Kazuomi Hanada

Central corneal thickness measurements with Fourier-domain optical coherence tomography versus ultrasonic pachymetry and rotating Scheimpflug camera.

Purpose: To compare the accuracy and repeatability of Fourier-domain optical coherence tomography (FD-OCT) with ultrasonic pachymetry (USP) and a rotating Scheimpflug camera for measuring the central corneal thickness (CCT). Methods: The CCT was measured in 30 subjects (30 normal corneas) by the same examiner using RTVue-100 FD-OCT with an anterior segment adaptor, Pentacam rotating Scheimpflug camera, and SP-2000 USP. Two examiners obtained one FD-OCT measurement from 10 eyes of 5 subjects to assess interexaminer reproducibility. Results: The mean CCT (±SD) measured by FD-OCT, USP, and the Pentacam were 530 ± 33, 544 ± 34, and 552 ± 35 μm, respectively. Significant correlations were found between FD-OCT and USP (r = 0.97; P < 0.0001), FD-OCT and Pentacam (r = 0.97; P < 0.0001), and USP and Pentacam (r = 0.96; P < 0.0001). Pairwise comparisons showed that the FD-OCT CCT measurement was significantly thinner than those of the other 2 methods (P < 0.001 for all comparisons). Regarding intraexaminer repeatability, the intraclass correlation coefficients ranged between 0.97 and 0.98. There was high repeatability of the CCT measurements with all methods. FD-OCT also had high interexaminer reproducibility (intraclass correlation coefficient = 0.98). Conclusions: RTVue-100 FD-OCT may be a useful alternative for measuring the CCT; however, it significantly underestimates the CCT compared with the USP and the Pentacam with slight differences. Although highly correlated, the measurements are not directly interchangeable in clinical practice.

The use of scanning laser ophthalmoscope microperimetry to detect visual impairment caused by macular photocoagulation

BACKGROUND AND OBJECTIVE To demonstrate the effectiveness of scanning laser ophthalmoscope (SLO) microperimetry in detecting retinal sensitivity and in describing areas of unstable fixation following photocoagulation therapy. PATIENTS AND METHODS Two patients with iatrogenic vision loss resulting from photocoagulation therapy underwent a fundus examination, SLO microperimetry, and fluorescein angiography. One patient also underwent indocyanine green angiography. RESULTS Two types of visual acuity decrease--sudden-onset and late-onset--were demonstrated following macular photocoagulation, the former resulting from incorrect identification of the fixation point, and the latter from enlarging photocoagulation scars placed in close proximity to the fovea. In one case, SLO microperimetry detected dense scotoma corresponding to the patients symptoms and an unstable fixation point. In the other case, different retinal sensitivities were found in the photocoagulation scars. No differences were found with fluorescein angiography or indocyanine green angiography. CONCLUSION SLO microperimetry might be effective for quantitative assessment of retinal sensitivity in photocoagulation scars and for detecting fixation points and determining their stability.

Therapeutic Keratoplasty for Corneal Perforation: Clinical Results and Complications

Purpose: To report the clinical results, postoperative progress, and complications after therapeutic keratoplasty for corneal perforation. Methods: Twenty consecutive eyes (20 patients) that underwent therapeutic keratoplasty between December 2003 and May 2006 were included. The eyes were evaluated retrospectively for the cause of the corneal perforation, the type of surgical technique and intraoperative complications, anatomic cure rates, graft clarity, visual prognosis, and postoperative complications. Results: The causes of corneal perforation were herpetic keratitis (n = 5), bacterial ulcer (n = 1), fungal ulcer (n = 1), neurotrophic ulcer (n = 3), rheumatoid arthritis (n = 2), Mooren ulcer (n = 2), Terrien marginal corneal degeneration (n = 1), keratoconus (n = 1), and Wegener granulomatosis (n = 1). In 3 cases, the etiology was unknown. Six cases had a previous history of corneal transplantation. Anatomic cures were obtained in 16 (80%) of 20 eyes after the first transplantation procedure. Visual acuity (VA) equal to or better than the preoperative level was achieved in 17 (85%) of 20 eyes. The graft transparency rate was 67% in 15 eyes that underwent central penetrating keratoplasty with fresh donor tissue. Major postoperative complications included cataract (n = 6), glaucoma (n = 4), and recurrent disease (n = 3). Conclusions: Keratoplasty is valuable for maintaining the ocular integrity and VA. In cases with severe preoperative inflammation of the anterior segment, it is difficult to achieve transparency after the first graft.

Wound healing process after corneal stromal thinning observed with anterior segment optical coherence tomography.

Purpose: The aim of this study was to observe the wound healing process after corneal stromal thinning by using anterior segment optical coherence tomography (AS-OCT) and a slit lamp. Methods: Four patients with corneal stromal thinning (2 patients: corneal iron foreign bodies; 2 patients: keratitis) were included. Serial AS-OCT and slit-lamp examinations were used to follow up the progress of these patients. The thicknesses of the whole cornea and the corneal stroma were measured with AS-OCT and compared with the findings observed during the slit-lamp examination. Results: AS-OCT showed that epithelial hypertrophy and hyperplasia initially occurred in the area of the corneal stromal thinning; subsequently, scar tissue formed in the area with an improvement in the thickness of the corneal stroma. This wound healing process was observed in all 4 patients. The scar tissue initially appeared opaque on slit-lamp examination and was characterized by a high signal produced on AS-OCT, which was different from the normal corneal stroma. The scar tissue gradually appeared clear on slit-lamp examination; however, the high signal on AS-OCT remained. Conclusions: AS-OCT can be used to detect the wound healing process of corneal stromal thinning.

Imaging of the Corneal Subbasal Whorl-like Nerve Plexus: More Accurate Depiction of the Extent of Corneal Nerve Damage in Patients With Diabetes

PURPOSE To show that noninvasive in vivo corneal confocal microscopy (IVCM) can make more accurate imaging of the corneal subbasal nerve plexus possible. This diagnostic technique monitors the status of diabetic peripheral neuropathy. However, it is difficult to accurately confirm the corneal area captured by IVCM, which can induce measurement errors. Because the whorl-like characteristic pattern of the corneal subbasal nerve plexus is in the inferocentral cornea, we evaluated whether IVCM images of the whorl-like patterns can accurately evaluate the corneal nerve fibers in diabetic neuropathy. METHODS Forty-seven patients with diabetes (DM group) and 21 healthy control subjects underwent IVCM examination to compare the characteristics of the corneal subbasal nerve plexus around the central cornea (conventional method) and the whorl-like pattern in the inferocentral cornea (study method). We measured the total corneal nerve fiber and branch length (CNFL). RESULTS The total CNFL were significantly shorter in the DM group than in the control group and tended to decrease with progression of diabetic retinopathy, nephropathy, neuropathy, and decreased corneal sensation. There was a significant positive correlation between the CNFL values obtained with the conventional method and those obtained with the study method. The coefficient of variation of the CNFL values in the study method was significantly smaller than in the conventional method. CONCLUSIONS Our findings indicated that IVCM measurements of the whorl-like patterns may accurately define the extent of corneal nerve damage in order to monitor diabetic peripheral neuropathy.

Transforming Growth Factor-β Signaling Cascade Induced by Mechanical Stimulation of Fluid Shear Stress in Cultured Corneal Epithelial Cells.

Purpose Because blinking is regarded as mechanical stimulation of fluid shear stress on the corneal epithelial cells, we investigated the effects of fluid shear stress on cultured human corneal epithelial cells (HCECs). Methods The HCECs were exposed to shear stress (0, 1.2, 12 dyne/cm2) with the parallel-plate type of flow chamber. Wound healing, cellular proliferation, growth factor expression, TGF-β1 concentration in the culture supernatant, and phosphorylation of SMAD2 were investigated. Results Monolayers of HCECs exposed to shear stress had delayed wound healing and decreased proliferation compared with those of the static control (0 dyne/cm2). With increasing shear stress, TGF-β1 expression and phosphorylation of SMAD2 increased significantly, but the levels of total TGF-β1 in the culture supernatant decreased significantly. Delayed wound healing, decreased proliferation, and phosphorylation of the SMAD2 by shear stress were canceled out with a TGF-β receptor inhibitor. Conclusions Fluid shear stress on the HCECs affected TGF-β signaling, which was associated with delayed wound healing. Mechanical stress by blinking might involve TGF-β signaling, and activation of TGF-β might be a key factor in wound healing of the corneal epithelium. Further studies should investigate the molecular mechanism of shear stress-induced activation of TGF-β.

Autologous Transplantation of a Free Tenon's Graft for Repairing Excessive Bleb Leakage after Trabeculectomy: A Case Report

Purpose: To report a case of autologous transplantation of a free Tenons graft to repair excessive bleb leakage after trabeculectomy. Case Report: A 39-year-old Japanese woman presented with severe hypotony in her left eye. She had undergone trabeculectomy with mitomycin C 14 years ago. Slit-lamp examination showed an ischemic and ruptured bleb, excessive bleb leakage, and an extremely shallow anterior chamber. A large scleral defect was vaguely observed through the bleb conjunctiva. The hypotony was attributed to excessive bleb leakage. A surgical revision was required. First, the avascular bleb conjunctiva and the melted scleral flap were excised. A scleral defect was observed. Thick fibrotic tissue, i.e., the autologous Tenons graft, was separated from the underlying sclera, cut to the desired size to cover the defect, and sutured to the sclera with 10-0 nylon sutures. Irrigation with balanced salt solution through the paracentesis confirmed deepening of the anterior chamber with no bleb leakage. In the current case, a layer of amniotic membrane was applied to cover the largely exposed sclera. Two weeks postoperatively, the surgical site was totally re-epithelialized with no aqueous leakage. Three months postoperatively, vascularization into the surgical site was observed. The intraocular pressure remained within normal levels without recurrent bleb leakage. Conclusions: Autologous transplantation of a free Tenons graft successfully repaired excessive bleb leakage through a scleral defect after trabeculectomy. This technique is easier, safer, and may be more cost effective for repairing excessive bleb leakage after trabeculectomy than conventional management techniques.

Pigmented squamous cell carcinoma in situ of the conjunctiva

Conjunctival squamous cell carcinoma (SCC) typically develops in either the limbal or bulbar conjunctiva as a fleshy pink, gelatinous, amelanotic, sometimes plaquelike, mass. Black SCC or pigmented SCC(PSCC) is rare, with only about ten cases of the conjunctiva reported [1–4]. Until 1990, most reported conjunctival PSCC cases were in patients of African descent [1, 2], and a few in other races were reported later [3, 4]. The case is of a Japanese patient.

Optic neuritis in a psoriatic arthritis patient treated by infliximab

Dear Editor, We report a case of psoriatic arthritis (PA) who developed optic neuritis (ON) during infliximab therapy. To the best of our knowledge, this is the first report of ON associated with infliximab in a Japanese psoriatic patient. The patient was a 55year-old man who had arthritis of finger joints, wrists and elbows, and well-demarcated hyperkeratotic scaly erythematous plaques on the umbilicus, groins, trunk and scalp (Fig. 1). Histopathology of the thigh lesion revealed hyperkeratosis, parakeratosis and neutrophilic microabscess in the horny layer. Absence of granular layer and elongation of rete ridges were compatible with psoriasis (Fig. 2). He did not have any prior history of demyelinating diseases. Anteroposterior radiographic finding of hands revealed narrowing of joint spaces with bone proliferation on all distal interphalangeal joints. His 28-joint Disease Activity Score based on C-reactive protein was 3.21. While skin lesions were well controlled with topical corticosteroid and active vitamin D3 ointment, joint pain was aggravated. Tuberculin skin test was positive and computed tomography detected two small old granulomatous nodules on his left lung. He was given isoniazid 300 mg once daily according to the Japanese standard guideline. After he received infliximab, his skin lesions and arthritis disappeared. However, he noticed numbness of the hands and feet 4 weeks after the fifth infusion of infliximab. Isoniazid-induced peripheral neuropathy was suspected and rifampicin 450 mg once daily was initiated instead of isoniazid. However, 4 weeks after the sixth infusion of infliximab, he developed blurred vision and superior visual field depression in his right eye. Best corrected visual acuity (BCVA) of the right eye was 20/100. The results of contrast-enhanced brain magnetic resonance imaging (MRI) and lumbar puncture were normal. Neither anti-aquaporine-4 antibody nor evidence for multiple sclerosis (MS) was detected. He was diagnosed as right ON by ophthalmologists in our hospital. Following i.v. methylprednisolone (1000 mg/day 3 days), oral predonisone was prescribed and tapered off. His vision improved gradually in the subsequent 8 weeks. His BCVA was 20/20 in the right eye and his visual field recovered completely. The numbness of hands and feet also gradually disappeared following the corticosteroid therapy. Rheumatoid factor and antinuclear antibodies were negative throughout the course, and there was no change of immunoglobulin levels during the development and course of ON. He did not receive further infliximab therapy. Tumor necrosis factor (TNF)-a inhibitors are used for rheumatoid arthritis, inflammatory bowel diseases and PA. There are several adverse events, however, after the TNF-a antagonists therapy, such as infections, congestive heart failure, and demyelinating diseases including MS and ON. ON is an inflammatory optic nerve demyelinating disease that is primary or MS-associated. Specific brain MRI abnormalities suggest the association with MS. Twenty-three cases of ON associated with TNF-a antagonists have been reported up until December 2011. Fifteen Figure 1. Well-demarcated hyperkeratotic scaly erythematous plaques on groins and pubic area. Figure 2. Histopathology of the lesion revealed hyperkeratosis, parakeratosis and microabscess of neutrophils in horny layer (hematoxylin–eosin, original magnification 9100). The epidermis showed absence of granular layer and mild acanthosis.

A low meat diet increases the risk of open-angle glaucoma in women—The results of population-based, cross-sectional study in Japan

Background Studies identifying modifiable lifestyle risk factors related to open-angle glaucoma (OAG) are limited, especially from Asian countries. This study aimed to identify lifestyle risk factors for OAG in a Japanese population. Methods and findings This population-based, cross-sectional study recruited Japanese participants aged 40 years or older from January 2013 to March 2015. We took fundus photographs for OAG screening, determined lifestyle and health characteristics through a questionnaire and performed physical examinations. The participants who had suspect findings in the fundus photographs were sent for a detailed ophthalmic examination to diagnose OAG. Lifestyle and heath characteristics were statistically compared between the OAG and non-OAG participants. A total of 1583 participants were included in the study, of which 42 had OAG and 1541 did not have OAG. The number of days per week that the female participants consumed meat (mean±SD; OAG: 1.7±1.2 days, non-OAG: 2.7±1.5 days) was negatively associated with OAG (OR = 0.61; 95% CI: 0.43–0.88; p = 0.007). Higher intraocular pressure was positively associated with OAG in men (OR = 1.20; 95% CI: 1.05–1.38, p = 0.009). No significant difference between participants with and without OAG was observed for a range of other lifestyle factors and health criteria including self-report of diabetes, number of family living together, body mass index, blood pressure, pulse rate, coffee drinking, tea drinking, alcohol drinking, number of fruits consumed per day and days of fish consumption per week. Conclusions A higher weekly consumption of meat appears to be negatively associated with OAG in Japanese women. Increasing the dietary intake of meat can contribute to reducing the risk of developing OAG.