Mami Yoshino

Dry eye after haematopoietic stem cell transplantation

AIMS To determine the incidence, natural course, and severity of dry eye occurring or worsening after haematopoietic stem cell transplantation (SCT). METHODS At a tertiary care hospital, 53 patients undergoing allogeneic or autologous SCT followed by at least 180 days of follow up were studied prospectively. Examination included grading of symptoms of dry eye, evaluation of ocular surface, tear break up time, and Schirmer tests with and without nasal stimulation. Meibomian gland secretion was also examined using a slit lamp while applying steady digital pressure. RESULTS Of the 53 patients, 44 received allografts. Half of these patients (22) developed dry eye or their pre-existing dry eye worsened after SCT, while none of nine autograft recipients did. Onset of dry eye was 171 (SD 59) days after SCT. Two types of dry eye occurred. One (n=10) was severe with ocular surface findings resembling Sjögren’s syndrome and reduction of reflex tearing soon after onset. A mild type (n=12) had unimpaired reflex tearing. Meibomian gland dysfunction (MGD) was more frequent and severe in patients with dry eye and chronic graft versus host disease (GVHD), and overall severity of dry eye was greater in patients with MGD and chronic GVHD. CONCLUSIONS Dry eye after SCT occurred only in allograft recipients, and was not evident in autograft recipients. The severe form of dry eye had a tendency to develop rapidly. Further study on the prediction and treatment of severe dry eye after SCT is necessary.

Fibrous membrane formation at the capsular margin in capsule contraction syndrome.

PURPOSE To determine whether the pathogenesis of capsule contraction syndrome involves the outgrowth of the fibrous membrane from the anterior capsule margin. SETTING Department of Ophthalmology, Keio University School of Medicine, Tokyo, and the Ando Eye Clinic, Kanagawa, Japan. METHODS A retrospective review of medical records and slitlamp photographs was conducted in 12 eyes (10 patients) that had required treatment for a narrowed anterior capsule opening after cataract surgery. All patients had had continuous curvilinear capsulorhexis and phacoemulsification with implantation of an intraocular lens in the capsular bag. Specimens of surgically removed fibrous membrane were examined by histopathological methods. RESULTS Fibrous membrane on the inner surface of the anterior capsule and the linear folds of the anterior capsule were present in each eye. In 10 eyes of 8 patients, the fibrous membrane was on the outer surface of the anterior capsule and covered the capsular folds at its margin. Pathological study showed that this fibrous membrane consisted of the flattened lens epithelial cells that proliferated on the inner and outer surfaces of the shrunken anterior capsule. The outgrowth of this membrane from the margin of the anterior capsule to the center of the opening of the anterior capsule was noted. CONCLUSION In this study, capsule contraction syndrome involved contraction of the fibrous membrane as well as its outgrowth from the capsule margin.

Elschnig pearl formation along the neodymium: YAG laser posterior capsulotomy margin: Long-term follow-up

Purpose: To examine the long‐term occurrence and course of Elschnig pearl (string of pearls) formation along neodymium:YAG (Nd:YAG) laser posterior capsulotomy margins. Setting: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. Methods: The clinical records of eyes having an Nd:YAG posterior capsulotomy to treat posterior capsule opacification after cataract surgery were retrospectively reviewed. Kaplan‐Meier and Cox proportional hazards analysis were performed. Results: Among 201 eyes, string of pearls developed in 139 (69.2%). The mean follow‐up after the Nd:YAG posterior capsulotomy was 32.1 months ± 25.3 (SD). At 2 years, the cumulative probability of developing string of pearls was 77.0% (95% confidence interval [CI], 70.6%‐83.4%), after which it reached a plateau. Among the 139 eyes, 100 had sufficient data to be reviewed to assess the long‐term outcome (mean follow‐up from Nd:YAG posterior capsulotomy, 43.7 ± 26.0 months). A second Nd:YAG posterior capsulotomy was performed in 18 eyes (18.0%) to treat progression of string of pearls, typically within 2 years after the initial Nd:YAG capsulotomy. The string of pearls disappeared spontaneously in 31 eyes (31.0%). The probability of disappearance was 80.4% (95% CI, 63.4%‐97.4%) 8 years after the Nd:YAG posterior capsulotomy. Cox proportional hazards analysis identified no factor significantly favoring the disappearance of the string of pearls. Conclusions: String of pearls was a common complication after Nd:YAG laser posterior capsulotomy. About 20% of cases were progressive and required a second capsulotomy; however, most regressed over several years.

Time course of lens capsule staining using trypan blue and indocyanine green: in vitro study in porcine eyes.

Purpose: To determine whether staining of the lens capsule with trypan blue 0.1% and indocyanine green (ICG) 0.5% diminishes with time and whether it differs between the anterior and posterior capsules. Setting: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. Methods: Crystalline lenses removed from porcine eyes were stained for 10 seconds with 0.1 mL of trypan blue 0.1% or indocyanine green 0.5%. They were then placed in distilled water and observed for the persistence of staining over time. In a second experiment, the anterior chamber and internal aspects of the anterior capsule and internal and vitreous aspects of the posterior capsule were gently irrigated with 0.1 mL of trypan blue 0.1% or ICG 0.5%. After 10 seconds, the capsules were irrigated with distilled water and the staining intensities were compared. Results: Staining was not diminished 30 seconds, 5 minutes, or 1 hour after application of either dye. No difference was evident in staining intensity or diminution with time between the anterior and posterior capsules, but the external aspects were stained more than the internal aspects with both dyes. Trypan blue produced more intense staining than ICG. Conclusions: Since the intensity of capsule staining in the intact lens did not change during a 1‐hour immersion in water, capsule dyes may not dissipate fully during cataract surgery. As possible long‐term adverse effects have not been ruled out, capsule dyes should be used in a low concentration for a short exposure time.

Laboratory scienceTime course of lens capsule staining using trypan blue and indocyanine green: In vitro study in porcine eyes☆

Purpose: To determine whether staining of the lens capsule with trypan blue 0.1% and indocyanine green (ICG) 0.5% diminishes with time and whether it differs between the anterior and posterior capsules. Setting: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. Methods: Crystalline lenses removed from porcine eyes were stained for 10 seconds with 0.1 mL of trypan blue 0.1% or indocyanine green 0.5%. They were then placed in distilled water and observed for the persistence of staining over time. In a second experiment, the anterior chamber and internal aspects of the anterior capsule and internal and vitreous aspects of the posterior capsule were gently irrigated with 0.1 mL of trypan blue 0.1% or ICG 0.5%. After 10 seconds, the capsules were irrigated with distilled water and the staining intensities were compared. Results: Staining was not diminished 30 seconds, 5 minutes, or 1 hour after application of either dye. No difference was evident in staining intensity or diminution with time between the anterior and posterior capsules, but the external aspects were stained more than the internal aspects with both dyes. Trypan blue produced more intense staining than ICG. Conclusions: Since the intensity of capsule staining in the intact lens did not change during a 1‐hour immersion in water, capsule dyes may not dissipate fully during cataract surgery. As possible long‐term adverse effects have not been ruled out, capsule dyes should be used in a low concentration for a short exposure time.

Visual Performance After Contralateral Implantation of Multifocal Intraocular Lenses With +3.0 and +4.0 Diopter Additions.

PurposeTo evaluate visual performance after contralateral implantation of AcrySof ReSTOR aspheric intraocular lenses (IOLs) with +3.0 and +4.0 diopter near additions. DesignThis was a retrospective case study conducted at Tokyo Dental College Suidobashi Hospital in Tokyo, Japan. MethodsEleven patients who were implanted with the SN6AD1 IOL and the SN6AD3 IOL contralaterally were included in this study. The distance, intermediate (1 m, 50 cm), and near (40 and 30 cm) uncorrected and corrected binocular visual acuity (VA), contrast sensitivity, depth of focus, and patient satisfaction were assessed more than 1 month postoperatively. ResultsPostoperatively, the mean uncorrected (corrected) binocular logarithm of the minimum angle of resolution VA levels were as follows: distance, −0.120 (−0.163); intermediate, 1 m, 0.226 (0.012) and 50 cm, 0.037 (0.006); and near, 40 cm, 0.067 (−0.040) and 30 cm, 0.091 (−0.053). The depth of focus had a smooth curve with double peaks. The mean contrast sensitivity was normal at all spatial frequencies. All patients were spectacle independent and expressed high satisfaction. ConclusionsContralateral implantation of multifocal IOLs with +3.0 and +4.0 D additions takes advantage of the good uncorrected near VA provided by both IOLs and may be an option for patients who require a broader range of good uncorrected near VA.

Effect of Posterior Convexity of Intraocular Lenses on Lens Epithelial Cell Migration

PURPOSE To investigate in vitro how the posterior convexity of an intraocular lens (IOL) affected the migration of lens epithelial cells (LECs) under its optic. METHODS Porcine LECs were cultured for 9 days with polymethylmethacrylate (PMMA) IOLs in a cell culture chamber insert containing a collagen membrane on which the IOLs were implanted. The central sagittal optic depths of the implanted IOLs were 0, 0.158, 0.303, and 0.452 mm. The migration of LECs was observed with an inverted phase microscope. The cell-free area under the IOL optic, where LECs had not migrated, was measured. RESULTS As time elapsed, LECs migrated onto the collagen membrane beneath the IOL optics from the periphery to the central area in a concentric fashion in all IOL configurations. At 5 days in culture, the greater central sagittal optic depths of the IOL optic were associated with wider cell-free areas (P=.0108). At 9 days in culture, LECs almost completely covered the collagen membrane under IOLs with 0-, 0.158- and 0.303-mm central sagittal optic depth whereas the cell-free area under the 0.452-mm IOL was 4.3+/-3.0% (P=.0029). CONCLUSIONS The posterior convexity of an IOL optic has an inhibitory effect on LEC migration under the optic. However, this inhibition had little effect after 9 days in culture.

Extracellular Matrix Influences Proliferation of Cultured Porcine Lens Epithelial Cells

Purpose: To investigate whether extracellular matrix (ECM) influences the proliferation of cultured lens epithelial cells (LECs). Material and Methods: Porcine LECs were cultured in F-12 nutrient mixture supplemented with 5% fetal bovine serum (FBS) for 24 or 96 hours on the dishes coated with laminin, fibronectin, type I collagen, or type IV collagen. As a control, LECs were cultured on uncoated dishes. Twenty-four or ninety-six hours later, the number of cells was determined. We determined the proliferation ratio of the number of cells 96 hours after plating to the number of cells 24 hours after plating. This ratio was used to assess the cell proliferation. Results: The ratio of the LECs on the uncoated dishes was 2.3. Dish coating with type I or type IV collagen, and fibronectin significantly increased this ratio (4.0, 3.5, and 3.0, respectively), whereas coating with laminin did not affect this ratio (2.5). Conclusion: These findings suggest that ECM influences cultured porcine LEC proliferation. (J Jpn Ophthalmol Soc 103:432–435, 1999)

Effect of Rabbit Aqueous Humor Obtained after Cataract Surgery on Collagen Gel Contraction Induced by Bovine Lens Epithelial Cells

We evaluated the effect of specimens of pre- and postoperative aqueous humor on the contraction of collagen gels, and the effect of transforming growth factor-β2 (TGF-β2) in postoperative aqueous humor. Rabbit aqueous humor was collected preoperatively and on postoperative day 7. Bovine lens epithelial cells (LECs) were cultured in collagen gel in F-12 nutrient mixture supplemented with 5% fetal bovine serum that contained 10% aqueous humor obtained under various conditions. Gel area was determined on day 4. Gels cultured with the medium that contained phosphate-buffered saline showed a statistically significant contraction after 4 days. Aqueous humor from aphakic or pseudophakic eyes significantly increased contraction, with both specimens having a similar effect. Approximately 60% of the contractile effect of the postoperative aqueous humor was neutralized by anti-TGF-β2 antibody. However, the promoting effect of the aqueous humor sampled postoperatively was less than that sampled preoperatively. Although the aqueous humor obtained postoperatively increased the contractility of the LECs, with the level of TGF-β2 apparently responsible for much of its effect, the effect was less than that observed in the aqueous humor obtained preoperatively.

Effect of Previous Myopic Laser In Situ Keratomileusis on Contrast Sensitivity After Diffractive Multifocal Intraocular Lens Implantations

Objective: To evaluate effects of previous myopic laser in-situ keratomileusis (LASIK) on decrease in contrast sensitivity after implantation of diffractive multifocal intraocular lens (MF-IOL). Methods: Retrospective case series included eyes that were implanted diffractive MF-IOLs after myopic LASIK. Contrast sensitivity was measured 1 month postoperatively and the area under log contrast sensitivity (AULCSF) was calculated. Principle component analysis (PCA) was used for extracting principal factors related with the previous LASIK and MF-IOL implantation. Effects of decrease in postoperative AULCSF and contrast sensitivity at each spatial frequency were evaluated using step-wise multiple regression analysis. Results: Twenty-six eyes of 20 patients were included. The mean postoperative uncorrected distance visual acuity was -0.06 ± 0.13 logMAR (20/17 in Snellen) and all eyes achieved 20/20 or better. The PCA determined central corneal thickness (CCT), distance-corrected near visual acuity, and absolute manifest refraction as principal factors. The multiple regression analysis revealed that the AULCSF showed significant decrease with a thinner CCT (P=0.017), while a particular trend was not found in the analysis results at the spatial frequencies. Conclusion: Degradation in contrast sensitivity after implantation of MF-IOLs in post-LASIK eyes was more affected by the amount of the previous LASIK corrections.