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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

Aim: To test the short term efficacy and safety of an infrared warm compression device (IWCD, Eye Hot, Cept Co, Tokyo, Japan) as treatment for non-inflamed meibomian gland dysfunction (MGD). [...]

Purpose: This study evaluated the bone-regeneration properties of titanium fiber web (TW) that had been coated with a thin hydroxyapatite (HA) layer using the molecular precursor method. Materials and Methods: TW disks with or without the thin HA coating were implanted into rat cranial bone defects. The rats were sacrificed after 3 or 6 weeks. New bone formation into the TW was evaluated. Results: The porous structure of TW was clearly maintained after the HA coating was applied. In the HA-coated TW group, new woven bone was observed in the majority of the disks after 6 weeks, whereas the control (uncoated TW) group showed limited new bone formation in the interior. The bone formation ratio in the HA-coated group was significantly higher than in the control group (20.6% and 59.1% after 3 and 6 weeks, respectively, versus 2.0% and 15.5%, respectively; P < .05). Conclusions: The molecular precursor method of applying a thin HA coating to TW appeared to effectively enhance new bone formation through maintenance of TW porosity and promotion of osteoconductivity in the TW three-dimensional scaffold. Int J Oral Maxillofac Implants 2010;25:888-892. [ABSTRACT FROM AUTHOR]

To develop a customer-pleasing and economically and technically feasible product, it is necessary to utilize the best possible know!edge of the market, the customers, the core product technology, and the cost implications of design alternatives. It requires the concurrent involvement of team members from merchandizing, product development, and purchasing and production-engineering departments of the enterprise. The merchandizing department identifies customer needs however, considering only customers' requirements, without technical information it is not possible to develop a feasible product. Conversely, the function-oriented designers in the product development department determine the subsystems' weight, which are technically feasible but may ignore the qualitative issues desired by the customers. To identity the economic feasibility of the product, the purchasing and production-engineering departments calculate the estimated cost by evaluating the cost implications of the design alternatives. Therefore, to produce an economically and technically feasible product with customer pleasing quality, a trade-off among these three sets of weights is essential. Here, we propose an optimization model that assimilates three sets of weights of the subsystems to a final one. The resultant set of weights will represent the effects of concurrent cooperation among merchandizing. product development, purchasing and production-engineering departments of the enterprise. [ABSTRACT FROM AUTHOR]

The sequencing of products for final assembly in JIT mixed-model manufacturing systems is sometimes based on multiple criteria. The two main criteria that have been discussed in the literature are: the smoothing of parts utilization and the smoothing of the product load. Product rate variation smoothing and sub-assembly load variation smoothing may also be considered. One procedure for treating these multiple criteria is by the use of a weighted multi-attribute cost function, which is an aggregation of the respective objective functions. However, one difficulty which may be associated with this approach is in obtaining proper estimates for the weights. In this paper, we propose an alternative approach (a parametric procedure), which utilizes only the relative preference information for the criteria. A numerical example is presented to illustrate the procedure. [ABSTRACT FROM AUTHOR]

Toyota's goal-chasing method has proved effective for dealing with practical-sized sequencing problems for mixed-model assembly lines in just-in-time (JIT) production systems. Miltenburg introduced the multi-level concept to JIT assembly line sequencing, and his remark about Toyota's neglect of product 'usage' smoothing (PUS) when determining the assembly-line product sequence, primarily gave impetus to this study. We note that for most JIT systems, PUS would only be of practical significance, if it helps to achieve sub-assemblies and parts usage smoothing (SUS). In this paper, we conduct a simulation experiment for two-level sequence scheduling for JIT assembly lines. Using the SUS objective value as the metric, the results show that in a comparatively higher percentage of cases (relative to single-level SUS objective scheduling), which can be reasonably considered as statistically significant, better sequences are produced. This phenomenon is found to apply to Toyota's SUS objective as well as Miltenburg's. [ABSTRACT FROM AUTHOR]