Jin A Choi

Combined application of autologous serum eye drops and silicone hydrogel lenses for the treatment of persistent epithelial defects.

Purpose: We investigated the utility of a combination of autologous serum eye drops and a silicone–hydrogel (SH) lens in the treatment of persistent epithelial defects (PEDs). Methods: Eight patients who had distinct PED conditions were treated with 50% (v/v) autologous serum eye drops in combination with silicone hydrogel contact lenses and prospectively observed. Results: The pathogenesis of PEDs included Sjo″gren-type dry eye syndrome, graft-versus-host disease, toxic keratitis, limbal cell deficiency, superior limbic keratoconjunctivitis, and neurotrophic keratitis. The patients had PEDs for 90±81.76 days (range: 30–240 days). Before the initiation of the combined treatment, three patients had already been unsuccessfully treated with SH lenses, and five patients had received serum eye drops alone. The PEDs of the eight eyes healed after a treatment period of 11.8±4.9 days. No visible deposits were noted on the surface of any contact lens. Conclusions: These findings demonstrate that the combination of an SH lens and serum eye drops may be effective in the treatment of intractable PEDs.

Changes in ocular wavefront aberrations and retinal image quality with objective accommodation.

PURPOSE: To evaluate changes in ocular wavefront aberrations and retinal image quality with objective accommodation in normal human eyes. SETTING: Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. DESIGN: Cohort study. METHODS: Healthy emmetropic eyes were measured with an iTrace wavefront aberrometer while the subjects fixated at far (6.0 m) and near (40 cm). Wavefront data were analyzed with 3.0 mm and 5.0 mm pupil diameters. The influence of higher‐order aberrations (HOAs) on retinal image quality was simulated by computing the modulation transfer function (MTF) from the wavefront aberrations. RESULTS: Eighty‐two eyes of 42 subjects were evaluated. The root mean square values of total HOAs before and after accommodation with 5.0 mm pupils were statistically significantly different (P=.021). In particular, total spherical aberrations became more negative with accommodation, and the difference was statistically significant with 3.0 mm and 5.0 mm pupils (both P<.001). The MTF curves were significantly different before and after accommodation at 5 cycles per degree (cpd) and 10 cpd with 5.0 mm pupils (P=.031 and P=.045, respectively). CONCLUSIONS: Ocular wavefront aberrations and retinal image quality changed with accommodation in normal human eyes. Total spherical aberration changed more than other HOAs with accommodation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Anterior Segment Parameters Using Pentacam and Prediction of Corneal Endothelial Cell Loss after Cataract Surgery

Purpose We evaluated various preoperative anterior segment parameters measured with a Pentacam rotating Scheimpflug camera and compared them with those of conventional methods. We also evaluated the effect of different parameters on corneal endothelial cells after cataract surgery. Methods Pentacam examination was performed in 88 eyes from 88 patients to evaluate central anterior chamber depth (ACDpentacam), nuclear density (Densitometrypentacam), anterior chamber volume (ACV), and lens thickness (LTpentacam). We compared values of ACDpentacam with those of ultrasound (ACDsono) and also compared Densitometrypentacam values with those of Lens Opacities Classification System (LOCS III) classification. We evaluated the effect of the following preoperative values measured with Pentacam on postoperative endothelial cell loss: pupil size measured both preoperatively and before capsulorrhexsis (PupilCCC), amount of viscoelastics, and LT measured by ultrasound (LTsono). Results A significant concordance was found between the two grading methods of nuclear opacity: Densitometrypentacam and LOCS III classification (τb = 0.414, p = 0.000). We also found a positive correlation between ACDpentacam and ACDsono (r = 0.823, p = 0.000) and between ACDpentacam and ACV (r = 0.650, p = 0.000). There were significant differences between the results of LTpentacam and LTsono. The final regression model identified Densitometrypentacam, viscoelastics and PupilCCC as independent predictors of decreased postoperative corneal endothelial cell density (CD) at postoperative day 3, and Densitometrypentacam, viscoelastics, and ACV as independent predictors of decreased CD two months postoperatively (p<0.05). Conclusions Good agreement was found between all results obtained with the Pentacam and conventional methods except LT. Analyzing anterior chamber parameters preoperatively using Pentacam could be helpful to predict postoperative endothelial cell loss.

Long-term outcomes of penetrating keratoplasty in keratoconus: analysis of the factors associated with final visual acuities.

AIM To investigate the long-term results of penetrating keratoplasty (PK) in patients with keratoconus (KC) and to evaluate factors that might influence the final visual outcome. METHODS We retrospectively reviewed the data of all patients with clinical KC who had undergone PK by a single corneal surgeon in a single center from May 1980 to December 2005. The age of the patients, preoperative best-corrected visual acuity (BCVA), corneal thickness, death to preservation time, and preservation to transplantation time were recorded. Additionally, postoperative complications such as graft rejection, development of glaucoma and specular microscopy were checked during the follow-up. RESULTS Sixty-nine eyes from 69 patients were finally included. The follow-up period was 8.64±6.13y. Graft rejection occurred in 4 eyes of 69 cases (5.8%), and the time to graft rejection was 2.1±1.3y. A Kaplan-Meier survival analysis showed that the estimated cumulative probability of graft rejection at 6, 13, and 17y after PK were 95.6%, 90.0%, and 78.8%, respectively. When we evaluated factors that might influence final BCVA in eyes, no disparity donor-host trephine size (same graft size) as well as higher spherical equivalent, and average K-value were associated with higher final BCVA. (P=0.006, 0.051, 0.092, and 0.021 in eyes with follow-up <8y; P=0.068, 0.065, and 0.030 in eyes with follow-up ≥8y, respectively). CONCLUSION The long-term results of PK in patients with KC were favorable with a high percentage of good BCVA. Less myopic change and low average K-reading, as well as a surgical technique using the same size donor-recipient button may provide better visual outcomes particularly in patients with KC.

Impact of β-1,3-glucan Isolated from Euglena gracilis on Corneal Epithelial Cell Migration and on Wound Healing in a Rat Alkali Burn Model

Abstract Purpose: To determine the impact of β-1,3-glucan isolated from Euglena gracilis on corneal epithelial cell migration and on wound healing in a rat alkali burn model. Methods: Immortalized human corneal epithelial cells (HCECs) were cultured in media with 50, 100 and 200 μg/mL laminarin (β-1,3- and β-1,6-glucans), β-1,3-glucan and hyaluronic acid (HA)-conjugated β-1,3-glucan; Dulbecco’s modified Eagle’s medium (DMEM)/nutrient mixture F-12 (negative control) and serum containing DMEM/nutrient mixture F-12 (positive control). Migration assays were conducted via the manual scraping of HCECs. Next, alkali injuries were induced using 1 N NaOH in 40 eyes of 40 Sprague-Dawley male rats. The injury-only group (n = 10) received topical phosphate-buffered saline four times a day for 2 d. The study groups received 200 μg/mL topical laminarin (n = 10), β-1,3-glucan (n = 10) and β-1,3-glucan HA (n = 10). Using slit-lamp biomicroscopy, injured corneas were evaluated in terms of re-epithelialization and opacity, and tissue sections were histologically analyzed. Results: Migration assay rates were enhanced as laminarin and β-1,3-glucan increased, compared to negative control cells (all p < 0.05). In the comparison between β-1,3-glucan and its HA conjugate form, β-1,3-glucan–HA showed more enhanced migration rate than β-1,3-glucan (p < 0.05). In rat alkali burn model, wound-healing ratio was greatest in β-1,3-glucan–HA groups (96.0 ± 4.1%), followed by β-1,3-glucan (86.0 ± 6.5%), laminarin (67.0 ± 7.5%) and injury-only group (54.0 ± 6.5%) (p < 0.0001; ANOVA). The opacity score was also lowest in β-1,3-glucan–HA groups (3.0 ± 0.75), followed by β-1,3-glucan (3.4 ± 0.5), laminarin (3.7 ± 0.8) and injury-only group (4.7 ± 0.46) (p < 0.0001; ANOVA) Histologically, relatively fewer polymorphonuclear leukocytes infiltrated the corneal stroma in the β-1,3-glucan and β-1,3-glucan–HA groups, compared to the injury-only group. Conclusions: β-1,3-Glucan, particularly when conjugated with HA, promoted epithelial wound healing in vitro and suppressed the acute inflammatory reaction in corneal alkali burns.

Presurgical Corticosteroid Treatment Improves Corneal Transplant Survival in Mice

Purpose: To examine the effects of presurgical corticosteroid treatment for normal-risk penetrating keratoplasty (NRPK), high-risk penetrating keratoplasty (HRPK), and high-risk penetrating keratoplasty plus lensectomy. Methods: We used 3 corneal transplantation models (NRPK, HRPK, and high-risk penetrating keratoplasty plus lensectomy). For each model, we tried to compare the effect of corticosteroid treatment according to different timetables as follows: The first trial began with a corticosteroid injection given 2 weeks before the PK and continued until 4 weeks after the PK (group 1). The second trial started with a corticosteroid injection given on the day of the PK and continued for 4 weeks after the PK (group 2). The third trial started with a corticosteroid injection administered on the day of the PK and continued for 8 weeks after the PK (group 3). After harvesting and immunostaining of corneas, graft survival, neovascularization (NV), and lymphangiogenesis (LY) were compared among the groups. A P value <0.05 was considered as being statistically significant. Results: With respect to graft survival, group 1 had improved graft survival compared with that of group 3 in the HRPK model (P = 0.025). In all the 3 PK models, groups 2 and 3 demonstrated a similar graft survival (P > 0.05). With respect to NV and LY, in NRPK, group 1 showed less NV than did group 2 (P < 0.001) and group 3 (P = 0.016). In HRPK, group 1 also demonstrated less NV and LY than did group 3 (P = 0.045 and 0.044, respectively). Conclusions: The initiation time point of the corticosteroid treatment is important for graft survival. Corticosteroid pretreatment is an effective means to increase graft survival for HRPK and to decrease NV and LY for both NRPK and HRPK.

Matrix Metalloproteinase-1 and Matrix Metalloproteinase-9 in the Aqueous Humor of Diabetic Macular Edema Patients.

Purpose To assess the concentrations of matrix metalloproteinase (MMP)-1 and MMP-9 in the aqueous humor of diabetic macular edema (DME) patients. Method The concentrations of MMP-1 and MMP-9 in the aqueous humors of 15 cataract patients and 25 DME patients were compared. DME patients were analyzed according to the diabetic retinopathy (DR) stage, diabetes mellitus (DM) duration, pan-retinal photocoagulation (PRP) treatment, recurrence within 3 months, HbA1C (glycated hemoglobin) level, and axial length. Results The concentrations of MMP-1 and MMP-9 of the DME groups were higher than those of the control group (p = 0.005 and p = 0.002, respectively). There was a significant difference in MMP-1 concentration between the mild non-proliferative diabetic retinopathy (NPDR) group and the proliferative diabetic retinopathy (PDR) group (p = 0.012). MMP-1 concentrations were elevated in PRP-treated patients (p = 0.005). There was a significant difference in MMP-9 concentrations between the mild NPDR group and the PDR group (p < 0.001), and between the moderate and severe NPDR group and the PDR group (p < 0.001). The MMP-9 concentrations in PRP treated patients, DM patients with diabetes ≥ 10 years and recurrent DME within 3months were elevated (p = 0.023, p = 0.011, and p = 0.027, respectively). In correlation analyses, the MMP-1 level showed a significant correlation with age (r = -0.48, p = 0.01,), and the MMP-9 level showed significant correlations with axial length (r = -0.59, p < 0.01) and DM duration (r = 049, p = 0.01). Conclusions Concentrations of MMP-1 and MMP-9 were higher in the DME groups than in the control group. MMP-9 concentrations also differed depending on DR staging, DM duration, PRP treatment, and degree of axial myopia. MMP-9 may be more important than MMP-1 in the induction of DM complications in eyes.

LASIK Interface-Captured Foreign Bodies after Mild Traumatic Corneal Scratch without Flap Displacement

A 38-year-old woman developed diffusely distributed opacities with crystalline materials in the laser in situ keratomileusis (LASIK) interface of her eye after she was scratched by a sprig during mountain climbing. No sign of flap displacement was noted. Despite two days of topical and systemic antibiotics therapy, the corneal infiltration with interface opacities persisted. The following day, the distribution of the crystalline materials had rotated in a counterclockwise direction. Flap lifting and foreign body removal using sufficient irrigation were performed. One month after surgery, the patients postoperative uncorrected visual acuity was 0.8 with cleared interface. No signs of epithelial ingrowth or flap striae were noted. Mild traumatic corneal scratching without flap displacement may threaten the integrity of the LASIK interface. If foreign bodies are suspected to be the cause of inflammation, early flap lifting with irrigation is imperative for successful treatment.

Ganglion Cell-Inner Plexiform Layer, Peripapillary Retinal Nerve Fiber Layer, and Macular Thickness in Eyes with Myopic β-Zone Parapapillary Atrophy

Purpose. To assess the correlations of myopic β-zone parapapillary atrophy (β-PPA) with the optic nerve head (ONH) and retina. Methods. We selected 27 myopic patients who showed prominent β-PPA in one eye and no β-PPA in the other eye. We studied their macula, macular ganglion cell-inner plexiform layer (mGCIPL), peripapillary retinal nerve fiber layer (pRNFL) thickness, and ONH parameters using optical coherence tomography. Results. The average of five out of six sectors and minimum values of mGCIPL thicknesses in eyes with prominent β-PPA discs were significantly less than those of the control eyes. The results of clock-hour sector analyses showed significant differences for pRNFL thickness in one sector. In the ONH analyses, no significant difference was observed between myopic β-PPA and control eyes. The macular thickness of the β-PPA eyes was thinner than control eyes in all sectors. There was a significant difference between the two groups in three sectors (the inner superior macula, inner temporal macula, and inner inferior macula) but there was no significant difference in the other sectors, including the fovea. Conclusions. The myopic β-PPA eyes showed thinner mGCIPL, parafovea, and partial pRNFL layers compared with myopic eyes without β-PPA.

Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model.

AIM To compare the effects of the surgical insult of cataract surgery on corneal inflammatory infiltration, neovascularization (NV) and lymphangiogenesis (LY) between the dry eye and non-dry eye in murine cataract surgery models. METHODS We established two groups of animals, one with normal eyes (non-dry eye) and the second with induced dry eyes. In both groups, we used surgical insults to mimic human cataract surgery, which consisted of lens extraction, corneal incision and suture. After harvesting of corneas on the 9(th) postoperative day and immunohistochemical staining, we compared NV, LY and CD11b+ cell infiltration in the corneas. RESULTS Dry eye group had significantly more inflammatory infiltration (21.75%±7.17% vs 3.65%±1.49%; P=0.049). The dry eye group showed significantly more NV (48.21%±4.02% vs 26.24%±6.01%; P=0.016) and greater levels of LY (9.27%±0.48% vs 4.84%±1.15%; P=0.007). In corneas on which no surgery was performed, there was no induction of NV in both the dry and non-dry group, but dry eye group demonstrated more CD11b+ cells infiltration than the non-dry eye group (0.360%±0.160% vs 0.023%±0.006%; P=0.068). Dry eye group showed more NV than non-dry eye group in both topical PBS application and subconjunctival PBS injection (P=0.020 and 0.000, respectively). CONCLUSION In a murine cataract surgery model, preexisting dry eye can induce more postoperative NV, LY, and inflammation in corneal tissue.