Fumiaki Yoshitomi

Relationship between apparent accommodation and corneal multifocality in pseudophakic eyes

OBJECTIVE To investigate whether any association exists between apparent accommodation in pseudophakic eyes and multifocal corneal effects. DESIGN A prospective observational case series. PARTICIPANTS A total of 121 eyes of 98 patients who had undergone phacoemulsification and posterior chamber intraocular lens implantation were studied. METHODS The amount of apparent accommodation was measured using an accommodometer. The degree of corneal multifocality was determined on the corneal topography by measuring the maximum and minimum corneal refractive powers within the pupillary area. Refractive astigmatism, keratometric astigmatism, pupillary diameter, and age were also analyzed. MAIN OUTCOME MEASURES Apparent accommodation, corneal multifocality, refractive and keratometric astigmatism, pupillary diameter, and age. RESULTS Multiple regression analysis revealed that corneal multifocality and pupillary diameter had significant positive correlations with apparent accommodation, whereas other explanatory variables showed no relationship with apparent accommodation. CONCLUSION Multifocal corneal effects contribute to apparent accommodation in pseudophakic eyes.

Three year prospective, randomized evaluation of intraocular lens implantation through 3.2 and 5.5 mm incisions

Purpose: To compare the long‐term clinical results of two small incision cataract surgery procedures. Setting: Seven centers in Japan. Methods: Two hundred eyes were randomly assigned to receive a silicone intraocular lens (IOL) through a 3.2 mm incision or a poly(methyl methacrylate) (PMMA) IOL through a 5.5 mm incision. Except for incision size and implantation technique, the surgical methods were identical. Uncorrected and corrected visual acuity, keratometry, flare‐cell intensity, specular microscopy, and neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate were analyzed up to 3 years after surgery. Results: Eyes in the 3.2 mm incision group had significantly better uncorrected and corrected visual acuity in the early postoperative period and lower aqueous flare intensity immediately after surgery, but these differences disappeared after the first postoperative month. However, surgically induced astigmatism was significantly less in the 3.2 mm incision group than in the 5.5 incision group throughout the study. The Nd:YAG laser capsulotomy rate was higher in the silicone IOL group (23.5% at 3 years postoperatively) than in the PMMA IOL group (18.4%), but the difference was not statistically significant. Conclusion: Smaller incision cataract surgery led to earlier recovery of visual function in the short term and less induced astigmatism in the long term.

Immunocytochemistry of types I-IV collagen in human anterior subcapsular cataracts

Human anterior subcapsular cataracts were examined by immunocytochemistry to investigate which types of collagen constitutes the subcapsular fibrous matrix. Types I, III, and IV collagen were shown to be immunologically positive by both light and electron microscopy. In light microscopy, types I and III collagen were stained diffusely whereas type IV collagen was stained in a streaky pattern in the opacities. The lens capsules were stained with antibody to type IV collagen, although the staining patterns were not homogeneous; the inner layers of the capsules were labeled more strongly than the outer layers. Neither type I nor III collagen was detected in the capsules. In electron microscopy, collagen fibrils were labeled with the antibodies to both type I and type III collagen. The lens capsules and multilamellae of the basement membranes in the opacities were labeled with the antibody to type IV collagen.

Arcuate keratotomy to treat corneal astigmatism after cataract surgery: A prospective evaluation of predictability and effectiveness

OBJECTIVE Although several nomograms are available for the incisional keratotomy to correct naturally occurring astigmatism, astigmatic keratotomy in eyes after cataract surgery has not been well analyzed. The predictability and effectiveness of arcuate keratotomy in pseudophakic eyes were studied. DESIGN A prospective, multicenter study. PARTICIPANTS One hundred four eyes of 86 patients with residual corneal astigmatism of 1.5 diopters (D) or more after cataract surgery were examined. INTERVENTION Arcuate keratotomy was performed in nine centers by nine surgeons. MAIN OUTCOME MEASURES The amount of astigmatic correction was calculated using the vector analysis of preoperative and 6-month postoperative refractive cylinder results. RESULTS Multiple regression analysis showed that optical zone size, number of incisions, and incision length had significant correlations with the amount of astigmatic correction. The regression equation was expressed as effects = (-0.643 x optical zone size) + (0.998 x incision number) + (0.057 x incision length) + 2.356. The parameter of predictability (r2: 35%) was lower than that reported for congenital astigmatism (48 to approximately 56%). A new nomogram was derived based on the multiple regression equation. CONCLUSIONS Astigmatic keratotomy in pseudophakic eyes is less predictable than that in eyes with idiopathic astigmatism, but the procedure is sufficiently effective in reducing the residual astigmatism after cataract surgery. Individual nomograms are necessary for astigmatic keratotomy in eyes with naturally occurring and postsurgical astigmatism.

Fibrinogen degradation products influence PGI2 synthesis by cultured porcine aortic endothelial and smooth muscle cells

The synthesis of prostaglandin I2 (PGI2) was found to decrease with age in cultured, porcine aortic endothelial cells. Arachidonic acid (AA)-induced PGI2 synthesis per cell at low cell density was higher than that at high cell density. PGI2 synthesis by cultured porcine aortic smooth muscle cells, without exogenous AA, was higher than that by cultured porcine aortic endothelial cells, while AA-induced PGI2 synthesis by cultured porcine aortic medial smooth muscle cells was lower than that by cultured endothelial cells. PGI2 synthesis by cultured smooth muscle cells incubated with fibrinogen degradation products (FDPs) for 24 h decreased. After incubation with FDPs for 24 h, AA-induced PGI2 synthesis by endothelial cells also diminished. These data suggest that PGI2 synthesis in the vascular wall is affected by FDPs, and that FDPs probably play an important role in the initiation of atherosclerosis.

Cellular reaction on the surface of intraocular lenses removed from human eyes

ABSTRACT We studied four angle‐supported anterior chamber lenses whose optics and haptics were made of poly(methyl methacrylate). All four lenses had been removed from human eyes because of bullous keratopathy. Using light and electron microscopy, we compared the cellular reaction on the optics, which had been in the anterior chamber, with that on the haptics, which had been in touch with the iris stroma. A typical foreign body granuloma was seen around the haptics, while the optics were free of foreign body reaction.

Anesthetic dose and analgesic effects of sub-Tenon’s anesthesia in cataract surgery

PURPOSE To compare the analgesic effects of different doses of sub-Tenons anesthesia in cataract surgery by assessing patient response to visceral stimulus. SETTING Inouye Eye Hospital, Tokyo, Japan. METHODS A prospective study was done of 1019 eyes of 1019 patients having phacoemulsification and posterior chamber intraocular lens implantation. They received a 1.0 mL (391 eyes), 2.0 mL (366 eyes), or 3.0 mL (262 eyes) anesthetic infiltration into the sub-Tenons space. Pain scores were recorded when the anterior chamber was irrigated with an acetylcholine chloride solution to attain miosis after lens implantation. RESULTS The distribution of pain scores was significantly different among the 3 groups (P < .0001, Kruskal-Wallis test). Multiple comparison revealed that the 3.0 mL anesthetic infiltration offered significantly higher analgesic effects than the 2 lower doses. The 3.0 mL sub-Tenons anesthesia effectively blocked the visceral stimulus. CONCLUSION For cataract surgery, 3 mL is the optimal dose of anesthetic solution in sub-Tenons anesthesia.

Ataxia-telangiectasia with renal cell carcinoma and hepatoma

This paper reports the occurrence of renal cell carcinoma, hepatoma and malignant hepatic mixed tumor in a 22-year-old male with ataxiatelangiectasia (AT). Incidence of various malignant neoplasms is high in the patients with AT. The majority of these are lymphoreticular tumors and leukemia, and epithelial tumors are rare. This report is the first case with renal cell carcinoma and the second with hepatoma. The reason for a low incidence of epithelial tumors in AT is still obscure. It is possible that as the result of abnormal aging the tumors expected in the aged will occur in longer survivors with AT.

Mechanical detachment of the anterior hyaloid membrane from the posterior lens capsule

OBJECTIVE To investigate the incidence of spontaneous detachment of the anterior hyaloid membrane from the posterior lens capsule and to explore the possibility of surgical separation of the anterior hyaloid membrane. DESIGN Prospective nonrandomized interventional comparative trial and comparative human tissue study. PARTICIPANTS Thirty-eight eyes of 32 patients undergoing primary pars plana vitrectomy combined with cataract extraction and intraocular lens implantation and 3 eye bank eyes for histopathologic examination. METHODS The anterior hyaloid membrane and posterior lens capsule were observed with a fiberoptic endoscope. Surgical separation of the anterior hyaloid membrane was attempted by either the hydrodissection method before cataract extraction (18 eyes) or the direct suction method after cataract extraction (20 eyes). In eye bank eyes, histopathologic examination was performed with (one eye) and without (two eyes) surgical separation of the anterior hyaloid membrane. MAIN OUTCOME MEASURES Incidence of spontaneous detachment and success rate of surgical detachment of the anterior hyaloid membrane. RESULTS No eye displayed spontaneous detachment of the anterior hyaloid membrane. Using the hydrodissection method, complete detachment of the anterior hyaloid membrane was achieved in 10 eyes (55.6%), partial detachment was attained in 2 eyes (11.1%), and detachment was not induced at all in 6 eyes (33.3%). With the direct suction method, the anterior hyaloid membrane was completely separated from the posterior lens capsule in 10 eyes (50%), partially detached in 10 eyes (50%), and not detached at all in any eye. The direct suction method had a significantly higher success rate than the hydrodissection method (P < 0.001, chi-square test). In eye bank eyes, the surgical manipulation induced complete separation of the anterior hyaloid membrane from the lens capsule. CONCLUSIONS Spontaneous detachment of the anterior hyaloid membrane from the posterior lens capsule is very rare. Under endoscopic observation, surgical detachment of the anterior hyaloid membrane was possible in half of the patients.

Radial keratotomy to treat myopicrefractive error after cataract surgery

PURPOSE To assess the predictability and effectiveness of radial keratotomy in patients with myopic refractive error and unacceptable anisometropia after cataract surgery. SETTING A prospective multicenter study. METHODS This study comprised 40 eyes of 40 Japanese patients who had had cataract surgery. Radial keratotomy was performed, and the 6 month postoperative data were analyzed. RESULTS Mean patient age was 71.0 years +/- 7.4 (SD) (range 51 to 84 years) and mean preoperative anisometropia -3.41 +/- 1.69 D (range -1.25 to -7.75 D). The surgery decreased mean anisometropia to -1.01 +/- 0.94 D (P < .000001, Wilcoxon signed-rank test), a mean reduction of 2.22 +/- 1.23 D (range 0.75 to 5.88 D). Postoperative anisometropia ranged from 0.81 to -3.13 D. The surgical effects were overestimated by the nomograms developed for the correction of naturally occurring myopia in the eyes of white patients. Multiple regression analysis revealed that optical zone size and number of incisions were significantly correlated with the amount of myopic correction, and the regression equation (R2 = 0.77) was expressed as follows: Effects = (-1.45 x optical zone size) + (0.24 x incision number) + 7.60. A new nomogram was derived based on this equation. CONCLUSIONS Radial keratotomy was a safe and efficient procedure to treat myopic refractive error in pseudophakic eyes. Separate nomograms are necessary for white and Asian populations.