Search

Purpose: To investigate the outcome of cataract surgery in patients with corneal endothelial disorders. Subjects and methods: Twenty patients (29 eyes) with Grade 2 or 3 (corneal endothelial cell density1,000 cells/mm2) corneal endothelial disorders underwent cataract surgery from 2009 to 2013 at Juntendo Hospital without complications and were followed for ≥1 year. We retrospectively investigated demographic data, visual acuity, endothelial cell density, and bullous keratopathy. Results: At 1 year postoperatively, mean visual acuity was 0.43 and the mean decrease of endothelial cell density was 13.9±14.5%. In 5 eyes with bullous keratopathy (17.2%), the mean time until onset was 3.0±3.7 months. Grade 3 patients had a significantly higher incidence of bullous keratopathy and more advanced hardening of the lens nucleus than Grade 2 patients. Conclusions: Cataract patients with severe corneal endothelial disorders often present advanced nuclear hardening whereas bullous keratopathy occurs relatively early after cataract surgery. Timing of surgery needs to be determined while taking these factors into consideration.

PURPOSE The aim of this study was to evaluate the 3-year outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of bullous keratopathy secondary to argon laser iridotomy (ALI). METHODS A total of 22 consecutive patients (22 eyes) with ALI who underwent DSAEK were retrospectively analyzed. Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complications were investigated over 3 years postoperatively. The outcome of DSAEK was also compared between the ALI group and 21 other patients with Fuchs endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) (FED/PBK group). RESULTS The median BSCVA improved from logarithm of the minimum angle of resolution 1.40 before DSAEK to 0.30 at 6 months, 0.30 at 12 months, 0.22 at 24 months, and 0.15 at 36 months after surgery. The median endothelial cell loss was 20.3% at 6 months, 18.4% at 12 months, 32.5% at 24 months, and 46.5% at 36 months. Comparison of the ALI group with the FED/PBK group showed no significant difference in the BSCVA or endothelial cell density. Rejection affected 9.1% of the ALI group versus 0% of the FED/PBK group (P = 0.49), the graft dislocation rate was 0% versus 9.5% (P = 0.23), and posterior synechiae were found in 31.8% versus 4.8% (P = 0.046). CONCLUSIONS The 3-year outcome of DSAEK for bullous keratopathy after ALI was excellent. However, caution should be exercised in patients with a history of ALI to avoid posterior synechiae after DSAEK.

To report the outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) for bullous keratopathy after Sato anterior-posterior radial keratotomy (APRK).The clinical records of patients who had DSAEK surgery for bullous keratopathy after APRK were reviewed.Five eyes of 4 patients (4 men) were included. The mean age at DSAEK surgery was 81.8 ± 7.1 years (range, 73-90 years), and the mean follow-up period after the surgery was 19.8 ± 16.9 months (range, 6-48 months). The mean preoperative logarithm of the minimum angle of resolution-corrected visual acuity was 1.96 ± 0.50 (range, 1.2 to counting fingers), and this improved to 0.49 ± 0.43 (range, 0.05-1.2) at the final follow-up. The mean preoperative donor cornea central endothelial cell density was 2826.0 ± 335.7 cells per square millimeter (range, 2352-3150 cells/mm), and this declined to 863.5 ± 501.7 cells per square millimeter (range, 500-1255 cells/mm) at the final follow-up, a mean reduction of 68.2%. The mean graft size was 8.2 ± 0.21 mm (range, 8.0-8.5 mm). Postoperative complications included early graft dislocation in 3 eyes (60.0%), with successful repositioning by a single rebubbling in all cases. There was no graft rejection, and no patient required repeat DSAEK or penetrating keratoplasty for graft failure.This small series suggests that DSAEK is an effective surgical option after APRK. Although there was a high rate of graft dislocation, this was successfully managed by rebubbling. Subsequently, the attachment of each graft improved gradually over time. DSAEK seems to be a reasonable alternative to penetrating keratoplasty for patients with bullous keratopathy after APRK.

The aims of this study were to investigate the incidence of positive donor tissue cultures before transfer to preservation medium (Optisol™-GS) for penetrating keratoplasty, to verify the efficacy of antibiotics contained in Optisol™-GS by examining the drug susceptibility and to assess the relationship between the results of our microbial assessments as well as donor factors and the incidence of contamination. We conducted a retrospective, cross-sectional study using Juntendo Eye Bank records for all corneal transplantations. Two hundred donor conjunctiva harvestings and storage medium (EP-II®) cultures were performed between July 2008 and June 2011. We analyzed the associations between donor factors (age, gender, history of cataract surgery, death-to-preservation interval, cause of death) and contamination rates using multivariate analysis by the generalized estimating equation model. We obtained positive bacterial cultures from 154 of the 200 eyes (77.0%). The isolated bacteria were indigenous, such as coagulase-negative Staphylococci, Corynebacterium sp., and methicillin-resistant Staphylococcus aureus (MRSA). There was significant resistance to levofloxacin (18 eyes, 9.0%) and gentamicin (12 eyes, 6.0%), and no vancomycin-resistant bacteria were detected. The donor factors did not correlate with the prevalence of bacterial contamination in our criteria. Pre-banking microbial assessment allows for microbial detection, bacterial susceptibility and resistance testing. This is useful for developing preservation mediums containing effective spectrum antibiotic agents for high quality control of corneal banking.

Background: Conjunctival intraepithelial neoplasia (CIN) is a precursor lesion of conjunctival squamous cell carcinoma (SCC). CIN recurs frequently but progresses less aggressively than SCC. We report 2 cases of recurrent CIN in immunosuppressed patients.A 60-year-old woman had been taking oral immunosuppressive drugs for 30 years for systemic lupus erythematosus. In 2005, both conjunctival tumor and high serum SCC levels were noted. Biopsy revealed right eye CIN and left eye SCC, and extended resection was performed. In 2008, right eye CIN recurred accompanied by high serum SCC levels and another extended resection was performed. The patient was free from recurrence for 1 year until her death.A 43-year-old woman who had been taking oral immunosuppressive drugs for 3 years for nephrotic syndrome. She had twice undergone right corneal transplantation for keratoconus. In 2011, right conjunctival tumor and high serum SCC levels were noted. Biopsy revealed right eye CIN, for which an extended resection was performed. At present she remains free from recurrence.CIN can recur in immunosuppressed patients. We suggest that serum SCC levels be monitored to help detect recurrence.

To evaluate the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) using corneas from elderly donors. A total of 90 eyes that underwent DSAEK at Juntendo University Hospital between January 2008 and December 2012 were divided into two groups. Group 1 was eyes that received corneas from elderly donors aged 80 years or older (29 eyes), and group 2 was eyes that received corneas from donors aged 79 years or younger (61 eyes). Patient characteristics and visual acuity, endothelial cell density, and postoperative complications at 2 years after surgery were examined retrospectively. The mean age of the donors was 86.3 ± 28.9 years (range, 80–98 years) in group 1 and 62.1 ± 23.2 years (range, 26–79 years) in group 2. At 2 years after surgery, median logMAR visual acuity was 0.48 ± 0.38 in group 1 and 0.42 ± 0.47 in group 2, while the median loss of endothelial cell density was 38.9 ± 22.5 % and 39.7 ± 23.8 %, respectively. There was no significant difference between the two groups for all the parameters. The rate of endothelial cell loss at 2 years after surgery was similar regardless of donor age (≥80 years vs ≤79 years). It seems reasonable to use corneas from donors aged 80 years or older for DSAEK provided the selection criteria are fulfilled.

The three-dimensional ultrastructure of the filamentous glycocalyx of the brush border in the mouse small intestine was successfully demonstrated by high resolution scanning electron microscopy (SEM). The specimens were fixed with 2% glutaraldehyde in a 0.1M phosphate buffer (pH 7.4), and rinsed with buffered solutions with differently adjusted pH values (pH 3.0, 7.0 or 11.0). They were then osmicated, dried, spatter-coated with gold (1.0-1.5 nm), and observed under a high resolution SEM. The glycocalyx on the luminal surface of the intestinal villi covered the top of the microvilli of the epithelial cells and were well preserved in the specimens treated with an alkaline buffer (pH 11.0). The glycocalyx was observed as filamentous structures, 7 to 15 nm thick in diameter. These filaments repeatedly branched and anastomosed with neighboring ones to form an actual network or plexus as a whole, in contrast with superimposed images in transmission electron microscopy (TEM) which suggested that such anastomoses were pseudo-networks. The filaments thickened globularly at the sites of the filament bifurcation or branching. On the other hand, specimens rinsed with an acid or neutral buffer showed no glycocalyx on their microvilli, whose naked top had knob-like structures. Thus, the pH values of the washing buffer solutions were considered to affect the preservation of the surface coat due to molecular characteristics.

To evaluate the outcome of Descemet's stripping automated endothelial keratoplasty (DSAEK) in eyes with endothelial failure after penetrating keratoplasty (PK).DSAEK was performed on 13 eyes of 13 patients with failed PK. Their mean age was 73.2 years. Evaluation of visual acuity, subjective astigmatism, corneal endothelial cell density, and complications was performed.In four eyes, PK was performed after previous surgery for hypometropia by Sato's anterior-posterior radial keratotomy. Mean followup time was 20.3 +/- 8.6 months. Mean logarithmic minimum angle of resolution (logMAR) visual acuity was 1.92 before DSAEK and 0.89 at final follow-up. Mean subjective astigmatism was 5.10 +/- 3.09D before surgery and 7.25 +/- 4.16 D at 6 months postoperatively. Mean corneal endothelial cell density at 6, 12, 24 months after DSAEK was 42.8%, 51.3%, 72.1%, respectively. Regarding postoperative complications, air was reinjected in four eyes, persistent epithelial defect and rejection occurred in one eye each, and PK was repeated in three eyes.DSAEK rapidly improved visual acuity after failed PK, but some eyes required repeat PK. Eligibility criteria for DSAEK after failed PK should be established.

The three-dimensional distribution of the biliary tract in the rat was studied by scanning electron microscopy of biliary casts. The casts were prepared by a retrograde infusion of a low viscosity or monomeric methacrylate resin mixture into the common bile duct. No resin flow from the bile canaliculi to sinusoidal capillaries was ever noted. Bile canaliculi formed intricate meshworks and drained via the Hering's canals into the bile ductules. The bile canalicular meshworks of adjacent lobules intercommunicated with each other. The bile ductules formed a marked periportal plexus around the portal vein branch, and drained into the intrahepatic bile duct running along the portal vein branch. The junctional zone of the Hering's canal and bile ductule usually showed an ampullary dilation. When the Hering's canal directly drained into a thick bile ductule or into a periportal plexus of bile ductules, such an ampullary dilation at the origin of the bile ductule was never replicated. The extrahepatic bile duct protruded many crypt-like projections which presumably corresponded to parietal glands. It is suggested that the periportal plexus of bile ductules may store the bile as a substitute for the gallbladder.

To evaluate the contribution of stem cell factor (SCF) to the pathogenesis of vernal keratoconjunctivitis (VKC), we determined levels of soluble SCF in the tear fluid of VKC patients.Samples of tear fluid were obtained from 38 VKC patients and 13 normal controls after we received informed consent from each participant. In the 38 VKC patients, disease severity was mild in 13, moderate in 17, and severe in 8. The levels of soluble SCF in tear fluid were determined by enzyme immunoassay.Mean +/- SD SCF levels in tears were 90.3 +/- 23.4 pg/ml in patients with mild VKC, 225.3 +/- 101.2 pg/ml in those with moderate VKC, and 872.0 +/- 313.2 pg/ml in those with severe VKC, and 68.3 +/- 15.3 pg/ml in healthy controls. The increase in SCF levels in patients with moderate or severe VKC was statistically significant compared with the level in healthy controls.Soluble SCF may make a crucial contribution to the pathogenesis of VKC.

Purpose To report a case of Kniest dysplasia with retinal detachment associated with a novel type II collagen gene ( COL2A1 ) mutation. Design Interventional case report. Methods DNA was isolated from peripheral lymphocytes, and mutational analysis was carried out using polymerase chain reaction and direct sequencing. Results A 14-year-old Japanese boy was diagnosed with Kniest dysplasia, and ophthalmic examination revealed a retinal detachment in the right eye. He was successfully treated by vitrectomy and silicon oil injection, and his visual acuity improved from 0.01 to 0.22. DNA analysis of COL2A1 revealed a single base-pair substitution at position +5 of intron 20. Conclusion Vitrectomy and silicon oil injection were effective in reattaching the retinal detachment in a Kniest dysplasia patient. The genetic alteration found in this patient suggested that this prevented the normal splicing of COL2A 1, resulting in an abnormal type II collagen product.

PURPOSE Further to our previous report of a genetic association between interferon-gamma (IFN-γ) receptor 1 gene and atopic cataract, we investigated the roles of plasminogen activator inhibitor-1 (PAI-1), a fibrosis-related, IFN-γ downstream molecule, in the pathogenesis of atopic cataracts. METHODS Cultured lens epithelial cells (LECs) were stimulated by IFN-γ and quantified by PAI-1 mRNA/protein expression. PAI-1 and TGF-β mRNA expression was quantified using cDNA samples obtained from the lens epithelium of atopic cataract patients (n = 7) and of senile cataract patients (n = 8). The anterior capsules obtained from atopic cataracts (n = 9) were immunostained with anti-PAI-1 and anti-alpha smooth muscle actin (α-SMA) antibodies. PAI-1 gene expression was knocked down by PAI-1 siRNA, and α-SMA expression was examined under TGF-β1 stimulation. Expression of α-SMA was examined as a pathological hallmark of anterior subcapsular cataracts, commonly observed in atopic cataracts. RESULTS The IFN-γ stimulation induced PAI-1 mRNA/protein expression in the LECs from 24 to 48 hours after stimulation. The expression of PAI-1 mRNA and TGF-β1 mRNA was significantly higher in the cDNA samples obtained from the atopic cataracts than those obtained from the senile cataracts. PAI-1-positive immunostaining was observed at the fibrotic lesion of the atopic cataracts, and α-SMA-positive myofibroblasts were observed at the vicinity of the PAI-1-positive lesion in all nine samples examined. PAI-1 gene knockdown resulted in reduced α-SMA expression in the LECs. CONCLUSIONS The findings of this study suggest that the IFN-γ, PAI-1, and TGF-β1 are involved in the pathophysiology of atopic cataracts.