Yosai Mori

Toxicity Evaluation of Antiglaucoma Drugs Using Stratified Human Cultivated Corneal Epithelial Sheets

PURPOSE To investigate the toxicity profiles of seven antiglaucoma topical eye drops and benzalkonium chloride (BAC) using stratified cultivated human corneal epithelial cell sheets (HCES) in a serum-free culture system. METHODS A range of prostaglandin analogies and preservatives, including BAC, sofZia (SZ), sodium benzoate (SB), and polyquaternium-1 (PQ) were tested. The barrier function and cell viability were examined by a carboxyfluorescein permeability assay and WST-1 assay. Histological evaluation of the HCES was also performed after application of each solution. RESULTS The carboxyfluorescein permeability assay had a higher sensitivity for the detection of toxicity of test solutions than the WST-1 assay or histological examination. Latanoprost BAC, latanoprost/timolol BAC, and 0.02% or higher concentration of BAC were the most toxic, followed by latanoprost SB, latanoprost preservative-free, BAC 0.002%, and travoprost/ latanoprost PQ. Travoprost SZ and tafluprost BAC (preserved with 0.001% BAC) was the least toxic in our experimental conditions. CONCLUSIONS The carboxyfluorescein permeability assay using HCES in a serum-free system was the most useful for the quantification of toxicity of ophthalmic solutions. Among the regimens examined, a BAC concentration of 0.001% or lower or non-BAC preservative sofZia was suggested to be the least toxic to the ocular surface.

Effect of diquafosol tetrasodium eye drop for persistent dry eye after laser in situ keratomileusis.

Purpose: To evaluate the effect of diquafosol tetrasodium (DQS) for the treatment of persistent dry eye after laser in situ keratomileusis (LASIK). Setting: Miyata Eye Hospital, Miyazaki, Japan. Design: Noncomparative case series. Methods: This prospective study included 30 eyes of 15 patients in whom dry eye had persisted for over 12 months after LASIK, and the symptoms had not improved with artificial tears and sodium hyaluronate treatment. In addition, treatment with DQS 3% eye drops, 6 times a day, was performed for 12 weeks. Best-corrected visual acuity, tear secretion with the Schirmer test, tear break-up time, and fluorescein and lissamine green staining scores on the cornea and conjunctiva were examined before and at 1, 4, and 12 weeks after the addition. A subjective questionnaire of 14 symptoms was also assessed before and 12 weeks after treatment. Results: The fluorescein and lissamine green staining scores significantly improved over 12 weeks; however, the best-corrected visual acuity and tear secretion did not change. The symptoms of fatigue, dryness, grittiness, discomfort, difficulty in reading, and discomfort within the area of dryness improved after the additional DQS treatment. Conclusions: The DQS treatment improved the subjective and objective symptoms of persistent dry eye after LASIK. Increased mucin production because of the addition of DQS probably improved the tear film stability and reduced the symptoms of dry eye in patients who had persistent dry eye after LASIK.

Intraoperative mydriasis by intracameral injection of mydriatic eye drops: in vivo efficacy and in vitro safety studies

Background:  This study investigated the efficacy and safety of intracameral injection of commercially available eye drops containing 0.5% tropicamide and 0.5% phenylephrine hydrochloride (Mydrin‐P, Santen Pharmaceutical, Osaka, Japan).

Corneal thickness and volume measurements by swept source anterior segment optical coherence tomography in normal subjects.

ABSTRACT Purpose: To evaluate central corneal thickness (CCT) and corneal volume (CV) in healthy eyes using swept source anterior segment optical coherence tomography (SS-AS-OCT) and other devices. Methods: Thirty-three healthy right eyes of 33 subjects were investigated. CCT was measured with SS-AS-OCT, rotating Scheimpflug camera, ultrasonic pachymetry and specular microscopy. CV was determined within a diameter of 10 mm at the center using SS-AS-OCT and Scheimpflug camera. Results: Mean CCT was 523.5 ± 25.2 μm by SS-AS-OCT, 523.9 ± 26.1 μm by Scheimpflug camera, 532.1 ± 26.6 μm by ultrasonic pachymetry, and 525.5 ± 33.5 μm by specular microscopy. The CCTs measured with SS-AS-OCT, Scheimpflug camera and specular microscopy were significantly thinner than those measured with ultrasonic pachymeter (p < 0.001). The mean CV within a diameter of 10 mm at the center was 57.2 ± 3.0 mm3 by SS-AS-OCT and 59.4 ± 2.9 mm3 by Scheimpflug camera. Scheimpflug measurements of CV were statistically larger than SS-AS-OCT measurements (p = 0.0008). Statistically significant correlation was found between the CCT and CV measurements of each imaging devices (p < 0.0001, r = 0.527, and p < 0.0001, r = 0.749, respectively). Conclusion: SS-AS-OCT enables the measurements of CCT and CV, demonstrating agreement with other devices. CV in addition to CCT measurement may serve as a practical parameter of the corneal endothelial pump function.

Topographic changes after excision surgery of primary pterygia and the effect of pterygium size on topograpic restoration.

Objective: To assess the effect of pterygium size on time-course change of corneal topography after excision surgery of primary pterygium. Methods: Retrospective case series included eyes that underwent excisions of primary pterygium. Pterygium size was graded according to the advancing edge position: less than one third of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Time-course changes in corneal refractive power, astigmatism, and irregularity (surface regularity and asymmetry indices) in corneal topographies over 12 months postoperatively were compared between the pterygium size grades. Results: Pterygium excision was performed on 562 eyes, consisting of 119, 338, and 105 eyes with grades 1 to 3, respectively. Grade 1 did not change in corneal irregularity, and there was no difference between grades 1 and 2, except for corneal astigmatism at 6 months. Grade 3 showed significantly higher corneal refractive power and irregularity than grade 1 until 3 and 6 months, respectively, whereas corneal astigmatism was higher over 12 months. Conclusions: Topographic changes after primary pterygium excision were associated with pterygium size. Pterygium advancing over the pupillary area required 6 to 12 months for corneal topography restoration, resulting in slow recovery of visual acuity.

Relationship of corneal asphericity to intraocular lens power calculations after myopic laser in situ keratomileusis

Purpose To examine whether corneal asphericity affects underestimation in the SRK/T intraocular lens (IOL) power calculation after myopic laser in situ keratomileusis (LASIK) and to evaluate the predictability of IOL power underestimation using the asphericity. Setting Kitasato University, Kanagawa, and Miyata Eye Hospital, Miyazaki, Japan. Design Retrospective case series. Methods The clinical records of eyes that had IOL implantation during cataract surgery after previous myopic LASIK between May 2008 and October 2014 were reviewed. For eyes with an available clinical history, the effect of manifest refraction spherical equivalent before LASIK, axial length, and the asphericity (Q value) on cataract surgery and the refractive error in the use of the SRK/T formula were examined using stepwise multiple regression analysis. Predictions with the resultant regression equation and significant factors were evaluated with Bland‐Altman plots. Results Fifty‐four eyes of 37 patients were included. The mean duration from LASIK to cataract surgery was 9.1 years ± 3.5 (SD) (range 2 to 14 years). Multiple regression analysis using 22 eyes of 22 patients resulted in a significant factor, which was the Q value (P < .001, R2 = 0.80). The refractive errors in 53 eyes were predicted with tolerances of 64.5% and 87.0% within ±0.5 diopter (D) and within ±1.0 D, respectively. Bland‐Altman analysis showed that 95% of the limitation range was 2.59 D. Conclusions The corneal asphericity after myopic LASIK significantly correlated with the IOL power underestimation with use of the SRK/T formula. The refractive error could also be predicted well with the use of asphericity. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Area densitometry using rotating Scheimpflug photography for posterior capsule opacification and surface light scattering analyses.

Purpose To compare area densitometry analysis using rotating Scheimpflug photography in quantifications of posterior capsule opacification (PCO) and surface light scattering with previous anterior‐segment analyzer measurement. Setting Miyata Eye Hospital, Miyazaki, Japan. Design Prospective observational case series. Methods Scheimpflug images of eyes with foldable intraocular lenses (IOLs) were obtained using rotating and fixed Scheimpflug photography. Area densitometry on the posterior and anterior surfaces was conducted for PCO and surface light scattering analyses, respectively, with an identical area size. Correlation between two measurements was analyzed using linear regression. Results The study included 105 eyes of 74 patients who received IOLs 1 to 18 years (mean, 4.9 ± 4.5 years) postoperatively. In the PCO analysis on the posterior IOL surface, there was a significant correlation between the two measurements (P < .001, R2 = 0.60). In the surface light scattering analysis, a significant and higher correlation was obtained (P < .001, R2 = 0.91) until the fixed Scheimpflug photography exhibited saturation due to intensive scatterings. Conclusion Area densitometry combined with a rotating Scheimpflug photography was exchangeable to previously established densitometry measurement, and allowed successive evaluation in longer‐term observations.

Comparison of Long-Term Outcomes of Visual Function and Endothelial Cell Survival After Descemet Stripping Automated Endothelial Keratoplasty and Penetrating Keratoplasty Using Mixed-Effects Models.

Purpose: To compare the long-term outcomes of visual function and endothelial cell survival after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK). Methods: The cohort included 108 eyes from 97 patients who underwent primary PK and 85 eyes from 78 patients who underwent primary DSAEK at Miyata Eye Hospital in Japan. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and four components from Fourier harmonic analysis of topography data (spherical component, regular astigmatism component, asymmetry component, and higher-order irregularity component) were retrospectively compared between PK and DSAEK at each time point for 5 years using mixed-effects models. Subgroup analyses were performed to compare the effect of PK and DSAEK on visual acuity. Results: Average BSCVA was significantly better in the DSAEK group compared with that in the PK group both preoperatively and postoperatively. Subgroup analyses revealed that average changes in BSCVA from preoperative baseline in eyes with preoperative logarithm of the minimum angle of resolution BSCVA between 0.39 and 1.0 and between 1.3 and 2.0 were not significantly different between the PK and DSAEK groups at all postoperative time points. All components from Fourier harmonic analysis were significantly higher after PK than DSAEK at almost all postoperative time points. There were no significant differences in endothelial cell density between PK and DSAEK after 3 years. Conclusions: PK and DSAEK provide similar recovery of BSCVA and endothelial cell survival at 5 years after surgery.

Predictability of Intraocular Lens Power Calculation for Cataract with Keratoconus: A Multicenter Study

This study was aimed to assess the predictability of intraocular lens (IOL) power calculation after cataract surgery for keratoconus. We retrospectively reviewed the clinical charts of 102 eyes of 71 consecutive keratoconic patients who developed cataract. We determined manifest spherical equivalent, prediction errors, and absolute errors, 1 month postoperatively. The achieved refraction was significantly more hyperopic than the targeted refraction, when keratometric readings were used (p = 0.001). At 1 month, 36% and 63% of the eyes were within ±0.5 and ±1.0 D, respectively, of the targeted correction. We found a significant correlation between the prediction error and the mean keratometry (Pearson correlation coefficient r =−0.545, p < 0.001). No vision-threatening complications occurred in any case. The achieved refraction was significantly more myopic than the targeted refraction, when total corneal refractive power was used (p = 0.013). Phacoemulsification with IOL implantation appeared to be safe and effective, and the accuracy was also good in mild keratoconus, but not in severe keratoconus. It should be noted that that a large amount of hyperopic shift occurred especially in advanced keratoconic patients, when keratometric readings were used for IOL power calculation, and that a slight, but significant, myopic shift occurred, when total corneal refractive power was used.

Suppression of surface light scattering in intraocular lenses manufactured using an improved production process.

Purpose To clinically examine the suppression of surface light scattering after implantation of an intraocular lens (IOL) manufactured using an improved production process. Setting Miyata Eye Hospital, Miyazaki, Japan. Design Comparative case series. Methods The prospective case series comprised eyes receiving hydrophobic acrylic Acrysof SN60WF IOLs that were manufactured before and after the improvement. Light scattering on the anterior IOL surface was examined up to 3 years postoperatively using an EAS‐1000 anterior segment analyzer. The changes during the postoperative period were evaluated and the 2 IOLs compared. The corrected distance visual acuity (CDVA) and contrast sensitivity under photopic and mesopic conditions were also examined 3 years postoperatively. Results The case series comprised 24 eyes (received IOL before improvement) and 27 eyes (received IOL after improvement). After the improvement, the IOLs showed no increase in surface light scattering up to 2 years, while there were increases after 2 years in the other IOLs. The light scattering with the improved IOL was significantly reduced at all observations (P < .048, t test with Holm correction). No difference was found in the CDVA and contrast sensitivity. Conclusions The improvement in the production process effectively decreased and slowed the development of surface light scattering. The slower increase in the improved IOL 3 years postoperatively showed that the development of water aggregates would not be completely prevented. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.