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PURPOSE To clarify the prognosis of corneal perforation, we compared the etiology and characteristics of patients with traumatic and non-traumatic corneal perforations. METHODS This retrospective observational study included patients treated for traumatic or non-traumatic corneal perforations at a single tertiary hospital from 1989 to 2019. The variables collected included the primary cause of corneal perforation, final best-corrected visual acuity (BCVA), and treatment administered. The initial treatment administered and treatment success rates were compared between the traumatic and non-traumatic groups. Multivariate linear regression analysis was performed to determine the predictors of final visual acuity. RESULTS Ninety eyes of 90 patients (mean age, 61.1 ± 19.7 years) were included. Traumatic and non-traumatic corneal perforations occurred in 40 (44.4%) and 50 eyes (55.6%), respectively. Among non-traumatic causes, infection and autoimmune disease were the causes for corneal perforation in 18 (20.0%) and 12 eyes (13.3%), respectively. The success rate for the closure of the perforated site with the initial procedure was significantly higher in traumatic corneal perforations than in non-traumatic corneal perforations (90.0% and 72.2%, respectively; p = 0.038). Patients with traumatic corneal perforation had significantly better final BCVA than those with non-traumatic corneal perforation (0.71 ± 1.18 and 1.52 ± 1.12, respectively; p = 0.0016). On multivariate analysis, older age and non-traumatic corneal perforation were significantly related to the final lower BCVA (p

Although perioperative blood-pressure control is important, especially for high-risk patients, no previous report has examined early monitoring of perioperative blood-pressure changes before cataract surgery. In this single-center, retrospective, observational study, we evaluated the early intervention for perioperative hypertension in cataract surgery with topical anesthesia.Hospitalized patients who underwent phacoemulsification and intraocular-lens insertion and whose blood pressure was controlled using standardized management to start early monitoring and control (standardized group; 134 eyes of 134 patients) were compared to age- and sex-matched patients who underwent the same cataract surgery and whose blood pressure was controlled using conventional means (control group; 134 eyes of 134 patients). The perioperative blood pressure, pulse pressure, and heart rate were compared preoperatively, upon entering the operation room, and at the beginning, end, and after the operation.Although there was no difference before the operation, the changes in systolic pressure in the standardized group were significantly lower at the point of entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, 0.001, and 0.001, respectively). No significant difference was observed between etizolam and nicardipine use.Early monitoring and control of blood pressure in cataract surgery could effectively control perioperative hypertension without additional drug use and could be widely applied in the clinical setting.

Keratoprosthesis is used for corneal transplantation in high-risk patients who require penetrating keratoplasty (PKP). Boston keratoprosthesis (BKpro) is a representative type of keratoprosthesis used worldwide. In Japan, the first BKpro was implanted in an eye after multiple corneal graft failures in 2008, but its use remains limited. A recent patient survey revealed that among the Japanese patients who had previously undergone multiple PKPs, the retention rate of BKpro was significantly higher than that of PKP at 5 years postoperatively (100% vs. 26%; P < 0.01). Patients with implanted BKpro also had better best corrected visual acuity of 20/200 or higher than those with PKP at 5 years postoperatively (80.0% vs. 17.6%; P = 0.03). Regarding the postoperative complications, retroprosthetic membrane formation was observed in 88.9%, infectious keratitis in 33.3%, and glaucoma progression in 11.1% of cases. Another retrospective analysis showed that fungal keratitis occurred in 0.09 patients per year and severely affected visual acuity. Furthermore, because it is difficult to accurately examine intraocular pressure after BKpro implantation, the intraocular pressure of patients with implanted BKpro was prospectively estimated using a transpalpebral tonometer (Diaton). In conclusion, BKpro implantation is effective and safe for Japanese patients, given the reported improvements in visual acuity and low rates of complications.

We report a case of open globe injury caused by Ardea albapecking that resulted in Escherichia colipanophthalmitis. A woman in her 70s complaining of ocular pain was referred to our hospital because her right eye had been pecked by an A. alba2 days earlier. Visual acuity in her right eye was reduced to light sensation. The right conjunctiva became hyperemic and edematous with swelling of the right upper eyelid. The upper side of the right cornea was densely cloudy with focal defect. Ultrasonography showed a thick sclera and choroid-like structure. Pathological investigation of a scraped sample from the infected site revealed gram-negative rods; E. coli was isolated. She had fever with elevated serum C-reactive protein levels and leukocytosis confirmed by laboratory examination. Topical levofloxacin and cefmenoxime and intravenous fosfomycin and aspoxicillin were initiated, but the right cornea melted near the perforated site with leakage of the eyeball contents on the next day. We decided to perform eye evisceration because of difficulty in controlling corneal melting and panophthalmitis. Her general state recovered the day after surgery. Orbital cellulitis improved gradually with normal C-reactive protein levels and white blood cell counts. As ocular injury caused by birds could become severe and cause ocular infection and visual dysfunction, it is important to exercise caution in the vicinity of wild birds, especially when they are aggressive.

This retrospective observational study compared long-term topographic changes after recurrent- and primary-pterygium surgery depending on pterygium size. Patients who underwent recurrent-pterygium excision between 2002–2013 and age, sex, and pterygium size-matched controls who underwent primary-pterygium surgery were included (33 eyes of 33 patients in each group). Pterygium size was graded per advancing edge position

Purpose To investigate effect of metabolic syndrome on blood pressure during cataract surgery with topical anesthesia. Design A single-centered, retrospective case series. Methods Consecutive patients who were hospitalized and underwent phacoemulsification and insertion of intraocular lens with topical anesthesia in October 2016 were included. Perioperative blood pressure and pulse pressure were compared between patients with metabolic syndrome (metabolic group) and sex- and age-matched patients without metabolic syndrome (nonmetabolic group) at six time points: on admission, in the morning of the operation, 2 hours before the operation, at the point of entering the operation room, during the operation, and after the operation. Perioperative use of etizolam and nicardipine was compared between the two groups. Results Thirty patients in the metabolic group and 30 in the nonmetabolic group were included. There was no difference in changes compared with the values on admission in systolic pressure and pulse pressure at any examination point between the two groups. There was no difference in changes in diastolic pressure between the two groups, except for at 2 hours before the operation (1.4 ± 9.6 mm Hg in the metabolic group vs -6.2 ± 8.5 mm Hg in the nonmetabolic group; P = 0.044). The number of patients who were administered etizolam was 5/30 (16.7%) in the metabolic group and 2/30 (6.7%) in the nonmetabolic group, showing no significant difference. No patients were administered intravenous nicardipine in either group. Conclusions Well-controlled metabolic syndrome did not affect the changes in perioperative blood pressure during cataract surgery with topical anesthesia.

Purpose To investigate the clinical courses of patients with corneal endothelial dysfunction due to Gomphocarpus physocarpus milky latex-induced injury. Patients and methods In this retrospective case series, we included consecutive patients who visited Miyata Eye Hospital or Kagoshima Miyata Eye Clinic between October 2010 and August 2017 and had corneal edema caused by G. physocarpus milky latex-induced injury. Patient information and data on central corneal thickness (CCT), corneal endothelial cell density (ECD), best-corrected visual acuity (BCVA), and treatment were retrospectively reviewed. Results Five eyes of four patients were included. The mean age was 79.0 ± 7.1 years. All patients complaining of symptoms visited the hospital 1 or 2 days after the injury. All patients had corneal edema; two of the five eyes showed hyperemia, whereas none showed corneal epithelial defect or blepharitis. The mean CCT was 699.8 ± 95.9 μm at the first visit and decreased to 563.2 ± 74.0 μm 1 week after the injury with treatment with topical steroids and antibiotics. The mean ECD and BCVA were 2695.8 ± 191.3 cells/mm2 and 0.22 ± 0.19 at the first visit and 2826.0 ± 132.9 cells/mm2 and 0.10 ± 0.09 one week after the injury, respectively. Conclusion G. physocarpus caused transient dysfunction of the corneal endothelium and thereby, corneal edema. Accurate diagnosis with history taking is important to ascertain the types of plants the patient has touched and to exclude other possible diagnoses.

Background To examine the effectiveness of the use of machine learning for adapting an intraocular lens (IOL) power calculation for a patient group. Methods In this retrospective study, the clinical records of 1,611 eyes of 1,169 Japanese patients who received a single model of monofocal IOL (SN60WF, Alcon) at Miyata Eye Hospital were reviewed and analyzed. Using biometric metrics and postoperative refractions of 1211 eyes of 769 patients, constants of the SRK/T and Haigis formulas were optimized. The SRK/T formula was adapted using a support vector regressor. Prediction errors in the use of adapted formulas as well as the SRK/T, Haigis, Hill-RBF and Barrett Universal II formulas were evaluated with data from 395 eyes of 395 distinct patients. Mean prediction errors, median absolute errors, and percentages of eyes within ± 0.25 D, ± 0.50 D, and ± 1.00 D, and over + 0.50 D of errors were compared among formulas. Results The mean prediction errors in the use of the SRT/K and adapted formulas were smaller than the use of other formulas (P Conclusions Adapting IOL power calculations using machine learning technology with data from a particular patient group was effective and promising.

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 visual performance and patient satisfaction in multifocal intraocular lens (IOL)-implanted eyes and multifocal contact lens (CL)-wearing eyes undergoing monofocal IOL implantation. Methods We retrospectively assessed visual acuity at all distances (0.3, 0.5, 0.7, 1, and 5 m), contrast sensitivity function, patient satisfaction score, and the rate of spectacle independence in the multifocal IOL and multifocal CL groups. Results Binocular visual acuity at 0.3, 0.5, 0.7, 1, and 5 m was 0.05 ± 0.11, − 0.02 ± 0.09, − 0.02 ± 0.09, − 0.02 ± 0.09, and − 0.04 ± 0.07, respectively, in the multifocal IOL group and 0.25 ± 0.13, 0.04 ± 0.10, 0.01 ± 0.09, − 0.01 ± 0.07, and 0.00 ± 0.08, respectively, in the multifocal CL group. We found significant differences in visual acuity at all distances. The area under the log contrast sensitivity function was 1.32 ± 0.14 and 1.33 ± 0.16 in the multifocal IOL and CL groups, respectively (p = 0.444). The patient satisfaction score for overall vision was 80.2 ± 20.6 and 82.9 ± 10.5 (p = 0.889), and the rate of spectacle independence was 23.4% and 41.7% in the multifocal IOL and CL groups, respectively (p = 0.277). Conclusions According to our experience, both multifocal IOLs and CLs provided good near-to-distance binocular vision and subsequent high patient satisfaction in daily activities with acceptable contrast sensitivity, suggesting their viability for presbyopic correction in elderly subjects.

Background This prospective comparative study aimed to investigate the influence of diffractive trifocal intraocular lenses (IOLs) implantation on standard automated perimetry. Methods Patients with no diseases affecting the visual field had undergone cataract surgery following the implantation of trifocal or monofocal IOLs from July 2019 to August 2020 were recruited. The normality of the anterior and posterior segments and absence of glaucomatous optic nerve cupping were confirmed preoperatively by slit-lamp examination. Standard automated perimetry was performed using Humphrey Visual Field 10–2 testing, 2–3 months after cataract surgery in only one eye per patient. The mean deviation (MD) and foveal sensitivity were compared between IOLs in eyes with acceptable reliability indices and best-corrected visual acuity of 20/25 or better. Results Among the 83 eyes of the 83 patients included, 39 and 29 eyes eligible for perimetry analysis had trifocal and monofocal IOLs, respectively. The mean MD and foveal sensitivity in eyes with trifocal IOLs were significantly lower than those in eyes with monofocal IOLs (P Conclusion The comparison in nonglaucomatous eyes demonstrated that the influence of trifocal IOLs on standard automated perimetry was greater than that of monofocal IOLs.

This study aimed to present a case of transient corneal damage after exposure to the effluent squirting from a sea anemone, Anthopleura uchidai, and to experimentally confirm the presence of toxic substances from an A. uchidai in the tissue culture.We reviewed the clinical course of a 51-year-old man who complained of decreased vision in his left eye after the stinging of a sea anemone, A. uchidai. The toxicity of the effluents from an A. uchidai in immortalized human corneal endothelial cells (HCEnC-21T) and human corneal epithelial cells in vitro were evaluated.Corneal edema was observed, and his best-corrected visual acuity was 0.2. Corneal endothelial cell density decreased to 1435 cells/mm2. Although his corneal edema and visual acuity recovered after topical instillation with a topical steroid and 5% NaCl, corneal endothelial cell density did not recover for 3 years after the injury. The in vitro study revealed fractioned effluence from the sea anemone, by size-exclusion chromatography, containing a substance toxic to HCEnC-21T with cytoplasmic swelling and nuclear dislocation.It is necessary to be cautious of effluents from sea anemones along the coast, and ophthalmologists should be aware that sea anemones can cause corneal endothelial dysfunction.

The prospective case series aimed to examine the agreement between the use of a slit-scanning contact specular microscope and a noncontact specular microscope in corneal endothelial cell (CEC) analysis and to evaluate the differences between the central and peripheral regions in normal corneas.After confirming normal corneal endothelium with slit-lamp microscopy, CEC images of 56 eyes of 56 cataractous patients were analyzed in the central and 4 peripheral regions using a slit-scanning contact specular microscope. A noncontact specular microscope was used for the analysis in the central region. The endothelial cell density (ECD), the percentage of hexagonal shape cells (HEX), and the coefficient of variation (CV) in the central region were compared. Differences between central and peripheral CECs were also evaluated.The mean ECD was 2778 cell/mm and was not different from the results using the noncontact specular microscope (2736 cell/mm, P = 0.051). There was a significant correlation (P0.001, R = 0.72). The analysis of HEX resulted in larger values with the slit-scanning contact microscope (53.13% vs. 48.89%, P0.001), whereas there was no difference in the CV (38.48 vs. 38.04, P = 0.56). On comparing the central and peripheral regions, there was no significant difference in the ECD, whereas significant differences were found in the superior region in the HEX and CV (P0.001) and in the nasal region in CV (P = 0.023).The analysis of ECD with the use of the slit-scanning contact specular microscope did not differ from the noncontact specular microscope, and the results demonstrated no difference between the central and peripheral ECD.

Purpose: The aim of this report was to describe a case of myopic foveoschisis and a macular hole with retinal detachment that resolved spontaneously. Observations: A 62-year-old woman with bilateral blurred vision was referred to our department. Her best-corrected visual acuity (BCVA) was 0.4 bilaterally; the standard equivalent refractive error was −17.0 diopters in the right eye and −18.75 diopters in the left eye. The axial length was 31.4 mm and 31.2 mm, respectively. After cataract surgery was performed, the BCVA of the right and left eye was 0.6 and 1.0, respectively. Four years later, slight macular traction, foveoschisis, and the macular hole had progressed in the left eye and the BCVA had decreased to 0.7. However, the macular hole had closed, the foveoschisis had resolved, and retinal detachment had mostly resolved three weeks later. The BCVA improved to 0.8. The macular hole did not reoccur and retinal detachment resolved completely after six more months. Conclusions and Importance: This case demonstrated that myopic foveoschisis and a macular hole with retinal detachment could improve spontaneously. It is necessary to decide carefully whether surgery is required or whether the patient should be observed. Keywords: Macular hole, Myopic foveoschisis, Retinal detachment, High myopia

To examine the effects of topical steroid instillation on central corneal thickness in eyes with bullous keratopathy (BK).Retrospective case series METHODS: Consecutive patients with BK who did not wish to receive corneal transplantation and were treated with 0.1% betamethasone eyedrops were included. Patients with BK treated with 5% sodium chloride (hypertonic saline) eyedrops served as controls. Central corneal thickness (CCT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), BK etiology, and clinical courses from medical records were retrospectively reviewed. We compared the two groups for differences in CCT, BCVA and IOP before treatment and 2 weeks, 1 month, and 3 months after treatment.Eighteen eyes of 18 patients who were treated with betamethasone and 18 eyes of 18 patients who were treated with hypertonic saline were included. There was no significant difference in CCT between the two groups before treatment. The reduction of CCT in the betamethasone group was significantly larger than in the hypertonic saline group at 2 weeks (p = 0.002), 1 month (p = 0.02), and 3 months (p = 0.001) after treatment. Complications such as infectious keratitis and IOP rise did not occur during the observation period.Topical steroid instillation reduced central corneal thickness in eyes with BK.

To determine the relationship between fluoroquinolone susceptibility of gram-positive cocci (GPC) isolated from patients with bacterial keratitis and the age of the patients or the date of onset.Bacterial isolates were obtained from corneal lesions of patients with infectious keratitis treated between January 2008 and December 2016. The fluoroquinolone susceptibility of GPC was assessed, and a retrospective review of microbiological records was performed. Fluoroquinolone susceptibility was measured through broth microdilution in accordance with protocols of the Clinical and Laboratory Standards Institute. Statistical analysis was performed using a generalized estimating equation and cubic spline to determine the association between fluoroquinolone susceptibility of GPC isolated from corneal lesions and patient age.Of the 1200 bacterial isolates, 471 GPC were identified. They included Staphylococcus epidermidis (45.6%), other coagulase-negative Staphylococcus sp. (17.8%), and Staphylococcus aureus (18.3%). Levofloxacin susceptibility of GPC exhibited a negative relationship with age and had an odds ratio of 0.893 (95% confidence interval, 0.825-0.967) for every 10 years of age. A non-adjusted cubic spline curve was well correlated with year-adjusted data in a generalized additive model, and the levofloxacin susceptibility of GPC was initially stable but gradually declined after 40 years of age, before re-stabilizing again after 70 years of age.The fluoroquinolone susceptibility of GPC isolated from corneal lesions of infectious keratitis is high in children under 15 years of age and declines with an increase in age of patients using a generalized estimating equation and cubic spline.

This prospective study aimed to investigate the influence of an extended depth-of-focus intraocular lens (EDOF IOL) on standard automated perimetry. Ninety eyes of 90 patients who had undergone cataract surgery from February 2018 to December 2018 were included. No patients had any diseases that might affect the visual field. ZMB00 (+ 4.00 D add), ZXR00V (+ 1.75 D add), and ZCB00V (Johnson & Johnson Surgical Vision, Santa Ana, CA, USA) were used as multifocal, EDOF, and monofocal IOLs, respectively. Humphrey Visual Field 10–2 testing was performed 2–3 months after cataract surgery, acceptable reliability indices were measured, and mean deviation (MD), pattern standard deviation (PSD), foveal sensitivity and mean sensitivity (MS) were compared. Seventy-one eyes (ZXR00V: 24 eyes, ZMB00: 25 eyes, ZCB00V: 22 eyes) were used for the analyses. The MD and MS of the EDOF and monofocal groups were significantly higher than those of the multifocal group (P P > 0.23). The PSD and foveal sensitivity were not different among the groups. In non-glaucomatous patients, the MD and MS of the EDOF IOL were comparable to those of the monofocal IOL and better than those of the multifocal IOL.

Purpose To quantitatively and intraindividually compare surface light scattering for 7 years after implantation of Clareon and AcrySof intraocular lenses (IOLs). Setting Miyata Eye Hospital, Miyazaki, Japan. Design Retrospective comparative case series. Methods Clinical records of eyes that had contralateral implantation of SN60WF and SY60WF IOLs were reviewed. Light scattering on the anterior surface of IOLs, corrected distance visual acuity (CDVA), and mesopic and photopic contrast sensitivities were examined at 1 year, 3 years, and 7 years postoperatively, and they were intraindividually compared. Results 34, 19, and 16 patients visited at 1 year, 3 years, and 7 years postoperatively, respectively. Surface light scattering in eyes with SY60WF IOL was significantly reduced, and the rate of increase was 2.74 computer compatible tapes per year. Although there were prominent increases in eyes with SN60WF IOL, no statistically significant difference was found in their CDVA and contrast sensitivities. Conclusions In eyes with Clareon IOLs, the development of surface light scattering was suppressed up to 7 years. The increase rate demonstrated that the visual acuity would be least deteriorated up to 12 years postoperatively, whereas the influence of straylight induced should be investigated.

Regional variations of the preoperative biometry can affect the refractive accuracy of cataract surgery. We aimed to compare the preoperative biometric data for cataract surgery between two domestic institutions. We retrospectively reviewed the preoperative biometric data of 673 consecutive eyes undergoing standard cataract surgery at Miyata Eye Hospital (Miyazaki; M group) and Kitasato University Hospital (Kanagawa; K group), and compared these data between the two groups. We found significant differences in the mean keratometric readings (44.39 ± 1.56 D vs. 44.09 ± 1.74 D) (unpaired t test, p = 0.034), the anterior chamber depth (3.14 ± 0.43 mm vs. 3.46 ± 0.62 mm) (p

Purpose We previously reported the presence of multidrug-resistant staphylococci on the ocular surface of glaucoma patients using prostaglandin analog drops for more than 1 year. Here, we investigated the effect of benzalkonium chloride (BAC) on these multidrug-resistant staphylococci. Methods Staphylococcus epidermidis was isolated from the conjunctival sacs of 32 eyes of 32 patients comprised of 13 eyes treated with 0.005% latanoprost (Xalatan; Xa group) and 19 eyes treated with 0.004% travoprost (Travatan Z; Tz group). The minimum inhibitory concentrations (MICs) of prostaglandin analogs and BAC were measured. The presence of efflux pump genes was analyzed using polymerase chain reaction. Results No difference was found in the MIC values of prostaglandin analogs. In contrast, the MIC values of BAC were significantly higher for the isolates from the Xa group than for those from the Tz group (2.02 vs. 1.02 µg/mL; P = 0.001). One proton-motive efflux gene, qacC/smr, was detected more frequently in the Xa isolates than in the Tz isolates (P < 0.001). The prevalence of methicillin resistance was correlated with the presence of qacC/smr (P = 0.010), and the MIC of BAC was significantly correlated with the detection of qacA/B and qacC/smr sequences (P = 0.03 and P < 0.001, respectively). Conclusions The long-term use of eye drops containing BAC might select BAC-resistant S. epidermidis harboring qacC/smr. Translational Relevance These findings suggest that the long-term use of eye drops containing BAC might be inappropriate in terms of avoiding antimicrobial resistance.

This retrospective study explored the effect of the ratio of axial length (AL) to average keratometry (K) on intraocular lens power calculation in long eyes. The clinical records of eyes that had an AL of 26.0 mm or longer, and underwent cataract surgery with intraocular lens implantations, were reviewed. This study was approved by the institutional review board of Miyata Eye Hospital. Preoperative biometry data were obtained using optical low-coherence reflectometry. Prediction errors in the use of the SRK/T formulas were obtained from manifest refraction spherical equivalents one month postoperatively. Significant factors inducing prediction errors were examined using stepwise multiple regression analysis with descriptive factors of AL, K value, and their ratio (AL/K). Clinical records related to 49 long eyes of 49 patients, and 93 eyes of 93 patients with normal AL, were evaluated. Stepwise multiple regression analysis revealed that the AL/K was a significant factor increasing the prediction errors (P = 0.0003). With the regression equation, 98% of prediction errors with the use of the SRK/T formula were within ±1.00 D of differences. For our sample of 49 long eyes, the ratio of AL to K was a significant factor inducing hyperopic prediction errors with the use of SRK/T for long eyes.

To compare the outcomes of ocular injuries of hornets and paper wasps’ stings. Retrospective case series. Patients diagnosed with ocular injuries sustained by bee stings at Miyata Eye Hospital (Miyazaki, Japan) between August 2000 and July 2016 were enrolled. Retrospective data regarding type of bee, visual acuity, and treatment were collected from medical records. Outcomes of the hornet and wasp groups were compared. Five eyes of 5 patients (3 men, 2 women; mean age 44.6±21.2 years [range 9–62 years]) were enrolled. The mean follow-up period was 50.6 ± 57.6 months (range 4 days to 121 months). The causative bee was hornet in 3 cases and wasp in 2. The anterior chamber was irrigated in 2 patients, both from the hornet group. The best-corrected visual acuity at the final visit was no light perception, light perception, and (0.02) in the hornet group, (1.5) and (1.2) in the wasp group. The hornet group exhibited significantly worse prognosis than the wasp group. Identifying the type of bee is important in establishing prognosis.

Purpose To the best of our knowledge, few detailed investigation of astigmatism with recurrent pterygium currently exists. We aimed to evaluate corneal irregularity after recurrent pterygium surgery. Methods This observational study included consecutive patients who underwent recurrent pterygium surgery and were observed for >12 months postoperatively via corneal examination. Patients who underwent primary pterygium surgery during the same period served as controls. Pterygium size and corneal irregularity evaluated with Fourier harmonic analysis (spherical component, regular astigmatism, asymmetry component, and higher-order irregularity) were compared between groups preoperatively and at 1, 3, 6, and 12 months postoperatively. Results Overall, 203 eyes of 203 patients (age, 66.5 ± 9.5 years) were included, of which 44 eyes had recurrent pterygium and 159 had primary pterygium. Regular astigmatism in the recurrent pterygium group was higher than that in the primary pterygium group preoperatively and at 1 and 3 months postoperatively. The asymmetry component and higher-order irregularity in the recurrent pterygium group were higher than those in the primary pterygium group at all observation points. Conclusions Fourier harmonic analysis showed that larger corneal irregularity that could not be corrected with spectacles persisted for a long time after recurrent pterygium excision than after primary pterygium excision. Thus, recurrence prevention is critical for primary pterygium surgery. Translational relevance We demonstrated that larger corneal irregularity that could not be corrected with spectacles remained long after excision of recurrent pterygium compared with excision of primary pterygium; thus, the prevention of recurrence is clinically important for primary pterygium surgery in terms of corneal irregularity.

Background To predict keratoconus progression using deep learning of the color-coded maps measured with a swept-source anterior segment optical coherence tomography (As-OCT) device. Methods We enrolled 218 keratoconic eyes with and without disease progression. Using deep learning of the 6 color-coded maps (anterior elevation, anterior curvature, posterior elevation, posterior curvature, total refractive power, and pachymetry map) obtained by the As-OCT (CASIA, Tomey), we assessed the accuracy, sensitivity, and specificity of prediction of keratoconus progression in such eyes. Results Deep learning of the 6 color-coded maps exhibited an accuracy of 0.794 in discriminating keratoconus with and without progression. For a single map analysis, posterior elevation map (0.798) showed the highest accuracy, followed by anterior curvature map (0.775), posterior corneal curvature map (0.757), anterior elevation map (0.752), total refractive power map (0.729), and pachymetry map (0.720), in distinguishing between progressive and non-progressive keratoconus. The use of the adjusted algorithm by age subgroups improved to an accuracy of 0.849. Conclusions Deep learning of the As-OCT color-coded maps effectively discriminates progressive keratoconus from non-progressive keratoconus with an accuracy of approximately 85% using the adjusted age algorithm, indicating that it will become an aid for predicting the progression of the disease, which is clinically beneficial for decision-making of the surgical indication of corneal cross-linking (CXL).

International audience; Exfoliation syndrome (XFS) is the commonest known risk factor for secondary glaucoma and a significant cause of blindness worldwide. Variants in two genes, LOXL1 and CACNA1A have been previously associated with XFS. To further elucidate the genetic basis of XFS, we collected a global sample of XFS cases to refine the association at LOXL1, which previously showed inconsistent results between populations,and to identify new variants associated with XFS. We identified a rare, protective allele at LOXL1 (p.407Phe, OR= 25, P=2.9 x 10-14) through deep resequencing of XFS cases and controls from 9 countries. This variant results in increased cellular adhesion strength compared to the wild-type (p.407Tyr) allele. A genome-wide association study (GWAS) of XFS cases and controls from 24 countries followed by replication in 18 countries identified seven genome-wide significant loci (P < 5 x 10-8). Index variants at the new loci map to chromosomes 13q12 (POMP), 11q23.3 (TMEM136), 6p21 (AGPAT1), 3p24 (RBMS3) and 5q23 (near SEMA6A). These findings provide biological insights into the pathology of XFS, and highlight a potential role for naturally occurring rare LOXL1 variants in disease biology.

Purpose To compare the long-term outcomes of visual function and endothelial cell survival after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK). Methods The cohort included 108 eyes from 97 patients who underwent primary PK and 85 eyes from 78 patients who underwent primary DSAEK at Miyata Eye Hospital in Japan. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and four components from Fourier harmonic analysis of topography data (spherical component, regular astigmatism component, asymmetry component, and higher-order irregularity component) were retrospectively compared between PK and DSAEK at each time point for 5 years using mixed-effects models. Subgroup analyses were performed to compare the effect of PK and DSAEK on visual acuity. Results Average BSCVA was significantly better in the DSAEK group compared with that in the PK group both preoperatively and postoperatively. Subgroup analyses revealed that average changes in BSCVA from preoperative baseline in eyes with preoperative logarithm of the minimum angle of resolution BSCVA between 0.39 and 1.0 and between 1.3 and 2.0 were not significantly different between the PK and DSAEK groups at all postoperative time points. All components from Fourier harmonic analysis were significantly higher after PK than DSAEK at almost all postoperative time points. There were no significant differences in endothelial cell density between PK and DSAEK after 3 years. Conclusions PK and DSAEK provide similar recovery of BSCVA and endothelial cell survival at 5 years after surgery.

Sphingosine 1 phosphate (S1P) is a bioactive lipid that regulates cellular activity, including proliferation, cytoskeletal organization, migration, and fibrosis. In this study, the potential relevance of S1P&ndash, Rho signaling in pterygium formation and the effects of ultraviolet (UV) irradiation on activation of the S1P/S1P receptor axis and fibrotic responses were investigated in vitro. Expressions of the S1P2, S1P4, and S1P5 receptors were significantly higher in pterygium tissue than in normal conjunctiva, and the concentration of S1P was significantly elevated in the lysate of normal conjunctival fibroblast cell (NCFC) irradiated with UV (UV-NCFCs). RhoA activity was significantly upregulated in pterygium fibroblast cells (PFCs) and UV-NCFCs, and myosin phosphatase&ndash, Rho interacting protein (MRIP) was upregulated, and myosin phosphatase target subunit 1 (MYPT1) was downregulated in PFCs. Fibrogenic changes were significantly upregulated in both PFCs and UV-NCFCs compared to NCFCs. We found that the activation of the S1P receptor&ndash, Rho cascade was observed in pterygium tissue. Additionally, in vitro examination showed S1P&ndash, rho activation and fibrogenic changes in PFCs and UV-NCFCs. S1P elevation and the resulting upregulation of the downstream Rho signaling pathway may be important in pterygium formation, this pathway offers a potential therapeutic target for suppressing pterygium generation.

IMPORTANCE Exfoliation syndrome is a systemic disorder characterized by progressive accumulation of abnormal fibrillar protein aggregates manifesting clinically in the anterior chamber of the eye. This disorder is the most commonly known cause of glaucoma and a major cause of irreversible blindness. OBJECTIVE To determine if exfoliation syndrome is associated with rare, protein-changing variants predicted to impair protein function. DESIGN, SETTING, AND PARTICIPANTS A 2-stage, case-control, whole-exome sequencing association study with a discovery cohort and 2 independently ascertained validation cohorts. Study participants from 14 countries were enrolled between February 1999 and December 2019. The date of last clinical follow-up was December 2019. Affected individuals had exfoliation material on anterior segment structures of at least 1 eye as visualized by slit lamp examination. Unaffected individuals had no signs of exfoliation syndrome. EXPOSURES Rare, coding-sequence genetic variants predicted to be damaging by bioinformatic algorithms trained to recognize alterations that impair protein function. MAIN OUTCOMES AND MEASURES The primary outcome was the presence of exfoliation syndrome. Exome-wide significance for detected variants was defined as P < 2.5 x 10(-6). The secondary outcomes included biochemical enzymatic assays and gene expression analyses. RESULTS The discovery cohort included 4028 participants with exfoliation syndrome (median age, 78 years [interquartile range, 73-83 years]; 2377 [59.0%] women) and 5638 participants without exfoliation syndrome (median age, 72 years [interquartile range, 65-78 years]; 3159 [56.0%] women). In the discovery cohort, persons with exfoliation syndrome, compared with those without exfoliation syndrome, were significantly more likely to carry damaging CYP39A1 variants (1.3% vs 0.30%, respectively; odds ratio, 3.55 [95% CI, 2.07-6.10]; P = 6.1 x 10(-7). This outcome was validated in 2 independent cohorts. The first validation cohort included 2337 individuals with exfoliation syndrome (median age, 74 years; 1132 women; n = 1934 with demographic data) and 2813 individuals without exfoliation syndrome (median age, 72 years; 1287 women; n = 2421 with demographic data). The second validation cohort included 1663 individuals with exfoliation syndrome (median age, 75 years; 587 women; n = 1064 with demographic data) and 3962 individuals without exfoliation syndrome (median age, 74 years; 951 women; n = 1555 with demographic data). Of the individuals from both validation cohorts, 5.2% with exfoliation syndrome carried CYP39A1 damaging alleles vs 3.1% without exfoliation syndrome (odds ratio, 1.82 [95% CI, 1.47-2.26]; P < .001). Biochemical assays classified 34 of 42 damaging CYP39A1 alleles as functionally deficient (median reduction in enzymatic activity compared with wild-type CYP39A1, 94.4%[interquartile range, 78.7%-98.2%] for the 34 deficient variants). CYP39A1 transcript expression was 47% lower (95% CI, 30%-64% lower; P < .001) in ciliary body tissues from individuals with exfoliation syndrome compared with individuals without exfoliation syndrome. CONCLUSIONS AND RELEVANCE In this whole-exome sequencing case-control study, presence of exfoliation syndrome was significantly associated with carriage of functionally deficient CYP39A1 sequence variants. Further research is needed to understand the clinical implications of these findings. National Research Foundation of SingaporeNational Research Foundation, Singapore [NRF-NRFI2018-01]; US National Eye Institute of the National Institutes of Health [R01 EY020928, P30 EY014104, UM1 CA186107, U01 CA167552, EY015473]; Glaucoma Research Foundation of Canada [X052, CIRG17may053]; National Medical Research Council of SingaporeNational Medical Research Council, Singapore The study was funded by grant NRF-NRFI2018-01 from the National Research Foundation of Singapore. Additional support was provided by grants R01 EY020928, P30 EY014104, UM1 CA186107, U01 CA167552, and EY015473 from the US National Eye Institute of the National Institutes of Health, funding from the Glaucoma Research Foundation of Canada, and grants X052 and CIRG17may053 from the National Medical Research Council of Singapore.

To conduct a long-term follow-up study evaluating the efficacy and safety of transplantation of preserved limbal allograft and amniotic membrane for recurrent pterygium. This was a retrospective, non-comparative, interventional case series conducted at a private eye hospital. Eighty-four eyes of 80 patients with recurrent pterygium were included in the study. The mean number of previous surgeries for pterygium was 1.36 ± 0.98 (range, 1–8). All subjects received transplantation of preserved limbal allograft and amniotic membrane. The mean follow-up period was 73.0 ± 38.1 months (range, 12–154 months). Pterygium recurred in 10 eyes (11.9 %). The mean period to recurrence was 16.3 ± 11.3 months (range, 5–33 months). Symblepharon was cured in 21 eyes, persisted in 2 eyes, and newly occurred in 3 eyes. Diplopia was cured in eight eyes, persisted in five eyes, and newly occurred in one eye. As for complications, intraocular pressure elevations over 21 mmHg were recognized in ten eyes of nine cases, in which the intraocular pressure was controlled by reduction of topical steroid in four eyes and by addition of topical prostaglandin derivatives in six eyes. Twenty-four eyes (28.6 %) gained two lines or more of Landolt best spectacle-corrected visual acuity (BSCVA), 56 eyes (66.7 %) stayed within one line from preoperation, and four eyes (4.8 %) lost two lines or more. There were no major complications and no graft rejection. Transplantation of preserved limbal allograft and amniotic membrane is a safe and effective procedure for recurrent pterygium.