Takaaki Fujiwara

Inhibition of lens epithelial cell migration at the intraocular lens optic edge: role of capsule bending and contact pressure

Purpose: To evaluate the inhibitory effect of a sharp intraocular lens (IOL) optic edge, a sharp capsule bend, and contact pressure between the optic edge and posterior capsule on lens epithelial cell (LEC) migration. Setting: Department of Ophthalmology, Kyorin University, Tokyo, Japan. Methods: This in vitro laboratory study evaluated a tumble‐polished convex‐plano IOL (CP group), an AcrySof® IOL (Alcon) with a sharp edge (AS group), a new IOL with a round ridge (RR group), and a new IOL with a sharp ridge (SR group). The 2 new IOLs have high ridges and high angled loops that create firm contact between the ridge and posterior capsule. After sham cataract surgery, an IOL and a capsular tension ring (CTR) were implanted in the capsular bag of rabbit eyes. The extracted capsular bags containing the CTR and IOL were cultured. The inhibitory effect of each IOL on cell migration was analyzed. Furthermore, LEC migration on the posterior capsule was compared in culture between capsules having a sharp right angle and those with gradually curving bends. Results: The inhibitory effect on cell migration was statistically greatest in the SR group followed by the RR, AS, and CP groups. A sharp capsule bend did not inhibit cell migration. Conclusions: The results suggest that inhibition of cell migration at the optic edge is regulated by the degree of contact pressure between the optic edge and posterior capsule. A sharp capsule bend might indicate strong contact but does not in itself inhibit cell migration.

Classification system for cataracts. Application by the Japanese Cooperative Cataract Epidemiology Study Group

A cataract classification and grading system for the main purpose of cataract epidemiological studies is proposed by the Japanese Cooperative Cataract Epidemiology Study Group. Cataractous types are classified principally into cortical, nuclear and subcapsular opacities. Stages of cataract advancement are classified into grade I (early stage), grade II (moderate stage) and grade III (advanced stage). Regarding cortical opacities an opacified area obtained from red-reflex images is utilized for grading judgment. Nuclear opacity grading is based on the intensity of scattering at the nucleus. Grading of subcapsular opacities is judged from their extension in the three different pupillary areas. To help grading judgments, standard pictures of cortical and nuclear cataracts are provided. Gradings of lens coloration are divided into pale yellow (grade I), yellow (II), brownish yellow (III) and brown including reddish and black brown (IV). A recording chart is also provided.

Intraoperative Stress Experienced by Surgeons and Assistants

BACKGROUND AND OBJECTIVE To determine the intraoperative stress on surgeons and assistants during cataract surgery, 12 surgeons and 3 assisting nurses were assessed based on their level of professional experience. METHODS Surgeons were classified as inexperienced, intermediate, or experienced. Nurse assistants were classified as inexperienced or experienced. The intraoperative heart rates and urine adrenaline levels of each participant were measured. RESULTS Inexperienced surgeons and nurse assistants had the highest heart rates at the beginning of surgery, and the rates tended to decrease toward the end of surgery. All values were higher than the other two groups throughout surgery. In surgeons with intermediate experience, the heart rates were not as high as in the inexperienced personnel; however, the heart rates were high throughout the surgery. The heart rate in one intermediate surgeon was markedly increased when a surgery was simultaneously broadcast on closed-circuit television. In experienced surgeons and a nurse assistant, the measurements increased slightly. CONCLUSIONS The variations in heart rates and urine adrenaline levels showed characteristic patterns based on the experience of the surgical personnel.

Inhibition of Posterior Capsule Opacification by a Capsular Adhesion–Preventing Ring

OBJECTIVE To assess the inhibitory effect of a capsular adhesion-preventing ring (CAPR) that facilitates aqueous humor circulation into the capsular bag on posterior capsule opacification (PCO) formation after cataract surgery. METHODS After phacoemulsification, a polymethyl methacrylate intraocular lens with (n=5) or without (n=5) a CAPR was implanted in rabbit eyes. The inhibitory effect of the CAPR on PCO formation was assessed by stereoscopic microscopy and histologic examination 8 weeks after surgery. RESULTS All eyes in which a CAPR was implanted demonstrated remarkably less PCO than the control eyes. Neither anteroposterior capsular adhesion nor regeneration of lens fiber occurred in 2 eyes in the CAPR group. The remaining 3 eyes with a CAPR showed partial capsular adhesion and limited lens fiber regeneration in the resultant closed capsular space. CONCLUSIONS The CAPR appears to prevent PCO formation by separating the anterior and posterior capsules and allowing circulation of aqueous humor, including growth inhibitory factors, into the equatorial space of the capsule through the holes and grooves in the ring. CLINICAL RELEVANCE A CAPR may be useful for preventing PCO in the clinical setting.

Diabetes as Risk Factor of Cataract: Differentiation by Retroillumination Photography and Image Analysis

We performed an epidemiological study to identify risk factors of cataract based on 2,243 subjects who underwent a general health checkup. Each subject underwent a 75-gram oral glucose tolerance test and blood chemistry analysis. The prevalence rate of cataract was higher in diabetic subjects in their 50s than in nondiabetics in the same age range (p less than 0.01). The incidence of vesicular and radial lens opacity was higher in diabetics than in nondiabetics (p less than 0.05).

Vitrectomy for Endophthalmitis after Cataract Surgery

PurposeTo identify risk factors of poor visual outcome with vitrectomy for early-onset endophthalmitis after cataract surgery.Patients and MethodsClinical records of 29 consecutive eyes with endophthalmitis developing within 6 weeks after cataract surgery and that underwent therapeutic vitrectomy between June 1996 and April 2001 were retrospectively reviewed. Twenty-two of the eyes received intravitreal injections of vancomycin and ceftazidime at the time of vitrectomy, and all patients received intravenous antibiotics. Eyes were divided into two groups; group A consisted of 22 eyes with a final visual acuity of 0.2 or greater, and group B consisted of 7 eyes with a final visual acuity of less than 0.2.ResultsFifteen eyes (52%) in group A achieved a visual acuity of 0.5 or better and 8 (28%) achieved a visual acuity of 1.0, while 4 eyes in group B developed phthisis bulbi. For eyes with a preoperative visual acuity of hand motions or worse, there was no correlation between final visual acuity and preoperative visual acuity. The overall culture-positive rate was 57%. In group A, methicillin-resistant Staphylococcus epidermidis was identified in 6 eyes, methicillin-resistant Staphylococcus aureus (MRSA) in 3 eyes and enterococcus in 2 eyes. In group B, α-hemolytic streptococcus (AHS) was identified in 4 eyes, aspergillus in 1 eye, and MRSA in 1 eye. All isolates were sensitive to vancomycin with the exception of the aspergillus. AHS infection appeared to be associated with wound failure from the initial cataract surgery and a poor visual outcome. In 3 of the eyes that developed phthisis bulbi, intravitreal injection of antibiotics was not performed.ConclusionEarly vitrectomy and intravitreal injection of vancomycin may improve visual outcomes, but infection with AHS may be associated with cataract surgery wound failure and a poor visual outcome. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:590–596, 2003)