Tomoki Sakuraba

Intercapsular cataract surgery with lens epithelial cell removal

ABSTRACT Characteristic lens epithelial cell behavior in the pseudophakic eye was examined by comparing 30 eyes that had extracapsular cataract surgery by the intercapsular technique and posterior chamber intraocular lens (IOL) implantation with lens epithelial cell removal but without anterior capsule capsulectomy and nine aphakic eyes that had the same procedure but without posterior chamber lens implantation over a mean follow‐up period of 30 and 23 months, respectively. Fibrous anterior capsule opacification was observed in 83% of the pseudophakic eyes in the area of contact with the IOL, while the region beyond the margin of the IOL remained transparent. Fibrous anterior capsular opacification was not noted in the aphakic eyes. This suggests that the IOL material, poly(methyl methacrylate), stimulates lens epithelial cells to undergo fibrous metaplasia and to produce collagen fibers. Various cytokines such as IL‐1 and TGF‐&bgr; synthesized by lens epithelial cells may play a crucial role as mediators in the process. We recommend that this effect be considered as a parameter of biocompatibility in developing and evaluating new biomaterials.

Postoperative refractive error after simultaneous vitrectomy and cataract surgery.

PURPOSE To evaluate the effect of vitrectomy on postoperative refraction after simultaneous vitrectomy and cataract surgery. METHODS We compared the spread between predicted and actual refractions in 206 eyes after a simultaneous vitrectomy, phacoemulsification, aspiration and acrylic lens insertion (combined surgery group), and in 67 eyes after cataract surgery only (cataract surgery group) as control. A vitrectomy was performed for diabetic retinopathy in 127 eyes, macular hole in 32 eyes, rhegmatogenous retinal detachment in 16 eyes, branch retinal vein occlusion in 15 eyes, and other conditions in 26 eyes. In the combined surgery group, 79 eyes had a gas tamponade after insertion of the intraocular lens. RESULTS The spread between predicted and actual refractions was - 0.05 +/- 1.18 diopters (average +/- SD) in the combined surgery group and +0.55 +/- 1.32 D in the cataract surgery group. The actual refractive errors in the combined surgery group were found to shift toward myopia when compared with the controls. Among the combined surgery group, 127 eyes without a gas tamponade showed a postoperative refractive error of +0.14 +/- 1.11 D, while 79 eyes with a gas tamponade demonstrated an error of -0.36 +/- 1.22 D. CONCLUSIONS Use of a gas tamponade in the combined surgery group increased the myopic change and was thought to have pressed the intraocular lens forward.

Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy.

Purpose To investigate long-term results of vitrectomy for the removal of submacular hard exudates in patients with diabetic maculopathy. Methods Thirteen eyes of 10 patients with diabetic maculopathy underwent vitrectomy to remove submacular hard exudates from December 1993 to March 1999. The mean preoperative logMAR visual acuity ± SD was 1.54 ± 0.43. Preoperatively, the exudates ranged from 0.5 to 3 disk diameters (average, 1.25 disk diameters). Exudates were removed using subretinal forceps through a minimal paramacular retinotomy after vitrectomy. In all cases, 20% SF6 gas tamponade was added. The mean postoperative observation period was 43.2 months. Results Visual acuity was improved in 7 eyes (54%) 1 year after surgery; however, visual acuity over longer periods was improved in only 5 eyes (38%) as compared with the preoperative findings. The mean final visual acuity ± SD was 1.62 ± 0.59, which did not show statistically significant improvement over that in the control group. Although submacular hard exudates and macular edema disappeared during the postoperative period, atrophic or degenerative changes occurred in many cases. Conclusion Visual improvement could not be obtained for a long period after removing submacular hard exudates in most of the patients, suggesting that diabetic maculopathy should be treated before massive exudate deposits appear in the macula.

Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases.

BACKGROUND To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). CASES Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. OBSERVATION Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. CONCLUSION Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.

Postoperative Complications After Simultaneous Vitrectomy and Cataract Surgery

OBJECTIVE We reviewed postoperative complications after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion. PATIENTS AND METHODS Combined surgery was performed in 316 eyes of 279 patients between 1995 and 1997. Postoperative observation was continued in all of them for more than 6 months. The diagnoses that led to vitrectomy included diabetic retinopathy in 155 eyes, rhegmatogenous retinal detachment in 64 eyes, macular hole in 43 eyes, and other diseases in 93 eyes. The rate of postoperative complications that needed any reoperation was investigated. RESULTS Reoperations were needed for intravitreal hemorrhage in 23 eyes (7.3%), retinal detachment in 15 eyes (4.7%), rubeotic glaucoma in 6 eyes (1.9%), and other conditions in 4 eyes (1.3%). Among them, reoperations were performed on 13 eyes (4.1%) twice and more. A removal of an intraocular lens was needed in 16 eyes (5.1%) for treatment of vitreoretinal disease. In patients with diabetic retinopathy, reoperations were needed for intravitreal hemorrhage in 21 eyes (13.5%), rubeotic glaucoma in 6 eyes (3.9%), other diseases in 4 eyes (2.6%), and a removal of an intraocular lens was needed in 10 eyes (6.5%) at a higher rate than the other disease. CONCLUSION This combined surgery is considered advantageous for removing peripheral vitreous, while preventing these complications is important for preserving visual function.

Visual improvement after removal of submacular exudates in patients with diabetic maculopathy

OBJECTIVE To improve the central visual function of eyes affected by massive hard exudates in cases of diabetic maculopathy. PATIENTS AND METHODS Six eyes of 4 patients with diabetic maculopathy were treated by pars plana vitrectomy for massive retinal exudates persisting for more than 3 months. The massive hard exudates were removed from the subretinal space with subretinal forceps. We evaluated the visual acuity of these eyes 6 months after surgery. RESULTS Following the removal of the hard exudates, visual acuity improved in all eyes. Massive hard exudates were mainly located in the subretinal space and were removable using subretinal forceps. No serious postoperative complications occurred. The removed tissues consisted of macrophages laden with many cholestrin crystals and lipid droplets, as well as fibrous tissues. CONCLUSION We concluded that central visual function can be improved by removing subretinal exudates surgically.

Morphological changes of retinal pigment epithelial and glial cells at the site of experimental retinal holes

Abstract Purpose: To investigate morphological changes of retinal pigment epithelial (RPE) cells and glial cells in the immediate and early phases of restoration at the site of experimental retinal holes. Methods: We made 0.2-disc-diameter retinal holes with a vitreous cutter in albino rabbit eyes. To assess very early changes of RPE cells, the eyes were enucleated at 0,1,3, and 5 h postoperatively and observed by scanning electron microscopy (SEM). At 1,5, and 7 days after surgery, eyes were enucleated and prepared in thin and ultra-thin sections for observation by light and transmission electron microscopy (TEM). Results: SEM showed the surface of the RPE cells lifting a few hours after surgery at the site of the retinal holes. The tissue filling the retinal hole was amorphous and homogeneous, as viewed by light microscopy. TEM revealed that this tissue consisted of glial cell processes containing many organelles. In addition, the cytoplasm of the cells was relatively dark, while the surface of the filling tissue continued smoothly to the internal limiting membrane. These findings suggested that these cell processes were parts of Müller cells. Conclusion: RPE cells and glial cells assembling at the site of the retinal hole may play an important role in retinal hole closure in this experimental model. In addition, RPE cells were morphologically changed in an immediate phase of restoration.

Clinicopathological Features of Dacryolithiasis in Japanese Patients: Frequent Association with Infection in Aged Patients

Purpose. The purpose of this study is to elucidate the clinicopathological features of dacryolithiasis and prevalence of associated infection in Japanese patients. Materials and Methods. Out of 13,471 outclinic patients from 2006 to 2011, 268 patients were scheduled to be performed dacryocystorhinostomy (DCR) due to dacryocystitis with nasolacrimal duct obstruction. Actually 266 patients underwent dacryocystorhinostomy (DCR) and two patients were cured by only ophthalmic examination. Dacryoliths were found in 17 cases (6.3%). Among 17 cases of dacryolithiasis, three patients were male, and 14 were female. The age of the patients ranged from 32 to 82 (mean 67) years, and 13 cases (76%) were more than 65 years of age. Pathological examination disclosed the infectious agents in 9 cases (53%), and all patients with infection were more than 65 years of age. Special stains revealed colonies of fungus, suspicious of Aspergillus, in 6 cases and gram-positive rods, and suspicious of Actinomyces, in 3 cases. Conclusions. The current study showed the frequent association of infection with dacryolithiasis in aged Japanese patients. This should be taken into the consideration for the treatment of dacryolithiasis.

Tear Lipid Layer Interference Changes After Dacryocystorhinostomy

PURPOSE Specular images of the tear film in the central cornea were examined in patients with nasolacrimal duct obstruction to observe changes before and after dacryocystorhinostomy (DCR). METHODS We observed the specular images in 4 patients (5 eyes) by a noncontact observation device and recording system. Observed patterns were classified into five grades. The specular images and tear meniscus height (TMH) were recorded. RESULTS Three of the 4 eyes with TMH values over 0.4 mm before DCR showed decreased TMH postoperatively. The 1 eye with a TMH value of 0.2 mm showed no change after DCR. Using specular images, 4 eyes were classified grade 1 or 2, and 1 eye was classified grade 4 before DCR. After DCR, the 5 eyes were classified as grade 3 or grade 4. CONCLUSION The results indicated that the eye after DCR has a thicker lipid layer than the eye before DCR.

Predicted versus actual postoperative refractive error after simultaneous vitrectomy and cataract surgery

PURPOSE We compared the spread between predicted and postoperative actual refractive errors after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion and after cataract surgery alone. METHODS Cataract surgery and vitrectomy (combined surgery group) were performed in 185 eyes, and cataract surgery only (cataract surgery group) in 63 eyes. Vitrectomy was needed for diabetic retinopathy in 104 eyes, macular hole in 26 eyes, rhegmatogenous retinal detachment in 25 eyes, and other conditions in 30 eyes. RESULTS The spread between predicted and actual refractive errors were +0.19 +/- 1.24 D (mean +/- standard deviation) in the combined surgery group and +0.91 +/- 1.40 D in the cataract surgery group. Gas tamponade in the combined surgery group increased the myopic change more than anything else. CONCLUSION Actual refractive errors in the combined surgery group were found to shift to myopia more than in the cataract surgery group. Gas tamponade was considered to press the intraocular lens forward in the combined surgery group.