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Expression of Lipid Peroxidation Markers in the Tear Film and Ocular Surface of Patients with Non-Sjogren Syndrome: Potential Biomarkers for Dry Eye Disease

ABSTRACT Purpose: To investigate the expression of lipid peroxidation markers in the tear film and ocular surface and their correlation with disease severity in patients with dry eye disease. Methods: The concentrations of hexanoyl-lysine (HEL), 4-hydroxy-2-nonenal (HNE), and malondialdehyde (MDA) were measured with enzyme-linked immunosorbent assays in tears obtained from 44 patients with non-Sjogren syndrome dry eye and 33 control subjects. The correlations between the marker levels and the tear film and ocular surface parameters, including tear film break-up time (BUT), Schirmer tear value, tear clearance rate, keratoepitheliopathy scores, corneal sensitivity, conjunctival goblet cell density, and symptom score, were analyzed. The expression of the lipid peroxidation markers HEL, 4-HNE, and MDA in the conjunctiva was evaluated using immunohistochemistry. Results: The concentrations of HEL, 4-HNE, and MDA were 279.84 ± 69.98 nmol/L, 0.02 ± 0.01 μg/mL, and 3.80 ± 1.05 pmol/mg in control subjects and 283.21 ± 89.67 nmol/L (p = 0.97), 0.20 ± 0.03 μg/mL (p < 0.01), and 13.32 ± 4.03 pmol/mg (p < 0.01) in dry eye patients. 4-HNE and MDA levels significantly correlated with BUT, Schirmer tear value, tear clearance rate, keratoepitheliopathy scores, conjunctival goblet cell density, and symptom score (p < 0.05), whereas HEL levels did not correlate with these parameters. Staining intensities for 4-HNE and MDA increased in dry eye patients. Conclusions: The expression of late lipid peroxidation markers, 4-HNE and MDA, increases in the tear film and ocular surface of patients with dry eye. The levels correlate with various tear film and ocular surface parameters and may reflect the severity of dry eye disease.

Operating microscope light-induced phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens implantation.

Purpose: The purpose of this study is to report the features of operating microscope light–induced retinal phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens (TSS PC-IOL) implantation. Methods: The charts of 118 patients who underwent TSS PC-IOL implantation surgery at Chonbuk National University Hospital (Jeonju, Korea) between March 1999 and February 2008 were retrospectively reviewed. Fourteen patients underwent combined 3-port pars plana vitrectomy and TSS PC-IOL implantation (vitrectomy group), and 104 patients underwent TSS PC-IOL implantation only (nonvitrectomy group). All surgeries were performed under the same coaxial illuminated microscope. All diagnoses were confirmed through careful fundus examination and fluorescein angiography (FA). Results: Diagnoses of retinal phototoxic maculopathy were established in 10 (8.47%) of 118 TSS PC-IOL implantation cases. Phototoxic maculopathy occurred more frequently in the vitrectomy group than in the nonvitrectomy group (6/14 versus 4/104, respectively; P < 0.001, chi-square = 24.21). Affected patients reported decreased vision and were found to have coarse alterations of the retinal pigment epithelium (RPE). In 5 of the phototoxic maculopathy cases (50%), the visual acuity was 20/200 or worse. Conclusion: Operating microscope light–induced retinal phototoxic maculopathy can occur more frequently after TSS PC-IOL implantation than after casual cataract surgery, especially when TSS PC-IOL is combined with vitrectomy surgery. Surgeons should take precautions to prevent retinal phototoxicity after TSS PC-IOL implantation and vitrectomy.

Factors Affecting Treatment Outcome of Graft Infection Following Penetrating Keratoplasty.

Purpose To evaluate the factors affecting treatment outcome of graft infection following penetrating keratoplasty (PKP). Methods In this retrospective study, 28 patients who underwent PKP between January 2005 and January 2013 and who were diagnosed with graft infection were classified into a treatment success group or a treatment failure group. Demographic and clinical characteristics, as well as the results of the microbiologic investigation, were analyzed and compared. A subsequent binary logistic regression analysis was performed to identify the prognostic factors affecting treatment outcome. Results Graft infection occurred at a mean of 38.29 ± 36.16 months (range, 1 to 96 months) after PKP. Seventeen patients developed bacterial keratitis, and 11 patients developed fungal keratitis. Overall, of the 28 patients, nine (32.1%) were classified in the treatment failure group. Multivariate analysis identified pre-existing graft failure (p = 0.019), interval longer than 72 hours between donor death and PKP (p = 0.010), and fungal infection (p = 0.026) as significant risk factors for treatment failure. Conclusions Pre-existing graft failure, extended interval between donor death and PKP, and fungal infection were important risk factors for treatment failure of graft infection following PKP.

Nontuberculous Mycobacterial Infection after Removal of the Exposed Hydroxyapatite

Dear Editor, Numerous complications are associated with hydroxyapatite orbital implants. Implant exposure, the most important complication, differs by study but occurs in approximately 2% to 10% of patients [1]. Nontuberculous mycobacteria (NTM) are generally free-living organisms that can also inhabit body surfaces or cause secretions without causing disease [2]. It is also known that these organisms can cause infection through wound entry. Reported herein is a case of abrupt NTM orbital cellulitis after removal of the exposed hydroxyapatite. A 43-year-old male presented with orbital implant exposure occurring about 1 year earlier. A culture was performed of a sample from the exposure site, but no growth was observed. The patient had undergone evisceration surgery with hydroxyapatite implantation 23 years earlier, due to trauma. Orbital implant removal surgery was initially recommended, but the patient refused. He changed his mind 1 year later and was admitted to the hospital with no sign of infection at the exposure site (Fig. 1A). Prophylactic antibiotic treatment was started, then removal of hydroxyapatite, enucleation with hydroxyapatite reimplantation, and a dermis-fat graft were performed. There were no sign of infection on the removed hydroxyapatite or the surrounding sclera. The removed material was sent to the Laboratory Department for Culture. The operation site was initially stable, although swelling and erythema were noted on postoperative day (POD) #2. Based on these findings, intravenous antibiotic treatment was changed, and 5% ceftazidime and 2.5% vancomycin eyedrops were added. Despite this treatment, the lesion continued to worsen with increased discharge and development into an erythematous lesion (Fig. 1B and 1C). NTM was observed in the culture on POD #7, for which intravenous antibiotics were changed to fourth-generation cephalosporin and vancomycin and polymerase chain reaction (PCR) examination was conducted to identify the subtype of NTM. The lesion continued to worsen, however, and reoperation, graft and hydroxyapatite removal, debridement, and wound irrigation with antibiotics were performed on POD #8. The removed Korean J Ophthalmol 2017;31(4):366-367 ht tps: / /doi.org /10.3341/k jo.2017.0022 Correspondence

Recurrent Paecilomyces Keratitis in a Patient with Jones Tube after Conjunctivodacryocystorhinostomy.

Dear Editor, Paecilomyces, which is found in soil and decaying vegetables, is a rare pathogen causing local and systemic infections [1]. We report a rare case of recurrent Paecilomyces keratitis 5 years after Jones tube placement in conjunctivodacryocystorhinostomy (CDCR). A 69-year-old woman was referred by a local ophthalmologist for the management of presumed fungal keratitis in the left eye. One month before presentation, she noted ocular discomfort with decreased vision. She had undergone left eye ocular surgery of CDCR 6 years previous and cataract surgery 2 months previous. After CDCR, she had used daily topical tobramycin and 0.02% fluorometholone eye drops. No known history of ocular trauma, contact lens use, or herpes simplex keratitis was evident. At initial examination, her best corrected visual acuity was finger counting at 30 cm. Slit-lamp examination demonstrated a 2.0 × 2.0-mm-sized epithelial defect with corneal stromal infiltration. There was moderate anterior chamber reaction and linear hypopyon. Corneal scrapings were cultured and confirmed the diagnosis of Paecilomyces infection. Topical amphotericin B 0.125% and voriconazole 1% were started. After 4 weeks of topical antifungal therapy, the epithelial defect and hypopyon were resolved. Her vision was improved to 20 / 50, but corneal opacity and thinning remained. There was no evidence of recurrence during the follow-up. Five years later, the patient presented with reduced vision in the left eye; her visual acuity in the left eye was 20 / 1,000 with spectacle correction. Slit-lamp examination showed geographic ulceration and radial Descemet’s membrane folding at the central cornea including the site of previous corneal opacity and thinning (Fig. 1A and 1B). The additional presence of mild anterior chamber reaction and no hypopyon led to a diagnosis of herpes simplex keratitis, for which acyclovir ointment and topical moxifloxacin were started. Cultures showed no growth of any organism. Geographic ulceration and chamber reaction were improved, but the corneal thinning resulted in a perforation despite treatment. The patient emergently underwent amniotic membrane transplantation and corneal button graft. Two weeks later, she developed a recurrence of keratitis in the graft and 2.0-mm hypopyon. A therapeutic keratoplasty was performed. The previous corneal graft was Korean J Ophthalmol 2016;30(6):479-480 http://dx.doi.org/10.3341/kjo.2016.30.6.479 Correspondence