refraction (Pearson's correlation coefficient, R = 0.45; P = 0.03). Conclusions Cycloplegia with atropine induced significant hyperopic shift and increases in ocular HOAs in children, leading to reduction in optical quality of the eye. It may be that physiologic tonic accommodation plays a role in improving retinal image quality by decreasing HOAs and refractive errors. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

This study investigated the efficacy and safety of intracameral injection of commercially available eye drops containing 0.5% tropicamide and 0.5% phenylephrine hydrochloride (Mydrin-P, Santen Pharmaceutical, Osaka, Japan).In vitro experiment and prospective clinical study at a private hospital.Mydrin-P was applied to confluent cultured human corneal endothelial cells, and the cellular morphology was examined. Clinical study subjects were 65 eyes of 65 patients that underwent phaco-emulsification and aspiration with intraocular lens implantation and received intracameral injection of Mydrin-P for poor mydriasis after preoperative topical instillation of mydriatics (intraocular mydriasis group; with five subgroups based on cause: diabetes, pseudo-exfoliation, post-surgery, uveitis, unknown). Controls, comprising 39 eyes of 39 patients, were not injected with Mydrin-P.The ratio of pupillary diameter to corneal diameter was determined before and after injection of Mydrin-P. Corneal endothelial density was measured preoperatively and 3 months and 1 year postoperatively.Pupillary diameter and corneal endothelial density.Human corneal endothelial cell morphology was unaltered after Mydrin-P injection. The mean ratio of the pupillary diameter to corneal diameter increased in the intraocular mydriasis group (before: 54.2 ± 4.8%, after: 58.4 ± 6.6%; P0.001) and in the diabetes and unknown subgroups. The corneal endothelial cell density reduction rate 3 months and 1 year after surgery was not significantly different between the intraocular mydriasis group and controls.Intracameral injection of Mydrin-P appears to be effective and safe for dilating the pupil in cases with poor mydriasis after preoperative instillation of mydriatics.

Purpose: To examine the efficacy and safety of topography-based limbal relaxing incision (LRI) surgery. Methods: Forty-four eyes of 36 consecutive patients who underwent cataract surgery more than 1 month previously, had refractive against-the-rule astigmatism of ≥2.00 diopters (D), and were scheduled to undergo LRI surgery were enrolled in the study. Patients were randomized into two groups—a topography-based LRI group (19 eyes of 14 patients) and a conventional LRI group (25 eyes of 22 patients). The topography-based LRI procedure comprised 3 steps: placing a mark on the cornea and conjunctiva, identifying this mark in the topographic image, and performing LRI based on the location of the mark. In the conventional LRI group, the horizontal meridian was marked under a slit lamp and LRIs were made based on the position of the horizontal mark. Results: Corneal astigmatism in the topography-based LRI group before and 1 month after surgery was 2.03±0.92 D and 1.33±0.69 D, respectively ( P =.014). Corneal astigmatism in the conventional LRI group before and 1 month after surgery was 2.36±0.77 D and 0.93±0.70 D, respectively ( P Conclusions: Compared with conventional LRI surgery, a topography-based procedure may reduce the deviation of the effect of LRIs.

Purpose To examine karyotype changes in cultured human corneal endothelial cells (HCECs). Methods HCECs with Descemet’s membrane were removed from 20 donors of various ages (range, 2–77 years; average, 43.7±26.4 years) and cultured on dishes coated with extracellular matrix produced by bovine corneal endothelial cells (BCECs). Karyotype changes were examined by G-band karyotyping of HCECs at the third passage from 12 donors and the fifth passage from 16 donors. The number of chromosomes was analyzed in 40–50 cells from the third and fifth passages of each HCEC preparation. A detailed karyotype analysis of 10–16 cells from the third and fifth passages of each HCEC preparation was performed. The frequency of aneuploid cells per case (the number of abnormal cells divided by the total number of cells examined at metaphase) was tested for correlation with age by Spearman’s correlation analysis. Results At the third passage, five cases (41.7%) showed an almost normal karyotype, and five cases (41.7%) showed sex chromosome loss. One case (8.3%) showed chromosome 21 trisomy. At the fifth passage, five cases (31.3%) showed an almost normal karyotype, and four cases (25%) showed sex chromosome loss. Three cases (18.8%) showed chromosome 8 trisomy, and one case (6.3%) showed chromosome 21 trisomy. Donor age and the frequency of aneuploidy had a statistically significant correlation at the fifth passage (R=0.653, p=0.042). Conclusions Donor age and the frequency of aneuploidy have a positive correlation in cultured HCECs at the fifth passage. Therefore, HCECs for clinical therapies should be obtained from donors as young as possible. Karyotyping cultured HCECs is crucial before clinical application.

PURPOSE: To evaluate the efficacy and safety of atelocollagen punctal occlusion for dry eye patients. DESIGN: Prospective noncomparative interventional case series. METHODS: Atelocollagen was injected into the superior and inferior canaliculi of 52 eyes of 28 dry eye patients. Vital staining of the ocular surface, breakup time of tears (BUT), tear volume, and corneal epithelial permeability to fluorescein were examined before and 1, 2, 4, and 8 weeks after treatment. RESULTS: Rose bengal stain, fluorescein stain, BUT, and corneal epithelial permeability to fluorescence were significantly improved 1 week after atelocollagen punctal occlusion, and the improvement was maintained for up to 8 weeks after treatment. CONCLUSIONS: Atelocollagen punctal occlusion effectively improves ocular surface disorders in dry eye patients.

PURPOSE To determine the influence of dispersive ophthalmic viscosurgical products (OVPs) on corneal endothelial cell (CEC) density during penetrating keratoplasty (PKP) and on the postoperative intraocular pressure (IOP). METHODS In 117 eyes of 113 patients, PKP was performed by a single surgeon from April 1, 1998 to April 30, 2002. Loss of CECs and postoperative IOP were evaluated retrospectively after use of Viscoat (sodium hyaluronate 3.0%, chondroitin sulfate 4.0%) plus Healon (sodium hyaluronate 1.0%) (Viscoat/Healon group) or Healon alone (Healon group) during surgery. RESULTS The average CEC loss was 14.6 +/- 15.5% and 9.0 +/- 10.5% at 1 month, 18.1 +/- 14.6% and 10.1 +/- 7.3% at 3 months, 20.1 +/- 16.3% and 12.2 +/- 10.9% at 6 months, and 31.7 +/- 21.4% and 18.1 +/- 15.5% at 12 months in the Healon (n = 74) and Viscoat/Healon (n = 43) groups, respectively. Patients were stratified into groups with corneal leukoma (n = 61) or bullous keratopathy (n = 56). Loss of CECs was significantly smaller in the Viscoat/Healon group compared with the Healon group irrespective of whether patients had corneal leukoma or bullous keratopathy at 3, 6, and 12 months postoperatively. There was no significant difference of postoperative IOP between the Healon and Viscoat/Healon groups over 12 months of follow-up. CONCLUSION These results suggest that the addition of Viscoat to Healon decreases CEC loss during PKP and does not affect postoperative IOP.

To compare central corneal thickness measurements and their reproducibility when taken by a rotating Scheimpflug camera, ultrasonic pachymetry, and scanning-slit corneal topography/pachymetry.Experimental study.Seventy-four eyes of 64 subjects without ocular abnormalities other than cataract.Corneal thickness measurements were compared among the 3 methods in 54 eyes of 54 subjects. Two sets of measurements were repeated by a single examiner for each pachymetry in another 10 eyes of 5 subjects, and the intraexaminer repeatability was assessed as the absolute difference of the first and second measurements. Two experienced examiners took one measurement for each pachymetry in another 10 eyes of 5 subjects, and the interexaminer reproducibility was assessed as the absolute difference of the 2 measurements of the first and second examiners.Central corneal thickness measurements by the 3 methods, absolute difference of the first and second measurements by a single examiner, absolute difference of the 2 measurements by 2 examiners, and relative amount of variation.The average measurements of central corneal thickness by a rotating Scheimpflug camera, scanning-slit topography, and ultrasonic pachymetry were 538+/-31.3 microm, 541+/-40.7 microm, and 545+/-31.3 microm, respectively. There were no statistically significant differences in the measurement results among the 3 methods (P = 0.569, repeated-measures analysis of variance). There was a significant linear correlation between the rotating Scheimpflug camera and ultrasonic pachymetry (r = 0.908, P0.0001), rotating Scheimpflug camera and scanning-slit topography (r = 0.930, P0.0001), and ultrasonic pachymetry and scanning-slit topography (r = 0.887, P0.0001). Ultrasonic pachymetry had the smallest intraexaminer variability, and scanning-slit topography had the largest intraexaminer variability among the 3 methods. There were similar variations in interexaminer reproducibility among the 3 methods.Mean corneal thicknesses were comparable among rotating Scheimpflug camera, ultrasonic pachymetry, and scanning-slit topography with the acoustic equivalent correction factor. The measurements of the 3 instruments had significant linear correlations with one another, and all methods had highly satisfactory measurement repeatability.

Objective To conduct a pilot study evaluating the efficacy and safety of limbal allograft, preserved amniotic membrane transplantation, and intraoperative mitomycin C treatment for recurrent pterygium. Design Prospective, noncomparative, interventional case series. Participants Twelve eyes of 11 patients with recurrent pterygium. The mean number of previous surgeries for pterygium was 1.9±1.4 (range, 1–6). Intervention All subjects received limbal allograft, preserved amniotic membrane transplantation, and intraoperative mitomycin C. Main Outcome Measures Pterygium recurrence and complications. Results The mean follow-up period was 21.6±5.6 months (range, 16–36 months). There was no pterygium recurrence in any of the eyes. Symblepharon reappeared in 3 eyes and diplopia recurred in 2 eyes. There were no other surgical complications and there was no graft rejection. Conclusions Limbal allograft, preserved amniotic membrane transplantation, and intraoperative mitomycin C may be a safe and effective procedure for recurrent pterygium.

A 25-year-old woman had traumatic flap folds and partial dehiscence of the flap edge in the right eye 5 and 30 months after laser in situ keratomileusis. The period from injury to treatment was 4 hours and 9 days, respectively. With the first injury, the flap was lifted and stretched with moistened sponges to clear the folds. With the second injury, the folds were hard so the flap was lifted and sutured to stretch the folds. The patient recovered visual acuity within 2 weeks.

Purpose To investigate age-related changes in ocular and corneal higher-order wavefront aberrations and elucidate relative contributions of the cornea and the lens in the age-related changes. Design Observational case series. Methods Corneal and ocular higher-order wavefront aberrations in the central 6 mm diameter were measured with videokeratography and the Hartmann-Shack wavefront aberrometer in 75 normal eyes of 75 patients with a mean age of 43.5 ± 11.7 years (range, 18–69 years). Higher-order wavefront aberrations were calculated with Zernike polynomials up to sixth order. From the Zernike coefficients, we calculated root mean square (RMS) of coma and spherical aberration. To examine age-related changes of the polarity of spherical aberration, the changes of the Zernike coefficient Z 4 0 was also investigated. Results Both corneal ( r = .307, P = .007) and ocular ( r = .334, P = .0033) coma RMS showed positive correlations with age. There was a positive correlation between corneal and ocular coma RMS ( r = .468, P r = .153, P = .1895), whereas the RMS of ocular spherical aberration had a positive correlation with aging ( r = .308, P = .0068). Conclusions These results suggest that the ocular coma increases with age, mainly because of the increase in the corneal coma, and the ocular spherical aberration increases with age, mainly because of the increase in the spherical aberration in the internal optics.

PURPOSE To evaluate tear meniscus (TM) changes in external dacryocystorhinostomy (ex-DCR) with quantitative measurement of tear meniscus height (TMH), area (TMA), and volume (TMV) using anterior segment optical coherence tomography (AS-OCT). METHODS Twenty-five eyes from 21 patients (11 males and 10 females) with primary acquired nasolacrimal duct obstruction (PANDO) who received ex-DCR from May 2010 to April 2011 were evaluated prospectively on their TMH, TMA, and TMV changes by AS-OCT. Measurements were performed before surgery (Pre) and 2 weeks (2W), 2 months (2M), and 6 months (6M) after surgery. Data were analyzed using Kruskal-Wallis test, Wilcoxon signed-rank test with Bonferroni adjustment, and Spearman's rank correlation coefficient. RESULTS All patients had a good clinical course, and there were significant differences in the values of each TM parameter before and after surgery (P < 0.0001). The median values of TMH (mm) throughout the observation period were 0.707 (Pre), 0.334 (2W), 0.278 (2M), and 0.277 (6M). The TMA median values (mm(2)) were 0.1097 (Pre), 0.0483 (2W), 0.0255 (2M), and 0.0224 (6M). The TMV median values (mm(3)) were 0.7799 (Pre), 0.1614 (2W), 0.1071 (2M), and 0.1553 (6M). There were significant differences in TMH, TMA, and TMV reduction at each postoperative visit as compared to preoperative values (P < 0.001). In addition, TMH change 6 months after ex-DCR showed a significant positive correlation with age (r = 0.4434, P = 0.0264). CONCLUSIONS The perioperative TM changes in ex-DCR can be evaluated noninvasively and quantitatively by using AS-OCT.

To investigate the repeatability of tear meniscus measurements using anterior segment swept-source optical coherence tomography (OCT) and the relationship of tear meniscus measurements with tear film breakup time and Schirmer test results.Prospective, observational, cross-sectional study.We enrolled 26 healthy subjects (26 eyes; 20 men and 6 women; mean age, 36.5 ± 6.8 years) at the University of Tokyo School of Medicine, Tokyo, Japan, in this study. Examinations were conducted in the following sequence: anterior segment vertical raster scans by swept-source OCT, tear film breakup time, and Schirmer test. Each subject underwent OCT measurements twice by the same grader, and the central upper and lower tear menisci height and area and the lower tear meniscus volume were examined. Each OCT image was evaluated by 2 masked graders using the software calipers.The average upper and lower tear meniscus heights were 231 ± 78 μm and 256 ± 57 μm, respectively, and the average upper and lower tear meniscus areas were 18 829 ± 7823 μm(2) and 21 903 ± 8173 μm(2), respectively. The average tear meniscus volume was 0.1327 ± 0.051 mm(3). The intergrader intraclass correlations for all the parameters were more than 95%. The OCT tear meniscus measurements and the Schirmer test scores were correlated significantly (P.05, Spearman nonparametric correlation analysis). However, tear film breakup time was not correlated significantly with any of the parameters of tear menisci (P.05).Anterior segment swept-source OCT is a noninvasive and practical method that can be used for quantitative evaluation of tear fluid.

To investigate the effect of topical latanoprost on the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase 1 (TIMP-1) on the ocular surface.Tears were collected from 39 patients with glaucoma who used latanoprost, 0.005%, eyedrops (Xalatan) and 28 healthy volunteers. The MMP-9 concentration was measured. Conjunctival epithelial cells were collected from 10 eyes of 10 patients before and 1 to 3 months after starting to take topical latanoprost, 0.005%, and MMP-1, MMP-9, and TIMP-1 messenger RNA (mRNA) expression was analyzed. Both eyes of 48 mice were treated once a day with latanoprost, 0.005%, timolol gel, 0.5%, eyedrops, vehicle of Xalatan, or phosphate-buffered saline, and MMP-9 and TIMP-1 mRNA expression was analyzed.The median MMP-9 concentration in latanoprost-treated cases was 91.2 ng/mL (in controls, 19.7 ng/mL; P.001). In latanoprost-treated cases, the relative ratio of MMP-9 to glyceraldehyde 3-phosphate dehydrogenase mRNA was significantly increased from 6.42 to 21.3 (P = .04, paired t test) and the relative amount of TIMP-1 was significantly decreased from 154 to 105 (P = .009). The relative amount of MMP-1 to GAPDH mRNA before and after latanoprost use was not significantly different (P = .16). In mice, MMP-9 expression was increased and TIMP-1 expression was decreased on the ocular surface at 8 weeks after latanoprost use.The topical use of latanoprost increases MMP-1 and MMP-9 and decreases TIMP-1 on the ocular surface.The use of topical latanoprost might not be recommended in patients with keratoconus or after laser-assisted in situ keratomileusis.