Shuichiro Yanagisawa

A Hyperdry Amniotic Membrane Patch Using a Tissue Adhesive for Corneal Perforations and Bleb Leaks

PURPOSE To evaluate the efficacy of hyperdry amniotic membrane (AM) patching attached using a tissue adhesive for corneal perforations and glaucoma filtering bleb leaks. DESIGN Prospective, noncomparative, interventional case series. METHODS Five eyes of 5 patients (glaucoma bleb leaks, 2 eyes; corneal perforations, 3 eyes) were treated with a single-layer patch of dried AM using a biological tissue adhesive. The dried AM was prepared with consecutive far-infrared rays and microwaves (hyperdry method) and was sterilized by gamma-ray irradiation. The dried AM was cut to the desired size and shape, and the tissue adhesive was applied to the amniotic epithelial side of the dried membrane. After applying the tissue adhesive, the dried membrane with glue applied then was positioned to cover the conjunctival bleb leak site or corneal perforation lesion using forceps. A therapeutic hydrogel contact lens then was installed as a bandage. RESULTS Bleb leaks or corneal perforations were repaired successfully within 21 days in all 5 cases. There were no remarkable adverse effects, and there was no recurrence of bleb leak or corneal perforation. CONCLUSIONS The hyperdry AM is a useful substrate, and this surgical procedure is a promising method to treat glaucoma filtering bleb leak or corneal perforation, which may result in serious vision-threatening ocular complications.

Use of a hyperdried cross-linked amniotic membrane as initial therapy for corneal perforations

PurposeTo report the use of hyperdried cross-linked (HDCL) amniotic membrane (AM) patching with tissue adhesive as an initial therapy for corneal perforations.MethodsCryopreserved AM was cross-linked with 0.1% glutaraldehyde and then dried using far-infrared rays and microwaves (hyperdry method). Three eyes of three patients with corneal perforations of up to 3 mm in diameter were included in this study. They were treated with a single-layer patch of HDCL-AM applied with a tissue adhesive (2-octyl-cyanoacrylate). We also evaluated the resistance of HDCL-AM to collagenases during in vitro digestion testing.ResultsIn all three cases, the corneal perforations were repaired within 28 days (range, 17–28 days). No recurrence occurred during the follow-up period (3–6 months). In the collagenase digestion testing, the HDCL-AM did not dissolve until 48 h, whereas the cryopreserved AM completely dissolved within 60 min.ConclusionsThree cases of corneal perforations were successfully managed using HDCL-AM patching with tissue adhesive. The HDCL-AM was resistant to collagenases during in vitro digestion testing. The HDCL-AM was a useful substrate for corneal perforations. This simple surgical technique may be one of the initial therapeutic options for corneal perforations.

Ocular findings in Japanese patients with varicella-zoster virus infection.

Purpose: To examine ocular findings in Japanese patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis. Methods: A retrospective study was conducted. Information on the ocular, cutaneous, systemic, and virologic findings on pediatric and adult patients was obtained from medical records. Results: A total of 77 (45 male and 32 female) patients were enrolled in the study: 4 children had varicella, 68 adults had herpes zoster ophthalmicus, and 5 adults had acute retinal necrosis. Children with varicella had eruptions on the eyelid. Patients with herpes zoster ophthalmicus had eruptions, conjunctivitis, keratitis, iridocyclitis, and other findings. Patients with acute retinal necrosis had intracameral cells and retinal lesions. Some patients with herpes zoster ophthalmicus had malignancy, type 2 diabetes mellitus, or other disease. One pregnant woman developed acute retinal necrosis shortly after varicella infection. A total of 48% of patients with negative Hutchinson sign had ocular lesions, while all patients with positive sign showed ocular lesions. Patients with varicella and herpes zoster ophthalmicus had good visual acuity at the last visit. Some patients with acute retinal necrosis had poor visual acuity at the last visit. Conclusions: Patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis had several ocular complications. Some patients with acute retinal necrosis had poor visual outcomes. Ophthalmologists should be aware that acute retinal necrosis may develop shortly after varicella infection.

Effects of Vitrectomy on Recurrent Macular Edema due to Branch Retinal Vein Occlusion after Intravitreal Injection of Bevacizumab

Purpose. To evaluate the effects of pars plana vitrectomy (PPV) on recurrent macular edema due to branch retinal vein occlusion (BRVO) after intravitreal injections of bevacizumab (IVB). Methods. This retrospective study included 22 eyes of 22 patients who underwent single or multiple IVB injections for macular edema due to BRVO and showed a recurrence of macular edema. All patients then underwent PPV and were followed up for more than 6 months after the surgery with examinations of best corrected visual acuity (BCVA) and optical coherence tomography (OCT). OCT parameters were central macular thickness (CMT) and average retinal thickness in a 1-mm-diameter circular region at the fovea (MRT). Results. Mean BCVA, CRT, and MRT were significantly improved from the baseline after PPV. Greater improvement of BCVA, CRT, and MRT was obtained after 1 month of IVB than after 6 months of PPV. No eyes showed worsening of macular edema after the surgery. Conclusion. PPV improved BCVA and recurrent macular edema due to BRVO, but PPV that was less effective than IVB had been in the same patients. PPV may be one of the treatment options for recurrent macular edema due to BRVO after IVB.

Vitreous Chemokines and Sho (Zheng in Chinese) of Chinese-Korean-Japanese Medicine in Patients with Diabetic Vitreoretinopathy

We examined the levels of vitreous chemokines and Sho (Zheng in Chinese) of Chinese-Korean-Japanese medicine in diabetic patients. Patients undergoing vitrectomy were classified into Group 1 (no diabetic retinopathy), Group 2 (diabetic retinopathy with no or a few new vessels), and Group 3 (diabetic retinopathy with many new vessels). The levels of IL-8, MCP-1, MIP-1alpha, MIP-1beta, and RANTES in the vitreous fluid were measured using cytometric bead array method. Sho was determined by the standard diagnostic method of Chinese-Korean-Japanese medicine. Vitreous levels of IL-8 and MCP-1 in Groups 2 and 3 were higher than those in Group 1. MIP-1alpha, MIP-1beta, and RANTES levels in Groups 2 and 3 were almost the same as those in Group 1. The percentage of patients with Keishibukuryo-gan (Guizhifuling-wan in Chinese) sho in Group 3 was higher than that in Group 1. In conclusion, vitreous levels of IL-8 and MCP-1 were high in patients with diabetic vitreoretinopathy. Keishibukuryo-gan sho may be associated with diabetic vitreoretinopathy.

Effect of Topical Betaxolol on Acute Rise of Aqueous Flare Induced by Prostaglandin E2 in Pigmented Rabbits

PURPOSE To evaluate the effects of topical betaxolol on experimental ocular inflammation. METHODS Transcorneal diffusion of 25 microg/mL (7.09 x 10(-2) mmol/L) of prostaglandin E(2) (PGE(2)), placed in a glass cylinder, was employed to induce aqueous flare elevation in pigmented rabbits. Betaxolol was administered topically before PGE(2) application. Aqueous flare was measured with a laser flare cell meter. RESULTS Four-, two-, and one-time topical instillations of betaxolol inhibited the PGE(2)-induced aqueous flare elevation by 44% +/- 8%, 32 +/- 7%, and 8 +/- 6%(mean +/- SD), respectively. The inhibition of flare elevation was dependent on the number of betaxolol instillations. CONCLUSION Topical betaxolol has an inhibitory effect on PGE(2)-induced aqueous flare elevation in rabbit eyes.

One-Year Results of Photodynamic Therapy Combined with Intravitreal Ranibizumab for Exudative Age-Related Macular Degeneration

Purpose. To evaluate the effects of photodynamic therapy (PDT) combined with intravitreal injection of ranibizumab (IVR) for exudative age-related macular degeneration (AMD). Methods. Retrospective case series. Thirty eight eyes of 38 patients with exudative AMD underwent combined therapy consisting first of IVR, followed by PDT within a week and the second IVR at 1 month. All patients were followed up for more than 12 months. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were examined. Results. The mean number of IVR and PDT sessions were 2.9 ± 1.3 and 1.1 ± 0.3, respectively. The mean BCVA and CMT were significantly improved to 0.38 logMAR units (P < 0.01) and 240 μm (P < 0.01) at 12 months, respectively. Thirty-six of 38 eyes (94.8%) improved or maintained BCVA at 12 months. Conclusion. PDT combined with IVR for exudative AMD was effective at improving visual acuity and CMT with a low recurrence rate for 12 months.

Congenital corneal staphyloma associated with aphakia.

A neonate had a globular mass bulging through the eyelids of the left eye. Computed tomography revealed a large ectatic corneal lesion and the absence of a lens. The enucleated globe revealed that the posterior surface of the ectatic cornea was lined by iris tissue, indicating corneal staphyloma.

Effect of Topical Iganidipine on Experimental Elevation of Aqueous Flare Induced by Prostaglandin E2 and EP Agonists in Pigmented Rabbits

We evaluated the role of topical iganidipine on experimental aqueous flare elevation in rabbits. Transcorneal diffusion of prostaglandin E2 (PGE2), 25 µg/ml or 7.09 × 10–2 mmol/l, or highly selective agonists for prostaglandin E2 receptor subtypes (EP), 25 µg/ml, was achieved with the use of a glass cylinder to produce aqueous flare elevation in pigmented rabbits. Iganidipine was topically administered before application of PGE2 or EP agonists. Aqueous flare was measured with a laser flare cell meter. Topical instillation of 0.1% iganidipine once or twice inhibited 64 ± 8% (p < 0.01) and 84 ± 9% (p < 0.01) of PGE2-induced aqueous flare elevation, respectively. Two instillations of 0.1% iganidipine inhibited 95 ± 5% (p < 0.01) of EP2-agonist(ONO-AE1-259-01)-induced flare elevation and 98 ± 3% (p < 0.01) of EP4-agonist(ONO-AE1-392)-induced flare rise. Topical iganidipine may have anti-inflammatory activity in the eye.

Effects of Isopropyl Unoprostone, Latanoprost, and Prostaglandin E2 on Acute Rise of Aqueous Flare in Pigmented Rabbits

Purpose: To evaluate the effect of isopropyl unoprostone, latanoprost, and prostaglandin E2 (PGE2) on aqueous flare elevation. Methods: Isopropyl unoprostone (0.12%) or latanoprost (0.005%) was topically instilled. Transcorneal diffusion of PGE2, 25 µg/ml, using a glass cylinder, was achieved in pigmented rabbits. Aqueous flare was measured with a laser flare cell meter. Results: Topical instillation of isopropyl unoprostone induced aqueous flare elevation in rabbit eyes. Also, topical isopropyl unoprostone additionally induced aqueous flare elevation in eyes with transcorneal diffusion of PGE2. Latanoprost did not induce flare elevation. Conclusion: Isopropyl unoprostone induced aqueous flare elevation in rabbits, and latanoprost did not produce aqueous flare elevation.