Hisayo Higashihara

Argon laser iridotomy‐induced bullous keratopathy—a growing problem in Japan

Aims: To describe the long-term risk of bullous keratopathy following argon laser iridotomy (ALI) in Japan and to compare it with other centres in the world. Methods: We retrospectively reviewed the case records of all patients with ALI-induced bullous keratopathy that underwent penetrating keratoplasty at Kyoto Prefectural University of Medicine (KPUM) from January 2001 to December 2004. The results were compared with the other representative centres in Singapore and the UK. Results: Thirty-nine eyes of 33 patients were included in the study. The mean age of patients was 73.3±6.9 years (range, 58 to 87 years). Patients developed bullous keratopathy at a mean duration of 6.9±4.9 years (range, 0.2 to 16 years) after the laser iridotomy procedure. The majority of eyes that developed bullous keratopathy (59.0%) occurred following prophylactic ALI. KPUM had the highest percentage of ALI-induced bullous keratopathy cases that underwent penetrating keratoplasties, as compared with other centres in Singapore and the UK (20.0%, 1.8% and 0%, respectively). Conclusion: Bullous keratopathy may arise many years following ALI, and is a growing problem in Asian countries. This condition is a major cause of ocular morbidity in Japan, which has seen a worrying increase in the number of cases in recent years.

The blood-aqueous barrier breakdown in eyes with endothelial decompensation after argon laser iridotomy

Argon laser iridotomy-induced bullous keratopathy (ALI-BK) is a growing medical problem in Asian countries.1 This disease is a common reason for either Descemets stripping automated endothelial keratoplasty or penetrating keratoplasty surgery in Japan.2 3 Our experience with penetrating keratoplasty, combined with cataract extraction and intraocular lens implantation in eyes with ALI-BK, is typically characterised by an aggressive anterior-chamber inflammatory response, both intraoperatively and postoperatively, as compared with pseudophakic and aphakic BK, corneal opacity, and corneal scarring. Therefore, we speculate that in eyes with ALI-BK, the disease tends to weaken the blood-aqueous barrier. We quantitatively evaluated the blood-aqueous barrier in eyes with early endothelial decompensation following ALI using iris fluorescein angiography (IFA) and fluorophotometry. This study involved nine eyes of seven patients with early endothelial decompensation following ALI, as well as eight eyes of four normal volunteers as a control. Relevant ethical committees approved the study protocol. A slit-lamp anterior fluorophotometer (FL-500; Kowa Company, Nagoya, Japan) was used to measure the blood-aqueous barrier function.4 After the autofluorescence values in the anterior chamber were measured, an intravenous injection of 10 ml of 10% sodium fluorescein solution was administered. At 10 and 30 min after the injection, the fluorescence intensity value in the anterior chamber was …

Using synthesized onion lachrymatory factor to measure age-related decreases in reflex-tear secretion and ocular-surface sensation

PurposeTo use synthesized onion lachrymatory factor (SOLF) to investigate age-related changes in reflex-tear secretion and ocular-surface sensation.MethodsWe separated 91 healthy volunteers into four groups: groups A, age 20–29 years; B, 30–39; C, 40–49; and D, older than 50 years. We exposed one eye of each subject to SOLF and measured the elapsed time until the subject’s limit of irritation tolerance (TLI) was reached and an increase in the tear meniscus radius (ΔR). After the SOLF stimulus, corneal sensitivity was examined by Cochet-Bonnet esthesiometry (CB), and reflex-tear secretion was examined by the Schirmer I-test (ST).ResultsTLI was significantly shorter in group A than in the other groups (P < 0.0001), and the groups B and D also differed significantly from each other (P = 0.0013). The increase in ΔR was significantly greater in group A than in group C (P = 0.0306) or D (P < 0.0001), and groups B (P = 0.0002) and C (P = 0.0308) also differed significantly from group D. There were no significant intergroup differences in the CB and ST results.ConclusionsAn age-related decrease in reflex-tear secretion and ocular-surface sensation was revealed by the SOLF test but could not be detected by either CB or the ST.