Masamoto Imaizumi

Analysis of p53 Mutations and the Expression of p53 and p21WAF1/CIP1 Protein in 15 Cases of Sebaceous Carcinoma of the Eyelid

PURPOSE The purpose of this study was to detect mutation of the p53 gene, to assess its relationship with p53 or p21(WAF1/CIP1) expression, and to evaluate the correlation between p53 mutation or p21(WAF1/CIP1) expression and clinicopathologic findings in sebaceous carcinoma of the eyelid. METHODS Fifteen conventional paraffin-embedded samples of sebaceous carcinoma of the eyelid were analyzed. Using the single-strand conformation polymorphism technique, the authors sequenced coding exons 5-8 of the p53 gene. The expression of p53 and p21(WAF1/CIP1) protein was analyzed by immunohistochemistry. RESULTS In 10 of the 15 cases (66.7%), point mutations were detected in the p53 gene. CC to TT double-base changes (tandem mutations), which are known to be induced only by UV, were not detected in any of the mutations. Correlations between p53 mutation and expression were found to be statistically significant (P = 0.007). There was no significant correlation between p53 mutation and clinicopathologic findings or p21(WAF1/CIP1) expression. However, there was a significant inverse correlation between p21(WAF1/CIP1) expression and presence of lymph node metastasis (P = 0.007). CONCLUSIONS Among human cancers, sebaceous carcinoma of the eyelid may be one of those showing most frequent mutation of the p53 gene, which may not be caused by exposure to UV. p21(WAF1/CIP1) downregulation may be associated with lymph node metastasis.

Phacoemulsification and intraocular lens implantation for acute angle closure not treated or previously treated by laser iridotomy

PURPOSE: To determine the effect of phacoemulsification, aspiration, and intraocular lens (IOL) implantation in eyes with acute angle closure or eyes with prior laser iridotomy for acute angle closure. SETTING: Department of Ophthalmology, Oita Prefectural Hospital, Oita, Japan. METHODS: Eighteen eyes with acute angle closure and 8 eyes with cataracts that had a prior acute angle closure treated by laser iridotomy had phacoemulsification, aspiration, and IOL. A third group that had phacoemulsification, aspiration, and IOL for cataracts only served as controls. The preoperative and postoperative intraocular pressures (IOPs), visual acuities, and number of antiglaucoma medications were compared between these 3 groups. RESULTS: The mean IOPs in the eyes with phacoemulsification, aspiration, and IOL alone and the eyes with prior acute angle closure treated by laser iridotomy were decreased significantly after phacoemulsification, aspiration, and IOL. The mean IOPs in the control group also decreased, but not significantly. There was no significant difference in the postoperative IOP between the 3 groups. The postoperative visual acuities were improved significantly in the 3 groups, and the differences in the final visual acuities were not significant. Postoperatively, the antiglaucoma medication was not needed in the phacoemulsification, aspiration, and IOL‐alone group, but medication was necessary in eyes treated previously with laser iridotomy. CONCLUSION: Phacoemulsification with IOL implantation lowered IOP, improved visual acuity, and diminished the need for antiglaucoma medication in eyes with acute angle closure and with a prior acute angle closure treated by laser iridotomy.

Changes in Refraction Caused by Induction of Acute Hyperglycemia in Healthy Volunteers

PURPOSE To determine whether the myopic changes and ocular hypotension after a glucose load are caused by hyperglycemia. METHODS Oral glucose tolerance tests were conducted on seven healthy young subjects with normal vision. The changes in the hematologic parameters and the refractive system were measured periodically for 150 minutes after the glucose load. RESULTS After the glucose load, there was an increase in plasma glucose level and the level of plasma osmosis, ocular hypotension, a myopic change in refractive power, shallowing of the anterior chamber, and a thickening of the lens. The degree of the myopic change exceeded the power of the residual accommodation. Normalization of the plasma glucose level led to a normalization of the intraocular pressure and a reversal of the myopic changes. CONCLUSIONS These findings suggest that the myopic changes that accompanied hyperglycemia were caused by a thickening of the lens resulting from a decrease in the tension of the zonule fibers of Zinn, and were secondary to ocular hypotension. Hyperopia appeared to be caused by the reversal of the myopia after normalization of plasma glucose levels.

Peribulbar fungal abscess and endophthalmitis following posterior subtenon injection of triamcinolone acetonide

for treatment of diabetic retinopathy. His best corrected visual acuity (VA) was 0.07 OD and 0.02 OS. He agreed to our recommendation that the macular oedema in the left eye be treated by a subtenon triamcinolone acetonide (TA) injection. The eye was anaesthetized with 4% topical lidocaine, and disinfected along with the lid margins and skin with 5% povidone iodine. A lid speculum was used, and the superonasal conjunctiva was incised to inject 20 mg of TA into the posterior subtenon space using a 27-gauge cannula with a dull tip. Topical ofloxacin ointment was instilled and levofloxacin q.i.d. was prescribed. Three months later, the patient reported diplopia and deep ocular pain OS. He had ptosis and restricted motility, and VA had dropped to 0.5 OS. The anterior chamber was quiet and the conjunctiva was not injected. Magnetic resonance imaging (MRI) showed a high-intensity lesion in the superonasal peribulbar area (Fig. 1A). Two months later, the diplopia worsened, and an epibulbar abscess was found superonasally (Fig. 1B). A repeat MRI revealed exophthalmos with two dome-like periocular cysts OS (Fig. 1C). The abscess was incised to drain a considerable amount of yellowishwhite purulent fluid. Gatifloxacin, pimaricin, levofloxacin (400 mg ⁄day) and itraconazole (100 mg ⁄day) were given topically and fluconazole (100 mg ⁄day) intravenously. Cultures yielded Scedosporium apiospermum, which was confirmed by DNA analysis. Therefore, itraconazole was replaced with voriconazole (300 mg ⁄day), to which the fungus was sensitive. The symptoms gradually decreased (Fig. 1D), but 4 weeks later the patient developed a central scotoma and a concentric visual field defect OS. His VA had decreased to 0.02. Repeat MRI showed a retrobulbar lesion in the superonasal region (Fig. 1E, F). Extensive vitritis with opacities, pale optic disc, periphlebitis, serous detachment of the macula, focal retinal haemorrhages and a whitish subretinal peripheral mass were noted (Fig. 1G–I). The former abscess, now replaced by fibrosis, was irrigated with balanced salt solution containing voriconazole, amphotericin B and ceftazidime. Six days later, pars plana vitrectomy and cataract extraction were performed. The mass gradually decreased, the retina was reattached, and VA improved to 0.5. No recurrence was observed in the following 6 months. Triamcinolone acetonide is a longacting steroid, and intravitreal or subtenon injection of TA has been used to treat macular diseases (Martidis et al. 2002). However, an intravitreal injection can cause a retinal detachment and endophthalmitis, and a subtenon TA injection can cause secondary ptosis and ocular infections (Engelman et al. 2004; Erol & Topbas 2006; Kusaka et al. 2007; Oh et al. 2007). A Medline search identified three patients with an orbital abscess or endophthalmitis following a subtenon TA injection (Engelman et al. 2004; Kusaka et al. 2007; Oh et al. 2007). One of these was caused by Pseudallescheria boydii and did not respond to intensive itraconazole therapy, leading to phthisis (Oh et al. 2007). The anamorph, S. apiospermum, is a filamentous fungus found in soil and polluted water. Its teleomorph is P. boydii, an emerging opportunistic fungus that usually affects immunocompromised hosts. Although the possibility of endogenous origin in the diabetes patient cannot be fully ruled out, the source of P. boydii in our case may have been direct contact with polluted Diagnosis ⁄ Therapy in Ophthalmology

Electroretinographic assessment of early changes in ocular siderosis

We examined a patient with an iron intraocular foreign body and recorded electroretinograms (ERGs) before and after the removal of the foreign body by vitrectomy. The amplitudes of the rod and cone ERGs and the oscillatory potentials (OPs) in the injured eye were reduced before the operation. In addition, the photopic on-responses (b wave) were more reduced than off-responses (d wave). One year after surgery, the amplitudes of the rod, cone and photopic on- and off-responses were markedly improved to within the low normal limit. However, the OP amplitudes remained unchanged with lower values. These findings suggest that iron retinotoxicity leads to a dysfunction of all layers but the changes may be reversible in the early period of the disease. The late period iron toxicity produces more severe damage to the inner retina than the outer retina.

Unusual Protrusion of Conjunctiva in Two Neonates with Harlequin Ichthyosis

Background: We present two patients who developed severe protrusion of the conjunctiva and chemosis secondary to Harlequin ichthyosis (HI). Case Reports: Case 1 was a male infant diagnosed with HI who had parchment-like appearance and conjunctival protrusion with severe chemosis. Case 2 was a female infant on whom HI had been suspected before birth through ultrasonography. She showed thickened skin over the entire body and conjunctival protrusion with severe chemosis. For both cases, a vitamin A derivative was applied and the hyperkeratotic layer was peeled off every day. Great care was taken to sterilize and moisten the ocular surface. The conjunctival protrusion gradually improved and other systemic conditions were successfully treated. HI is a rare condition, but affected infants are surviving longer than previously and hence guidelines for ocular management are now required. Conclusions: Gentle and patient debridement of the hyperkeratotic skin and moisturizing were important in treating the unusual conjunctival protrusion.

Primary conjunctival epithelial cyst of the orbit.

BackgroundA primary conjunctival epithelial cyst is an uncommon lesion that consists of nonkeratized, stratified squamous epithelium without dermal appendages.MethodsCase report.ResultsA 57-year-old woman presented with a soft mass in the anterior portion of the nasal orbit. Magnetic resonance imaging demonstrated a rounded, cystic lesion between the right eye and the nasal bone. Histopathological examination following complete surgical excision disclosed a conjunctival epithelial cyst lined by nonkeratinized cuboidal epithelium without goblet cells and adnexal structures.ConclusionA conjunctival epithelial cyst should be considered in the differential diagnosis of a mass in the anterior portion of nasal or superonasal orbit.

Electroretinographic changes in eyes with idiopathic macular hole treated by vitrectomy

We recorded full-field electroretinograms before and after vitrectomy in 18 eyes of 18 patients with idiopathic macular hole. The results were compared between affected and fellow eyes in the preoperative and early (within 10 days) and late (3 to 6 months) postoperative periods. No significant changes between affected and control eyes were found in the amplitude of the rod electroretinogram, mixed cone-rod electroretinogram, cone electroretinogram a-and b-waves or 30-Hz flicker electroretinogram in all stages of the study. The peak implicit times of the cone electroretinogram (a-and b-wave) and dark-and light-adapted oscillatory potential (O1-O4), however, were delayed. Also, the amplitude of the oscillatory potentials (O1+O2+O3+O4) was significantly reduced in the early postoperative period. By the late period, all of these changes had resolved. We concluded that electrophysiologic changes were derived from a transitory dysfunction of the inner retina. The possible causes of the electroretinographic changes would include mechanical trauma of the surgery, intravitreous air tamponade or the changes in vitreous electrolytes after surgery. Oscillatory potentials were more sensitive than a-and b-waves in eliciting dysfunction of the inner retina in operate on eyes.

Oncocytoma of the peripunctum

BackgroundOncocytoma is rarely found around the lacrimal punctum. We describe a case of oncocytoma of the peripunctum.MethodsCase report.ResultsAn 88-year-old patient presented with a upper peripunctal mass in the left eye. The tumor was completely excised including the lacrimal punctum and part of the canaliculus. The upper eyelid was reconstructed with a skin flap from the residual skin of the lid, and the lacrimal canaliclus was replaced by a silicone rubber tube. Histologically, the tumor had tubulo-papillary architecture and was composed of two layers of cuboidal cells. The cytoplasm of the tumor cells was rich in eosinophilic granules. The diagnosis was oncocytoma arising from the canaliculus.ConclusionOncocytoma should be considered in differential diagnosis of a peripunctal mass in elderly patients. In this patient it probably originated from the epithelium of the lacrimal canaliculus.

On response dysfunction in multifocal posterior pigment epitheliopathy.

Purpose To determine the electroretinographic properties of one patient with multifocal posterior pigment epitheliopathy. Methods Rod and cone electroretinograms (ERGs) and photopic ERGs elicited by long-duration stimuli were studied in a patient with multifocal posterior pigment epitheliopathy. Results The amplitudes of both the rod and cone ERGs were significantly reduced. Photopic ERGs elicited by long-duration stimuli demonstrated that the b-wave (“on” response) was abolished but the d-wave (“off” response) was reduced by only amplitude. Conclusion The ERG findings in multifocal posterior pigment epitheliopathy indicate that there is dysfunction not only of the photoreceptors but also in the signal transmission specific for the “on” pathway.