Dogru Murat

Effect of anterior and posterior corneal surface irregularity on vision after Descemet-stripping endothelial keratoplasty

PURPOSE: To evaluate irregularity of the anterior and posterior cornea before and after Descemet‐stripping endothelial keratoplasty (DSEK) and its effect on visual acuity. SETTING: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. METHODS: Corneal data were acquired using a rotating Scheimpflug camera before and 1 month and 3 months after DSEK. Anterior and posterior corneal elevation data were decomposed into a set of Zernike polynomials up to the 8th order within a 4.0 mm diameter region. Total higher‐order root mean square (HO‐RMS) and RMS from the 3rd to 8th order were calculated. The effects of anterior and posterior surface irregularity on visual acuity were evaluated. RESULTS: This clinical study comprised 13 consecutive eyes of 12 bullous keratopathy patients. The mean best corrected visual acuity (BCVA) was 1.11 logMAR ± 0.5 (SD) preoperatively, 0.49 ± 0.49 logMAR 1 month postoperatively, and 0.27 ± 0.32 logMAR at 3 months. The HO‐RMS of the anterior surface 1 month (P = .040) and 3 months (P = .048) postoperatively was significantly lower than preoperatively. There were no significant differences in posterior surface HO‐RMS between preoperatively and 1 month (P = .45) and 3 months (P = .054). The postoperative BCVA was significantly correlated with HO‐RMS (P<.001), but not with posterior surface HO‐RMS, at 3 months (P = .354). CONCLUSION: Postoperative BCVA correlated with irregularity of the anterior surface but not the posterior surface. In addition to corneal transparency, regularity of the anterior surface is an important factor in visual acuity after DSEK.

Calorie restriction: A new therapeutic intervention for age-related dry eye disease in rats

A decrease in lacrimal gland secretory function is closely related to aging and leads to an increased prevalence of dry eye syndrome. Since calorie restriction (CR) is considered to prevent functional decline of various organs due to aging, we hypothesized that CR could prevent age-related lacrimal dysfunction. Six-month-old male Fischer 344 rats were randomly divided into ad libitum (AL) and CR (-35%) groups. After 6months of CR, tear function was examined under conscious state. After euthanasia, lacrimal glands were subjected to histological examination, tear protein secretion stimulation test with Carbachol, and assessment of oxidative stress with 8-hydroxy-2 deoxyguanosine (8-OHdG) and 4-hydroxynonenal (HNE) antibodies. CR significantly improved tear volume and tended to increase tear protein secretion volume after stimulation with Carbachol compared to AL. The acinar unit density was significantly higher in the CR rats compared to AL rats. Lacrimal glands in the CR rats showed a lesser degree of interstitial fibrosis. CR reduced the concentration of 8-OHdG and the extent of staining with HNE in the lacrimal gland, compared to AL. Furthermore, our electron microscopic observations showed that mitochondrial structure of the lacrimal gland obtained from the middle-aged CR rats was preserved in comparison to the AL rats. Collectively, these results demonstrate for the first time that CR may attenuate oxidative stress related damage in the lacrimal gland with preservation of lacrimal gland functions. Although molecular mechanism(s) by which CR maintains lacrimal gland function remains to be resolved, CR might provide a novel therapeutic strategy for treating dry eye syndrome.

Increased serum total antioxidant status and decreased urinary 8-hydroxy-2'-deoxyguanosine levels in patients with normal-tension glaucoma.

Acta Ophthalmol. 2010: 88: e259–e264

Efficacy of a novel moist cool air device in office workers with dry eye disease

Purpose:  To evaluate the efficacy and safety of new moist cool air device (MCAD) for ocular symptoms, tear film stability and ocular surface status in office workers with dry eye disease (DED).

Aetiology-specific comparison of long-term outcome of deep anterior lamellar keratoplasty for corneal diseases

Aims To evaluate the long-term outcome of deep anterior lamellar keratoplasty (DALK) for the treatment of herpetic keratitis, keratoconus, stromal scars and corneal dystrophies. Methods This retrospective consecutive case study includes 275 consecutive eyes of 254 patients who underwent DALK; 35 eyes with herpetic keratitis, 114 eyes with stromal scar, 93 eyes with keratoconus and 67 eyes with corneal dystrophy. Exclusion criteria included therapeutic DALK for the treatment of descemetocele or infectious keratitis, and eyes with limbal stem cell deficiency. Patients were examined at 1, 3 and 6 months, and 1, 3 and 5 years after DALK. Graft survival rate, best corrected visual acuity (BCVA), endothelial cell density (ECD) and postoperative complications were evaluated. Results The mean postoperative follow-up duration was 51±41 months. The graft survival rate of all subjects was 96.8% at 1 year, 89.9% at 3 years, 83.5% at 5 years and 74.1% at 10 years. At 6 months, BCVA significantly improved from 1.14±0.54 to 0.22±0.21 in the keratoconus group, from 1.13±0.60 to 0.44±0.54 in the herpes group, from 1.00±0.59 to 0.49±0.38 in the stromal scar group and from 1.04±0.52 to 0.32±0.29 in the corneal dystrophy group (all, p<0.0001). BCVA stabilised after 6 months thereafter up to 5 years. ECD decreased just after DALK and maintained >1000 cell/mm2 at 5 years in all groups. Conclusions DALK provides good visual acuity with slight ECD decrease over long term in all groups.

Pupillary Block Glaucoma After Implantation of Iris-Fixated Phakic Intraocular Lens

To report a case of pupillary block glaucoma after implantation of iris-fixated phakic intraocular lens (IF pIOL). A 43-year-old man was referred for pupillary block one day after implantation of IF pIOL. Slit-lamp examination revealed extremely shallow anterior chamber, closure of peripheral laser iridotomy and contact of iris on the peripheral of the optics of IF pIOL. The intraocular pressure (IOP) was 62 mm Hg. The iris moved forward in contact with the IF pIOL and the lens remained in the physiologic position, which made the distance between the lens and the iris wide. He underwent an uneventful peripheral surgical iridectomy and the IOP decreased to 6 mm Hg. Acute pupillary block glaucoma can occur after IF pIOL implantation due to the occlusion of aqueous flow between the IF pIOL and the iris if the peripheral iridotomy closes.

A new method to prevent loss of mitomycin C soaked sponges under the conjunctiva during trabeculectomy

Surgically acquired foreign body is a serious complication of microscopic surgery.1 In fornix-based trabeculectomy with mitomycin C, sponges soaked with mitomycin C are placed under the conjunctival flap for 3–5 min, after which the sponges are removed with a toothed forceps. Sponges may be lost under the conjunctival flap because in fornix-based trabeculectomy, the sponges are inserted deep into the conjunctival–scleral interface. Numerous complications due to retained cellulose sponges after trabeculectomy with mitomycin C such as granulomas or conjunctival hole formation have already been reported.2 3 We used DELICOT (Cat# 63-01, American Surgical Sponges, Lynn, Massachusetts; figure 1) as a device to deliver mitomycin C to the sclera during trabeculectomy. Figure 1 (A) DELICOT sponge tied to a cotton …