The Challenge of Contact Lens Visual Rehabilitation for Open Globe Injuries in Children Under 5 Years of Age.

PURPOSE: To investigate the clinical course of children younger than 5 years old who underwent rigid gas-permeable (RGP) contact lens (CL) wearing as visual rehabilitation of open globe injuries (OGIs) in Japan. METHODS: This retrospective case series involved six eyes of six children (four boys and two girls) with OGIs. The mean patient age at injury was 4.0±0.83 SD (range: 2.5-5 years), and the mean follow-up period was 42.9 months (range: 31.6-52.8 months). In each child, data regarding injury type, ocular surgery performed, outcomes of amblyopia management (including best-corrected visual acuity [BCVA] with RGP CL or spectacles), the RGP CL-wear training period, and rate of continuous RGP CL-wear were analyzed. RESULTS: Trauma type was penetrating injury (four eyes) and globe rupture (two eyes). All six cases showed lens penetration, and underwent corneal suture, lensectomy, and pars plana vitrectomy under general anesthesia. The mean RGP CL-wear training period was 3.5 months, and only one of the six cases discontinued RGP CL use. The mean BCVA with spectacles and with RGP CL was LogMAR: 1.52±0.41 (range 1.00-2.00) and 0.73±0.41 (range: 0.30-1.15), respectively. In all patients, except in one case in which strabismus developed, BCVA improved with RGP CL wear more than 0.2 logMAR compared with that with spectacles. CONCLUSION: Although the training period for RGP CL-wear is long in pediatric patients with OGIs, the treatment can be effective for refractive problems and for preventing the development of strabismus.

[Severe Ocular Infection in Elderly Patients with Dementia: a Case Study].

UNLABELLED: Purpose : To report 3 cases of severe ocular infection in elderly patients with dementia. CASE REPORTS: Case 1 involved a 75-year-old man who presented after his wife noticed hyperemia and discharge in his right eye. Corneal infection with perforation was found. Wife-administered antibiotics healed the infection within 1 month. Case 2 involved a 97-year-old man who was referred to us after nursing-home staff members noticed redness and discharge in his right eye. Severe corneal infection with hypopyon was found. Following systemic and topical and antibiotics' administration by the nursing-home staff, the infectious keratitis healed within 2 weeks. Case 3 involved an 80-year-old woman referred to us from another clinic due to persistent epithelial defect in her left eye. Since the defect was accompanied by anterior uveitis and vitreous opacity, we suspected bacterial endophthalmitis. Following systemic and topical antibiotics' administration by family members, signs of infection diminished within 3 weeks. In all 3 cases, medical examination was difficult, topical eye-drop instillation by the patients themselves was impossible. CONCLUSIONS: In elderly dementia patients, cognizance of infection, medical examination, and treatment are difficult. Support by family members or nursing-home staff is necessary to obtain improved outcomes.

[Clinical characteristics of short tear film breakup time (BUT) -type dry eye].

PURPOSE: To evaluate the clinical characteristics and management of short tear film breakup time (BUT) -type dry eye. METHODS: Clinical background and post-treatment changes of symptoms in 77 patients with short BUT -type dry eye were investigated. Treatment consisted of artificial-tear eye-drop instillation and, if necessary, the addition of a low-density-level steroid, hyaluronic acid, a low-density-level cyclopentolate prepared by ourselves and punctal plugs inserted into the upper and lower lacrimal puncta. RESULTS: There were three times more women than men among the patients, and the peak age of occurrence was in the twenties in the men and in the sixties in the women. Our findings show that visual display terminal (VDT) work, contact lens (CL) wear, and changes in the sex hormones may initiate subjective symptoms. Some patients had simultaneous conjunctivochalasis, allergic conjunctivitis, and meibomian gland dysfunction. Nineteen patients (24.7%) were effectively treated with eye-drop instillation alone. Thirty-seven patients (48.1%) required punctal-plug insertion, which was completely effective in only 8 of them (21.6%). CONCLUSION: Mainly young men and menopausal women contract short BUT -type dry eye. Changes in sex hormones, VDT work and CL wear may be causal, and the disease cannot be controlled by eyedrop and punctal-plug treatment alone.

Thermokeratoplasty for Keratoconus: A More Than 30-Year Follow-Up Study.

PURPOSE: The aim of this study was to investigate the long-term outcomes of thermokeratoplasty (TKP) surgery in patients with keratoconus (KC). METHODS: We retrospectively reviewed our clinical database of 2949 patients with KC seen at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan, between April 1979 and December 1991. Patients with KC who underwent TKP with a greater-than 30-year postoperative follow-up were included. The occurrence of adverse events including infectious keratitis, corneal perforation, corneal melting, bullous keratopathy, consistency of contact lenses (CL) wear at the final visit, and a history of corneal transplantation post-TKP was assessed. RESULTS: Forty-two patients (29 male and 13 female patients) with a mean age at initial visit of 23.4 years (range: 13.9-39.5 yrs) were included, and TKP was performed unilaterally in all cases. The mean follow-up period was 35.2 years (range: 30.1-41.6 yrs). As for adverse events/complications, no cases of infectious keratitis, corneal perforation, corneal melting, and/or BK were observed. However, 11 eyes received corneal transplants at an average of 24.9 years postoperatively because of the inability to wear CL continuously. At the last visit, 31 eyes were able to continue wearing CL without corneal transplantation, and the remaining 11 eyes were able to continue wearing contact lenses in all cases after corneal transplantation. CONCLUSIONS: TKP for KC resulted in relatively favorable surgical outcomes over the long-term postoperative period.

New grading system for the evaluation of chronic ocular manifestations in patients with Stevens-Johnson syndrome.

PURPOSE: To evaluate and grade the extent and severity of chronic ocular manifestations in Stevens-Johnson syndrome (SJS). DESIGN: Prospective multicenter case series. PARTICIPANTS: We enrolled 73 patients (138 eyes) with SJS seen between April 2003 and March 2005 at 3 tertiary referral centers. METHODS: Patients with a confirmed history of SJS and chronic ocular complications that persisted for at least 1 year from the onset of SJS were included. Their detailed medical history and ophthalmic examination results were recorded on an itemized data collection form. Complications were categorized as corneal, conjunctival, and eyelid complications, and 13 components were evaluated and graded on a scale from 0 to 3 according to their severity. MAIN OUTCOME MEASURES: These were broadly classified as corneal (superficial punctate keratopathy, epithelial defect, loss of the palisades of Vogt, conjunctivalization, neovascularization, opacification, keratinization), conjunctival (hyperemia, symblepharon formation), and eyelid (trichiasis, mucocutaneous junction involvement, meibomian gland involvement, punctal damage) complications. RESULTS: The most severely affected complication components were loss of the palisades of Vogt (114 eyes; 82.6%) and meibomian gland involvement (102 eyes; 73.9%). Visual acuity in 74 of the 138 eyes (53.6%) was worse than 20/200. The severity of corneal, conjunctival, and eyelid complications was significantly correlated with visual loss. All 13 complications were correlated significantly with logarithm of the minimum angle of resolution (logMAR) visual acuity; the correlation coefficient (R) ranged from 0.359 to 0.810 (P<0.0001); for corneal epithelial defects, R was 0.169 (P = 0.0473). Eyes with a higher total score for the 3 complication categories had poorer vision (R = 0.806; P<0.0001). Multivariate regression analysis showed that corneal neovascularization, opacification, keratinization, and cataracts significantly affected logMAR visual acuity (P<0.0001, P<0.0001, P = 0.0142, P = 0.0375, respectively). CONCLUSIONS: The authors describe a new method for grading the extent and severity of ocular involvement in patients with SJS and demonstrate that the severity of ocular involvement is correlated significantly with the final visual outcome. This new grading system provides a more objective method for evaluating SJS patients and may be adapted for use in other cicatricial ocular surface diseases.

[Relationship between ocular surface infection or colonization of methicillin-resistant Staphylococcus aureus and nasal carriage].

PURPOSE: To study the relationship between ocular surface colonization or infection and nasal carriage of methicillin-resistant Staphylococcus aureus(MRSA) among patients at high risk of infection and those who have already been infected. SUBJECTS AND METHODS: We isolated MRSA from ocular surface and anterior nares in 35 patients at high risk of MRSA colonization and from 4 patients who had developed an active MRSA ocular infection in the conjunctiva. RESULTS: Of the 7 patients who were carriers of conjunctival MRSA, 5 patients (78%) were found to be carriers of MRSA in the anterior nares. This ratio of nasal carriers is very high compared to the 11% in 28 patients without MRSA in the conjunctiva. All 4 cases who had active infections of MRSA in the cornea or conjunctiva showed MRSA from the nares. Even after MRSA was negative in their eye lesions, MRSA colonization in their nares continued for a long time. CONCLUSION: A significant relationship exists between MRSA in the ocular surface and MRSA found in the nares.

Using synthesized onion lachrymatory factor to measure age-related decreases in reflex-tear secretion and ocular-surface sensation.

PURPOSE: To use synthesized onion lachrymatory factor (SOLF) to investigate age-related changes in reflex-tear secretion and ocular-surface sensation. METHODS: We separated 91 healthy volunteers into four groups: groups A, age 20-29 years; B, 30-39; C, 40-49; and D, older than 50 years. We exposed one eye of each subject to SOLF and measured the elapsed time until the subject's limit of irritation tolerance (TLI) was reached and an increase in the tear meniscus radius (DeltaR). After the SOLF stimulus, corneal sensitivity was examined by Cochet-Bonnet esthesiometry (CB), and reflex-tear secretion was examined by the Schirmer I-test (ST). RESULTS: TLI was significantly shorter in group A than in the other groups (P < 0.0001), and the groups B and D also differed significantly from each other (P = 0.0013). The increase in DeltaR was significantly greater in group A than in group C (P = 0.0306) or D (P < 0.0001), and groups B (P = 0.0002) and C (P = 0.0308) also differed significantly from group D. There were no significant intergroup differences in the CB and ST results. CONCLUSIONS: An age-related decrease in reflex-tear secretion and ocular-surface sensation was revealed by the SOLF test but could not be detected by either CB or the ST.

Argon laser iridotomy-induced bullous keratopathy a growing problem in Japan.

AIMS: To describe the long-term risk of bullous keratopathy following argon laser iridotomy (ALI) in Japan and to compare it with other centres in the world. METHODS: We retrospectively reviewed the case records of all patients with ALI-induced bullous keratopathy that underwent penetrating keratoplasty at Kyoto Prefectural University of Medicine (KPUM) from January 2001 to December 2004. The results were compared with the other representative centres in Singapore and the UK. RESULTS: Thirty-nine eyes of 33 patients were included in the study. The mean age of patients was 73.3+/-6.9 years (range, 58 to 87 years). Patients developed bullous keratopathy at a mean duration of 6.9+/-4.9 years (range, 0.2 to 16 years) after the laser iridotomy procedure. The majority of eyes that developed bullous keratopathy (59.0%) occurred following prophylactic ALI. KPUM had the highest percentage of ALI-induced bullous keratopathy cases that underwent penetrating keratoplasties, as compared with other centres in Singapore and the UK (20.0%, 1.8% and 0%, respectively). CONCLUSION: Bullous keratopathy may arise many years following ALI, and is a growing problem in Asian countries. This condition is a major cause of ocular morbidity in Japan, which has seen a worrying increase in the number of cases in recent years.