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Norihiko Yokoi,1 Aoi Komuro,1 Chie Sotozono,1 Shigeru Kinoshita2 1Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan Purpose: Surgical punctal occlusion is indispensable for the treatment of severe dry eye in cases where punctal-plug insertion is not applicable due to an enlarged or deformed punctum. However, permanent punctal occlusion is difficult in some cases. In our aim to establish a more reliable punctal occlusion, we have devised a new surgical approach for punctal occlusion.Patients and methods: This study involved 20 puncta of 12 eyes of 12 patients (1 male and 11 females; mean age: 65.2 years) with severe aqueous-tear-deficient dry eye. A new surgical procedure for punctal occlusion using fibrous tissue from under the lacrimal caruncle into the diathermy-induced deepithelialized canaliculus as supporting tissue for punctal closure was performed. In all patients, the assessment of eye symptoms, as well as the condition of punctal occlusion by slit-lamp biomicroscopy, tear volume (tear-meniscus radius [TMR] measurement by meniscometry), the condition of precorneal tear film (graded by interferometry [IG]), measurement of fluorescein breakup time (FBUT), and scoring of ocular surface staining (fluorescein score of area [FSA] and density [FSD], and lissamine green score [LGS]) were performed, and the preoperative and 6-month-postoperative values were compared.Results: In regard to the postoperative improvement of symptoms, 11 patients showed remarkable improvement, 1 patient showed improvement, and no reopening of the closed punctum was found in any patient. Test values were all significantly improved post surgery (all: P

Yoko Ikeda,1,2,* Kazuhiko Mori,1,* Kaori Tada,3 Morio Ueno,1 Shigeru Kinoshita,4 Chie Sotozono1 1Department of Ophthalmology, Kyoto Prefectural University of Medicine, 2Oike-Ganka Ikeda Clinic, 3Department of Ophthalmology, Japanese Red Cross Society Kyoto Daini Hospital, 4Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan *These authors contributed equally to this work Purpose: To evaluate and compare the intraocular pressure (IOP) reduction efficacy and safety between the ophthalmic solutions 0.005% latanoprost (Lat) and 0.0015% tafluprost (Taf) in Japanese patients with normal-tension glaucoma (NTG).Methods: In this randomized nonmasked study, we prospectively enrolled 30 Japanese NTG patients who had used Lat monotherapy for more than 4 weeks, and randomly divided them into the following two groups: 1) Lat-to-Taf group (LT group) and 2) Taf-to-Lat group (TL group). At the beginning of the study, both groups were switched from initial Lat to Lat or Taf for 12 weeks, and then switched over to the other drug (crossover) for 12 additional weeks. At 0, 4, 12, 16, and 24 weeks, we evaluated each patient’s IOP, conjunctival injection, and corneal epitheliopathy score, and at 0, 12, and 24 weeks, we evaluated their eyelash changes and pigmentation of the eyelids and irises.Results: The mean IOP of the LT group (15 eyes) was 10.5, 10.6, and 11.1 mmHg, at 0, 12, and 24 weeks, respectively, whereas that of the TL group (15 eyes) was 11.7, 11.1, and 10.5 mmHg at 0, 12, and 24 weeks, respectively. No significant differences were found between the two groups and in the intragroup comparisons. Moreover, no significant differences were found between Lat and Taf in regard to the conjunctival injection score and corneal epitheliopathy score. Eyelash changes and eyelid and iris pigmentation were similar in both groups.Conclusion: The findings of this study show that Lat and Taf have equivalent efficacy and safety in Japanese patients with NTG. Keywords: latanoprost, tafluprost, normal-tension glaucoma, crossover

Motoko Kawashima,1 Miki Uchino,1,2 Norihiko Yokoi,3 Yuichi Uchino,1,2 Murat Dogru,1 Aoi Komuro,3 Yukiko Sonomura,3 Hiroaki Kato,3 Shigeru Kinoshita,3 Kazuo Tsubota1 1Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, 2Ryogoku Eye Clinic, Sumida-ku, Tokyo, 3Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan Purpose: To investigate the association of dry eye disease with sleep quality. Methods: In 2011, a cross-sectional survey was conducted among all the employees, mainly young and middle-aged Japanese office workers, who used visual display technology, at a company in Osaka, Japan (N=672; age range =26–64 years). The participants were classified according to the Japanese dry eye diagnosis criteria by dry eye examination results including the Schirmer test, fluorescein and lissamine green staining, tear film break-up time, and symptom questionnaire into three groups as follows: definite dry eye disease, probable dry eye disease, and no dry eye disease. To determine sleep quality, Japanese version of the Pittsburgh Sleep Quality Index (global score) was implemented. The global score (range =0–21) was calculated by summing seven sleep variable scores (scale, 0–3); scores ≥5.5 indicated poor sleep. Results: The total mean global score was 5.1±2.3 (completed N=383); 45% of the dry eye disease participants reported having poor sleep quality, while 34% of the no dry eye disease participants did so, with a significant difference found in the global score (P=0.002). Furthermore, a statistically significant association was observed between the global score and dry eye disease (P=0.005). Conclusion: Poor sleep quality is associated with dry eye disease, especially with dry eye symptoms. Keywords: dry eye, sleep quality, symptom, questionnaire, Pittsburgh Sleep Quality Index, tear film break-up time, visual display terminals

Kazuhiko Mori, Yoko Ikeda, Yuko Maruyama, Shigeta Naruse, Morio Ueno, Shigeru Kinoshita Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan Purpose: To report the cases of six consecutive patients who underwent amniotic membrane (AM)-assisted trabeculectomy (TLE) to treat refractory glaucoma with severe corneal disorders. Methods: This study involved six patients (three males and three females, mean age: 69.5±15.8 years) with refractory glaucoma and severe corneal disorders. The surgical procedure for each patient involved trabecular tissue being excised, and human AM then being placed epithelial side up on the corneal surface, sutured at the limbal sclera, and flipped over onto the sclera to cover the TLE area. The remaining edge of the AM was then inserted into the subconjunctival space and sutured. Medical records of all cases were reviewed with regard to intraocular pressure (IOP), visual acuity, and condition of the filtering bleb and ocular surface. Results: The mean observation period was 69.5±15.8 months, and mean IOP at presurgery and at 1, 3, and 7 years postoperative was 40.3±6.9, 23.0±12.1, 25.6±12.8, and 28.5±19.1 mmHg, respectively. Glaucoma medications decreased from 3.0±1.1 drugs (presurgery) to 0.8±1.0 drugs (7 years postoperative). However, in some cases, ocular surface conditions or visual acuity worsened during the follow-up period. Conclusion: Using AM as an internal patch for TLE, moderately good IOP control was obtained initially for the refractory glaucoma with severe corneal disorders; however, ocular surface conditions required special care, and the long-term IOP control was limited in some cases. Keywords: amniotic membrane, refractory glaucoma, trabeculectomy

Yuko Maruyama,1,2 Yoko Ikeda,1,3 Kazuhiko Mori,1 Morio Ueno,1 Haruna Yoshikawa,1 Shigeru Kinoshita41Department of Ophthalmology, Kyoto Prefectural University of Medicine, 2Fukuchiyama City Hospital, 3Oike-Ganka Ikeda Clinic, 4Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, JapanBackground: The purpose of this study was to prospectively evaluate and compare intraocular pressure (IOP) reduction efficacy and safety between bimatoprost and latanoprost-timolol fixed combination (LTFC) in Japanese patients with open-angle glaucoma.Methods: In this prospective, randomized, non-masked study, after enrolling 70 eyes of 70 Japanese open-angle glaucoma patients who had used latanoprost monotherapy for more than 4 weeks, the subjects were randomly divided into a bimatoprost group or an LTFC group. Both groups were switched from latanoprost to bimatoprost or LTFC for 12 weeks. IOP, conjunctival injection score, corneal epitheliopathy score (area density classification; AD score), tear film break-up time, heart rate, and blood pressure were evaluated at 0, 4, and 12 weeks after switching. The paired t-test and Mann–Whitney U-test were used for the statistical analysis.Results: After 13 of the 70 patients dropped out, 57 were analyzed for IOP reduction and safety. There was a significant decrease in mean IOP at 4 weeks compared with week 0 in both groups (both P

Yuko Maruyama, Kazuhiko Mori, Yoko Ikeda, Morio Ueno, Shigeru Kinoshita Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan Purpose: To analyze age-related morphological changes of the iridocorneal angle in normal subjects and glaucomatous cases, using anterior segment optical coherence tomography (AS-OCT). Methods: This study involved 58 eyes of 58 open-angle glaucoma cases and 72 eyes of 72 age-matched normal-open-angle control subjects. Iridocorneal angle structures in nasal and temporal regions and anterior chamber depth (ACD) were measured using AS-OCT. Axial length and refractive error were measured by use of an ocular biometer and auto refractor keratometer. Angle opening distance (AOD), angle recess area (ARA), and trabecular-iris space area (TISA), measured at 500 µm (TISA500) and 750 µm (TISA750) distant from the scleral spur, were calculated, in the nasal and temporal regions. A new index, the peripheral angle frame index (PAFI), which represents the peripheral angle structure, was proposed, and was defined as (TISA750-TISA500)/TISA500. Results: Refractive power in the glaucoma cases was less than in control cases (P

Abstract The antioxidant and hepatoprotective actions of Terminalia catappa L. collected from Okinawa Island were evaluated in vitro and in vivo using leaves extract and isolated antioxidants. A water extract [...]