Hiroshi Toshida

An international analysis of contact lens compliance.

PURPOSE To evaluate compliance to contact lens use in 14 countries, and to identify wearer attributes which indicate lower compliance levels. METHODS A web-based survey was undertaken by 4021 contact lens wearers, revealing information about demographics, and lens and solution information including daily handling details, case care and aftercare frequency. Particular attention was paid to eight modifiable compliance-related behaviours which are associated with an increased risk of microbial keratitis. RESULTS Full compliance was very rare for most lens users, although better (15% of wearers) for daily disposable lenses. Reduced compliance was demonstrated in South Korea, and for young male full-time contact lens users, especially those who have not consulted their eyecare practitioner for some time. The behaviours associated with the lowest levels of compliance were rubbing and rinsing, handwashing, correct lens replacement and case cleaning. CONCLUSIONS Given other recent literature, which suggests improved contact lens compliance with regular self-review exercises, we encourage clinical colleagues to particularly examine case cleaning, handwashing and rubbing and rinsing at aftercare examinations, especially in young male wearers.

Trends in microbial keratitis in Japan.

Purpose. To identify microbiologic characteristics of infectious keratitis and predisposing factors. Methods. The microorganisms isolated from patients with infectious corneal ulcers during the 5 years between January 1999 and December 2003 were retrospectively examined. Herpetic and other viral infections were excluded from this study. Patient age, sex, risk factors, and isolated organisms were collected. Results. In 123 eyes of 122 patients, organisms were isolated from 72 (58.5%) eyes. In total, 99 different organisms were isolated. Among these, 77 (77.8%) were gram-positive bacteria; 18 (18.2%) were gram-negative bacteria; six (6.1%) were fungi; and one (1.0%) was acanthamoeba. Contact lens wear was the main risk factor (54.5%), and ocular surface disease and previous ocular surgery were present in 20.5% and 13.1% of cases, respectively. Posttreatment visual acuity was significantly improved by pretreatment in culture-positive groups treated according to the antibiotic susceptibilities (Wilcoxon t test, P<0.01). Conclusions. The results are changing to those reported by other countries and generations. Contact lens wear is the most important risk factor in Japan. The results of isolation and culture are essential for improving the cure rate.

Simplified and safe method of sutureless intrascleral posterior chamber intraocular lens fixation: Y-fixation technique

&NA; We report a new surgical technique that allows intrascleral fixation of a posterior chamber intraocular lens (IOL) without sutures. The Y‐fixation technique does not involve complicated intraocular manipulation and achieves safe sutureless fixation. A Y‐shaped incision is made in the sclera and a 24‐gauge microvitreoretinal (MVR) knife is used to create the sclerotomy instead of a needle. The Y‐shaped incision eliminates the need to raise a large lamellar scleral flap and to use fibrin glue because the haptic can be fixed both inside the tunnel and in the groove, and performing the sclerotomy with the 24‐gauge MVR knife simplifies extraction of the haptic and improves wound closure. There is no risk of infection from exposure of the haptic on the sclera and no use of fibrin glue. There was significantly less IOL decentration and tilt than with suture fixation. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Gefarnate Stimulates Goblet Cell Repopulation Following an Experimental Wound to the Tarsal Conjunctiva in the Dry Eye Rabbit

Geranyl farnesylacetate (gefarnate) has been used to stimulate mucin production from goblet cells of patients who have gastritis and/or gastric ulcer.1,2 In previous studies, Nakamura et al.3 reported that gefarnate increased the mucin-like glycoprotein secretion from cultured rat corneas in vitro in a dose-dependent manner. The ability of topically applied gefarnate to increase goblet cell density in vivo was reported in normal4,5 and dry eye rabbit.5,6 In the present study, we investigated the effect of topical gefarnate treatment in a rabbit model of dry eye on goblet cell repopulation of the tarsal conjunctiva after a mild alkali injury.

Effects of topical unoprostone and latanoprost on acute and recurrent herpetic keratitis in the rabbit.

PURPOSE To determine the effect of the topical ocular hypotensive drug, isopropyl unoprostone, a docosanoid molecule with very weak prostaglandin activity, on herpes keratitis in the rabbit eye. METHODS For acute disease, rabbit corneas inoculated with the corticosteroid-sensitive F(MP)E strain of herpes simplex virus type 1 were treated with various combinations of 0.12% isopropyl unoprostone, latanoprost, trifluridine, benzalkonium chloride 0.02%, dexamethasone sodium phosphate, ketorolac tromethamine, or saline solution beginning 1 day after infection. Severity of keratitis was evaluated in a masked manner. For recurrent disease, rabbit corneas infected with McKrae strain herpes simplex virus type 1 were treated with unoprostone or saline solution on postinfection days 25 to 42, and the presence or absence of lesions was recorded. RESULTS Eyes treated with unoprostone showed significantly less severe disease than saline-treated or latanoprost-treated eyes during acute infection. Unoprostone-treated and saline-treated eyes showed no significant difference in the frequency of recurrent lesions. Eyes treated with latanoprost and/or dexamethasone, separately or in combination, showed increased severity of acute herpes simplex virus keratitis, whereas benzalkonium chloride 0.02%--treated eyes showed no significant difference, compared with saline treatment. Trifluridine resulted in rapid healing. CONCLUSIONS Unoprostone did not increase the severity or recurrence rate of herpes simplex virus keratitis. Unoprostone requires twice-a-day administration, compared with once-a-day for latanoprost, and unoprostone lowers intraocular pressure less than latanoprost. Nevertheless, unoprostones superior safety profile may make its use advantageous. Benzalkonium chloride alone did not make the keratitis worse.

Conjunctival sac bacterial flora isolated prior to cataract surgery

Objective To determine the trends of conjunctival sac bacterial flora isolated from patients prior to cataract surgery. Subjects and methods The study comprised 579 patients (579 eyes) who underwent cataract surgery. Specimens were collected by lightly rubbing the inferior palpebral conjunctival sac with a sterile cotton swab 2 weeks before surgery, and then cultured for isolation of bacteria and antimicrobial sensitivity testing. The bacterial isolates and percentage of drug-resistant isolates were compared among age groups and according to whether or not patients had diabetes mellitus, hyperlipidemia, dialysis therapy, oral steroid use, dry eye syndrome, or allergic conjunctivitis. Results The bacterial isolation rate was 39.2%. There were 191 strains of Gram-positive cocci, accounting for the majority of all isolates (67.0%), among which methicillin-sensitive coagulase-negative staphylococci was the most frequent (127 strains, 44.5%), followed by methicillin-resistant coagulase-negative staphylococci (37 strains, 12.7%). All 76 Gram-positive bacillary isolates (26.7%) were from the genus Corynebacterium. Among the 16 Gram-negative bacillary isolates (5.9%), the most frequent was Escherichia coli (1.0%). The bacterial isolation rate was higher in patients >60 years old, and was lower in patients with dry eye syndrome, patients under topical treatment for other ocular disorders, and patients with hyperlipidemia. There was no significant difference in bacterial isolation rate with respect to the presence/absence of diabetes mellitus, steroid therapy, dialysis, or a history of allergic conjunctivitis. Methicillin-resistant coagulase-negative staphylococci showed a significantly higher detection rate in diabetic patients than nondiabetic patients (20.3% versus 7.0%, P < 0.05). The percentage of all isolates resistant to levofloxacin, cefmenoxime, and tobramycin was 14.0%, 15.2%, and 17.9%, respectively, with no significant differences among these drugs. Conclusion The high bacterial isolation rate in patients >60 years old and the high methicillin-resistant coagulase-negative staphylococci isolation rate in patients with diabetes are important to consider for prevention of perioperative infections.

Contact lens-induced infectious keratitis in Japan.

Purpose. To identify microbiologic characteristics of infectious keratitis associated with contact lenses. Methods. The authors retrospectively examined the microorganism isolated from patients with microbial corneal ulcer associated with contact lenses during a 5-year period. Herpetic and other viral infections were excluded from this study. Patient age, sex, type of contact lens, and isolated organisms were collected from medical records. Results. Sixty-seven eyes of 66 patients (54.5%) who possibly had contact lens–induced infectious keratitis were reviewed. Cultures of corneal scrapings or eye discharge were positive in 30 (44.8%) of 67 eyes. A total of 35 strains of bacteria were detected, among which there were 29 (82.9%) gram-positive bacteria, two (5.7%) gram-negative bacteria, three (8.6%) fungi, and one (2.9%) species of Acanthamoeba. The most common type of contact lens was a conventional soft contact lens (25 eyes, including extended wear in seven eyes), whereas hard contact lenses, including rigid gas-permeable contact lenses, were worn in 19 eyes. In addition, frequent-replacement lenses were used in 17 eyes, whereas weekly lenses and daily lenses were used for three eyes each. The largest age group was the 20s for all types of lenses. Conclusions. The results of isolation and culture are essential for improving the cure rate, especially for patients who have severe corneal ulcers.

Neurologic Evaluation of Acute Lacrimomimetic Effect of Cyclosporine in an Experimental Rabbit Dry Eye Model

PURPOSE To evaluate neurologically acute lacrimation caused by cyclosporine (CsA) eyedrops in rabbit. METHODS Normal adult male New Zealand White rabbits and those that underwent parasympathectomy each received a single instillation of 0.1% CsA or vehicle eyedrops. Schirmer tear test (STT) results, flow rate of lacrimal gland (LG) fluid from the excretory lacrimal duct of the main LG, and blink rate (over a 3-minute period) were measured before and after instillation of CsA or vehicle. Light microscopy was performed to examine the main LG in vitro. Protein release from LG fragments was assessed after incubation with CsA for 30 minutes. RESULTS In normal rabbits, the STT value and the flow rate of LG fluid were significantly increased after treatment with CsA compared with vehicle (P < 0.05). In contrast, no changes were found in denervated eyes. The blink rate of CsA-treated eyes was significantly higher than that of vehicle-treated eyes in normal rabbits (P < 0.005), whereas that of denervated eyes decreased significantly after CsA instillation compared with before administration (P < 0.005). Light microscopy showed that the cytoplasm of acinar cells was packed with secretory granules in denervated LG tissue 7 days after parasympathectomy. The same finding was observed 3 hours after CsA instillation. CsA had no stimulatory effect on protein release by acinar cells in LG fragments at all concentrations tested. CONCLUSIONS These results suggest that CsA has no direct effect on tear fluid secretion from the LG in an acute model. Instead, CsA increases reflex tear flow.

Effect of gefarnate on the ocular surface in squirrel monkeys.

Purpose. To investigate the ability of gefarnate (geranyl farnesylacetate) to stimulate goblet cell function in the primate eye after a mild alkali injury of the tarsal conjunctiva. Methods. A bilateral injury was created on the conjunctival surface of the lower eye lid of squirrel monkeys by means of a 30-second application of a 4-mm diameter piece of filter paper wetted with 0.5% NaOH. Gefarnate drops (1%) were administered to one eye of each monkey and vehicle alone in the contralateral eye six times a day, 5 days a week for 4 weeks. Slit-lamp biomicroscopy, impression cytology staining of the ocular surface, fluorescein and rose bengal staining, and Western blot for mucin were performed before injury and weekly thereafter. Light microscopy was used to evaluate the lower conjunctiva. Results. Topical application of gefarnate was not associated with any adverse ocular surface effects. Goblet cell repopulation after injury was significantly greater in the gefarnate-treated eyes compared with the vehicle-treated eyes. In the gefarnate-treated eyes, tear mucin content was significantly greater at 1 week after injury. Fluorescein staining was significantly reduced at 3 weeks after injury, and rose bengal staining was significantly reduced in the area of the wound at 2 weeks in the gefarnate-treated eyes compared with the vehicle-treated eyes; at other times, conjunctival staining in the two groups of eyes was not significantly different. Conclusions. Gefarnate promotes goblet cell repopulation and increases mucin production after a conjunctival injury. No adverse affects of the treatment were found. Thus, this agent may be useful in conditions that diminish goblet cell function.

Influence of the signal-to-noise ratio on the accuracy of IOLMaster measurements

PURPOSE: To evaluate the relationship between the sound‐to‐noise ratio (SNR) and the reliability of axial length (AL) measurements obtained with the IOLMaster (Carl Zeiss Meditec AG). SETTING: Department of Ophthalmology, Saiseikai Kurihashi Hospital, Saitama, Japan. METHODS: In a clinical prospective study, 216 consecutive eyes of 144 patients scheduled for cataract surgery were evaluated for the type and severity of cataract using the Lens Opacities Classification System III. Preoperative and postoperative AL measurements were performed with the IOLMaster. The preoperative SNR values were used to divide the eyes into 5 groups. The following were compared between the groups: preoperative logMAR best spectacle‐corrected visual acuity (BSCVA), difference in AL between preoperatively and postoperatively, error in the postoperative predicted refraction, and type and severity of cataract. RESULTS: The preoperative logMAR BSCVA was significantly worse in eyes with an SNR <2 (P<.05). The AL was longer preoperatively than postoperatively in all groups, and there was a significant difference in the <2 SNR group and the 2 to <5 group (P<.05). There were no significant differences in the error in postoperative predicted refraction. The percentage of patients with P4 or worse posterior subcapsular cataract (PSC) increased significantly with a decrease in the SNR (P<.01). However, there was no correlation between nuclear color grade and the SNR. CONCLUSION: The SNR value was useful in confirming the good quality of AL readings taken with the IOLMaster, even though the SNR value correlated significantly with the preoperative logMAR BSCVA and PSC severity.