Submicroscopic deletions at 13q32.1 cause congenital microcoria.

Congenital microcoria (MCOR) is a rare autosomal-dominant disorder characterized by inability of the iris to dilate owing to absence of dilator pupillae muscle. So far, a dozen MCOR-affected families have been reported worldwide. By using whole-genome oligonucleotide array CGH, we have identified deletions at 13q32.1 segregating with MCOR in six families originating from France, Japan, and Mexico. Breakpoint sequence analyses showed nonrecurrent deletions in 5/6 families. The deletions varied from 35 kbp to 80 kbp in size, but invariably encompassed or interrupted only two genes: TGDS encoding the TDP-glucose 4,6-dehydratase and GPR180 encoding the G protein-coupled receptor 180, also known as intimal thickness-related receptor (ITR). Unlike TGDS which has no known function in muscle cells, GPR180 is involved in the regulation of smooth muscle cell growth. The identification of a null GPR180 mutation segregating over two generations with iridocorneal angle dysgenesis, which can be regarded as a MCOR endophenotype, is consistent with the view that deletions of this gene, with or without the loss of elements regulating the expression of neighboring genes, are the cause of MCOR.

Properties of new diffusion filters for treatment of amblyopia with accurate occlusive effects.

PURPOSE: Our purpose is to present the characteristics of newly developed diffusion filters that can reduce the best-corrected visual acuity (BCVA) of the non-amblyopic eye to a specified value and that can be used to treat amblyopia. METHODS: Silica sol is a colorless and transparent colloidal gel of different particle sizes. The silica was added to an emulsion adhesive, thoroughly mixed, and coated evenly on polyethylene terephthalate films. Twelve filters with 12 different concentrations of silica were constructed. The density of the silica particles on the films was determined by scanning electron microscopy, and the haze values and light transmittance were measured with a goniophotometer. The reduction of the BCVA by the filters was determined in 16 healthy young women (mean age, 22.0 ± 2.3 years) by attaching the filters to spectacles. RESULTS: Scanning electron microscopy showed a monolayer of evenly spaced silica particles. The haze values of the 12 filters were related to the concentration of silica. The total light transmittance of the 12 filters was not significantly correlated to the concentration of silica. The BCVAs measured with the 12 filters were significantly and inversely correlated with the concentration of silica for both eyes (right eye, y = 0.174x - 0.197, R(2) = 0.951; left eye, y = 0.173x - 0.212, R(2) = 0.983). CONCLUSIONS: These findings indicate that these diffusion filters can reduce the BCVA with no reduction of light transmittance. We conclude that they can be used to degrade the image of the dominant eye by known amounts in patients with amblyopia without affecting the overall light levels to the eye, i.e., form deprivation without light deprivation.

[Questionnaire survey of ocular injuries due to fireworks in Japan].

PURPOSE: To report the results of a questionnaire survey of ocular injuries caused by fireworks in 2011. METHODS: A survey was performed by recovery of questionnaire postcards asking details of firework-related ocular injuries which were sent to 1,094 institutes recognized as training hospitals by the Japan Ophthalmological Society. RESULTS: The cards were recovered from 57.9% institutes, and showed that 23 eyes of 20 patients (17 men and 3 women) with firework-related ocular injuries were seen in 19 institutes. The patients' ages ranged from 1 to 45 (average 18.4) years old. Injuries were caused by either carelessness or accidents in 18 eyes of 15 patients, and by wrong usage of fireworks in 5 eyes of 5 young men (15-27 years old). These 5 eyes showed severe injuries involving the lens and/or retina, and required surgical treatment with finally measured visual acuities 0.4 or less. CONCLUSIONS: In Japan, hazardous use of fireworks seems to cause severe eye injuries from which at least 5 young adults suffered during one fireworks' season. Therefore, preventive measures should be taken including public education on the usage of fireworks.

Genetic variants of FZD4 and LRP5 genes in patients with advanced retinopathy of prematurity.

PURPOSE: Retinopathy of prematurity (ROP) is a complex disease with a genetic predisposition, but little is known about its genetic background. It has a clinical resemblance to familial exudative vitreoretinopathy (FEVR), a hereditary disease characterized by defects in the development of retinal vessels. Several studies have suggested that mutations in the causative genes for FEVR may account for a proportion of advanced ROP, but conflicting data have also been reported for some variants. To address the possibility of genetic involvement of FEVR genes in ROP, we performed comprehensive sequence analyses of 53 Japanese patients with advanced ROP for the FEVR-causing genes. METHODS: Peripheral blood DNA was obtained from 53 patients referred to our hospitals for retinal surgery. Polymerase chain reaction followed by direct sequencing of the coding regions of the known FEVR-causing genes (FZD4, LRP5, TSPAN12, and NDP) and a noncoding exon of the NDP gene was performed. Possible pathogenicity of the sequence changes were analyzed by orthologous protein sequence alignment and by computational predictions. RESULTS: We identified six different nonsynonymous DNA variants in the coding region of either the FZD4 gene (p.H69Y, p.R127H, and p.Y211H) or the LRP5 gene (p.R1219H, p.H1383P, and p.T1540M) in seven patients. The corresponding codons of these changes were highly conserved among species, and these changes were predicted to be pathogenic by at least two of four computational prediction programs. No such changes were found in the TSPAN12 and NDP genes. CONCLUSIONS: Six possibly pathogenic variants of FZD4 or LRP5 were found in seven advanced ROP patients. Although these variants do not yet provide definitive evidence that they are causal, the results imply a role of the FZD4 and LRP5 genes in the development of advanced ROP.

Identification of causative pathogens in eyes with bacterial conjunctivitis by bacterial cell count and microbiota analysis.

PURPOSE: To determine the causative pathogens in eyes with bacterial conjunctivitis. DESIGN: Evaluation of diagnostic test or technology. PARTICIPANTS: Thirteen eyes diagnosed clinically with bacterial conjunctivitis and 12 eyes with normal conjunctival sac were studied. METHODS: The bacterial cell numbers were counted in the samples stained by ethidium bromide (EtBr). The microbiota was determined by the clone library method using polymerase chain reaction (PCR) amplification of the 16S ribosomal RNA (rRNA) gene with universal primers. In addition, examinations of smears and cultures of samples were performed. MAIN OUTCOME MEASURES: Bacterial cell numbers determined by the EtBr staining method and microbiota analysis based on 16S rRNA gene of samples from eyes with bacterial conjunctivitis. RESULTS: The bacterial cell numbers in the eyes with bacterial conjunctivitis were significantly higher than those in the normal conjunctival sacs. Ten of 13 samples from the eyes with bacterial conjunctivitis had positive PCR results. The remaining 3 samples and all 12 samples from the normal conjunctiva had negative PCR results. In 5 of the 10 PCR-positive samples, the predominant species accounted for 84.5% or more of each clone library. In the remaining 5 samples, the predominant and the second dominant species accounted for 27.4% to 56.3% and 19.0% to 26.8%, respectively, of each clone library. The number of detected species in the clone libraries was between 8 and 20 (average ± standard deviation, 7.5 ± 5.8). Bacteria were detected in 8 of the 10 bacterial conjunctivitis samples and in 5 of the 12 normal samples in the cultures. The number of species detected by cultures was 1 in the eyes with bacterial conjunctivitis and between 1 and 3 (mean ± standard deviation, 1.6 ± 0.9) in the normal conjunctiva. CONCLUSIONS: These results showed that the bacterial cell number in a sample is a good method of determining bacterial conjunctivitis. The microbiota analysis detected a diverse group of microbiota in the eyes with bacterial conjunctivitis and showed that the causative pathogens could be determined based on percentages of bacterial species in the clone libraries. The combination of bacterial cell count and microbiota analysis is a good method for identifying the causative pathogens in cases of monomicrobial and polymicrobial conjunctivitis.

Reconstruction of a nonfunctional trabeculectomy bleb using an amniotic membrane-wrapped silicone sponge to treat refractory glaucoma.

BACKGROUND: This study was conducted to verify the usefulness of nonfunctional trabeculectomy bleb reconstruction using a silicone sponge wrapped with amniotic membrane. Its purpose was to allow aqueous humor to flow from the flap to the posterior orbital space. METHODS: Seven consecutive patients who had undergone two or more surgeries in one eye for refractory glaucoma followed by our operation were included in this study. Conjunctival adhesion to the sclera was detached with a limbus-based conjunctival incision, followed by reopening the former trabeculectomy flap. A 1.5 × 12 mm silicone sponge used for retinal detachment surgery was wrapped three to four times with amniotic membrane, placed longitudinally on the sclera, and fixed with 10-0 nylon sutures. The anterior end of the amniotic membrane was fixed underneath the scleral flap with sutures, and the conjunctival wound was closed. We periodically checked the intraocular pressure (IOP) and for complications. Follow-up periods ranged from 15 to 30 months (average 19.4 months). Surgical success was defined as a final IOP of ≤ 21 mmHg with or without additional treatment. We defined failure as an IOP of > 21 mmHg on the second of two consecutive visits after the first 4 weeks, or the need for additional glaucoma surgery. RESULTS: Surgery was successful in five of the seven eyes, although bleb needling was performed in two eyes and amniotic membrane patch covering for early aqueous leakage was needed in one eye. In four of the five successful eyes, IOP was well controlled for longer than the period between the previous and present surgeries. One of the unsuccessful eyes, with neovascular glaucoma, had high IOP with hyphema followed by phthisis of the eyeball. The other, with aqueous leakage via the conjunctival wound, required trabeculectomy in a different area. There were no other complications. CONCLUSIONS: Reconstruction of the nonfunctional trabeculectomy bleb using a silicone sponge wrapped with amniotic membrane can be a useful strategy for treating refractory glaucoma.

Potential preventive effects of a new visual intervention for accommodative insufficiency and asthenopia due to sustained near task.

BACKGROUND: The objective of this study was to experimentally investigate whether a new visual intervention with optical and binocular vergence demands prevents accommodative insufficiency and asthenopia after sustained periods of visual task. METHODS: Fourteen female students were given the intervention with optical and binocular vergence demands for 1.5 min immediately after 20 min of a sustained task on a three-dimensional display. Before and after the trial, their ocular functions were measured and their symptoms assessed. A new type of intervention was developed that can vary optical and binocular vergence demands. For control, the subjects rested with eyes closed for 1.5 min after the task instead of the intervention. RESULTS: In the control group, accommodative contraction time (from far to near) and accommodative relaxation time (from near to far) was delayed from 1.13 to 1.68 s and from 1.36 to 1.60 s, respectively, and the symptom of asthenopia increased after rest. In the intervention group, however, changes in those functions were smaller than those in the control group. CONCLUSIONS: These results suggest that the new intervention with optical and binocular vergence demands is effective for the treatment of accommodative insufficiency that follows sustained periods of visual task, and consequently, the symptom of asthenopia induced by accommodative insufficiency may decrease.

Prevalence of Glaucoma and Its Systemic Risk Factors in a General Japanese Population: The Hisayama Study.

Purpose: To estimate the prevalence of glaucoma and its risk factors in a Japanese community. Methods: This study included 3405 Japanese community dwellers who were ≥40 years of age and enrolled in the Hisayama Study. This population-based, cross-sectional study was conducted from 2017 to 2018. A glaucoma screening test was performed using stereo fundus images and swept-source optical coherence tomography. Glaucoma was defined based on the International Society of Geographical and Epidemiological Ophthalmology criteria. Results: The prevalence of glaucoma was 7.6% (95% confidence interval [CI], 6.7-8.6) overall. The prevalence of primary open-angle glaucoma (POAG) was 5.8% (95% CI, 5.0-6.6); that of primary angle-closure glaucoma (PACG) was 0.7% (95% CI, 0.5-1.1); and that of exfoliation glaucoma was 1.1% (95% CI, 0.7-1.4). In addition to aging, lower estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 1.15; 95% CI, 1.02-1.33), higher intraocular pressure (OR = 1.06; 95% CI, 1.01-1.12), longer axial length (OR = 1.44; 95% CI, 1.31-1.59), and thinner central corneal thickness (CCT) (OR = 1.09; 95% CI, 1.04-1.15) were significant risk factors for POAG. Diabetes (OR = 2.81; 95% CI, 1.19-6.62) was a significant risk factor for PACG, and diabetes (OR = 2.15; 95% CI, 1.03-4.47) and thinner CCT (OR = 1.14; 95% CI, 1.02-1.28) were significant risk factors for exfoliation glaucoma. Conclusions: The prevalence of glaucoma was approximately 8%, probably due to the increase in the Japanese aging population. Not only ocular factors but also lower eGFR for POAG and diabetes for PACG and exfoliation glaucoma were risk factors in a general Japanese population. Translational Relevance: Systemic factors such as eGFR and diabetes must also be considered when implementing preventive measures against glaucoma.

Histology of fibrovascular membranes of proliferative diabetic retinopathy after intravitreal injection of bevacizumab.

PURPOSE: The purpose was to study the histology of the fibrovascular membranes in proliferative diabetic retinopathy (PDR) with an intravitreal injection of bevacizumab. METHODS: Light and electron microscopic studies were performed on surgical specimens obtained during a pars plana vitrectomy from 6 PDR eyes after intravitreal injection of bevacizumab. The patients had preoperatively received no or scant retinal photocoagulations. The presence and distribution of CD34 was assessed as a marker of vascular endothelium using immunostaining. The presence of vascular endothelial growth factor was stained with a method of immunostaining. As controls, we examined 7 surgical specimens from 7 PDR eyes obtained during pars plana vitrectomy without bevacizumab therapy. All control patients had preoperatively received full or nearly full pan retinal photocoagulations. RESULTS: Light microscopy showed that the CD34-positive vascular endothelial cells formed capillarylike structures in the fibrovascular membranes of all 13 PDR eyes. Vascular endothelial growth factor was positively stained in the vascular endothelium of both groups; however, the number of vascular endothelial growth factor-positive vascular endothelial cells significantly decreased in the fibrovascular membranes with intravitreal injection of bevacizumab. Electron microscopy showed the newly formed vascular endothelial cells with junctional complex in both groups. CONCLUSION: The vascular endothelial cells with decreased expression of vascular endothelial growth factor are still present in the fibrovascular membranes of patients with PDR after intravitreal injection of bevacizumab.

Effect of latanoprost on the diurnal variations in the intraocular and ocular perfusion pressure in normal tension glaucoma.

PURPOSE: To evaluate the effects of latanoprost on the diurnal variations in the intraocular pressure (IOP) combined with the ocular perfusion pressure (OPP) in patients with normal tension glaucoma (NTG). PATIENTS AND METHODS: Twenty-two eyes from 22 patients with NTG were used for the study. The diurnal variations in the IOP and blood pressure (BP) were measured every 3 hours without therapy, and then the patients were treated with latanoprost (0.005%) once daily for more than 12 weeks. The diurnal variations in the IOP and BP under medication were again measured every 6 hours. The diurnal variation of IOP for 24 hours, mean diurnal IOP, maximum IOP, minimum IOP, range of variation in IOP, OPP, and BP were compared between the baseline and after treatment by means of a paired t test. RESULTS: At 3 months after the start of the latanoprost treatment regimen, the IOP showed a statistically significant decrease at every assessed time point over 24 hours (P<0.001). Latanoprost significantly reduced the mean diurnal IOP, maximum IOP, minimum IOP, and mean range of variation in the IOP values from baseline (P<0.001, <0.001, <0.001, and 0.009, respectively). OPP after treatment showed no significant difference at any assessed time points from the baseline (P>0.1). Latanoprost did not significantly alter the mean diurnal OPP (P>0.1), and BP (P>0.5) from the baseline. CONCLUSIONS: Latanoprost was thus found to significantly reduce IOP over 24 hours, whereas it does not affect OPP and BP in NTG patients. Therefore, it may be a useful medication for NTG.

Ultrastructure of the trabecular meshwork in secondary glaucoma eyes after intravitreal triamcinolone acetonide.

PURPOSE: To study the histology of the trabecular meshwork of eyes with glaucoma by intravitreal injection of triamcinolone acetonide (TA). DESIGN: Two cases report. PARTICIPANTS/METHODS: A 68-year-old Japanese man with branch retinal vein occlusion and a 48-year-old Japanese woman with uveitis were treated by cataract surgery, intraocular lens implantation, and TA-assisted pars plana vitrectomy. At the end of surgery, TA suspension (4 mg) was intravitreously injected. During the follow-up period, the intraocular pressure (IOP) of the patients increased over 30 mm Hg even with full medication. Trabeculectomy was performed at 4 months after TA injection in case 1 and at 6 months in case 2, and intraocular pressure returned to the normal range in both cases. Light and electron microscopic studies of the resected trabecular tissue were carried out. RESULTS: The histology showed minimal deposition of extracellular matrix in the trabecular meshwork in case 1. Case 2 showed the beginnings of deposition of extracellular matrix including fingerprintlike material in the trabecular meshwork with decreased intertrabecular spaces. CONCLUSIONS: The ultrastructural changes in the trabecular meshwork of eyes with glaucoma after treatment with intravitreal TA might resemble those with glaucoma after topical corticosteroid treatment.

[Effects of visual optical stimuli for accommodation-convergence system on asthenopia].

PURPOSE: We investigated the effect on eyestrain of optical stimuli that we designed for accommodation and convergence systems. METHODS: Eight female students were given optical stimuli for accommodation and convergence systems for 1.5 min immediately after 20 min of a sustained task on a 3-D display. Before and after the trial, their ocular functions were measured and their symptoms were assessed. The optical stimuli were applied by moving targets of scenery images far and near around the far point position of both eyes on a horizonal place, which induced divergence in the direction of the eye position of rest. In a control group, subjects rested with closed eyes for 1.5 min instead of applying the optical stimuli. RESULTS: There were significant changes in the accommodative contraction time (from far to near) and the accommodative relaxation time (from near to far) and the lag of accommodation at near target, from 1.26 s to 1.62 s and from 1.49 s to 1.63 s and from 0.5 D to 0.65 D, respectively, and in the symptoms in the control group after the duration of closed-eye rest. In the stimulus group, however, the changes of those functions were smaller than in the control group. CONCLUSION: From these results, we suggest that our designed optical stimuli for accommodation and convergence systems are effective on asthenopia following accommodative dysfunction.

[A case of secondary retinal detachment caused by ocular toxocariasis].

PURPOSE: We report a case with bullous retinal detachment secondary to ocular toxocariasis. CASE: A 68-year-old man, who was a professional dog breeder, visited an ophthalmologist because of visual field defect in the left eye, and was referred to our clinic. The patient had bilateral cataract and bullous retinal detachment in the left eye. Fundus examinations after cataract surgery revealed no break but a white mass in the temporal lower peripheral retina of the left eye. Initial treatment with systemic corticosteroids was ineffective. Retinal detachment was treated by retinal cryocoagulation, scleral buckling, and subretinal fluid drainage. Subretinal fluid obtained during the operation showed high antibody titer for Toxocara canis. CONCLUSION: Ocular toxocariasis can cause bullous retinal detachment. To confirm the diagnosis, examination of the antibody titer of Toxocara canis in the subretinal fluid is useful.

[Effects of implementing clinical pathways for the care of patients undergoing ophthalmic surgery for cataract, glaucoma, and vitreoretinal disorder].

PURPOSE: To evaluate the actual use of clinical pathways and variances, and compare the length of hospital stay for surgery of cataract, glaucoma, and vitreoretinal disorder. METHODS: We designed eight types of clinical pathways for the treatment of cataract, glaucoma, and retinal-vitreous disease. We performed 102 phacoemulsifications and intraocular lens (IOL) implantations, 19 glaucoma or combined trabeculotomy and phacoemulsification/IOL, and 69 retinal-vitreous surgeries during a 1-year period from February 2002. We compared the length of the hospital stay before and after clinical pathway implementation. RESULTS: We applied the clinical pathways to 102 eyes (100%) of 67 patients undergoing phacoemulsification/IOL, to 17 eyes (89.5%) of those undergoing glaucoma surgery, and to 69 eyes (100%) of those undergoing retinal-vitreous surgery. The vaiances occurred in 20 eyes (29.9%) of 67 phacoemulsification/IOLs, 6 eyes (31.6%) of glaucoma, and 24 eyes (34.2%) of retinal-vitreous surgery. The length of hospital stay was shortened in phacomulsification/IOL after clinical pathway implemenation: 7.8 +/- 3.3 to 6.7 +/- 2.5 (mean +/- standard deviation) days. Glaucoma patients had a significantly shorter stay, from 16.4 +/- 5.0 to 12.6 +/- 3.3 days Mann-Whitney U test ; p = 0.032), and the hospital tay for retinal-vitreous surgery was shortened rom 22.8 +/- 11.1 to 17.9 +/- 6.2 days (p = 0.001). CONCLUSIONS: The application of clinical pathways resulted in substantially reduced hospital stay.

Clinical utility of antimicrobial susceptibility measurement plate covering formulated concentrations of various ophthalmic antimicrobial drugs.

PURPOSE: The purpose of this study was to evaluate the clinical utility of SG17, an ophthalmic antimicrobial susceptibility measurement plate. DESIGN: This was a multicenter, retrospective, observational study. PATIENTS AND METHODS: Using clinical isolates from patients with ocular infections, drug susceptibility testing using the Clinical Laboratory and Standards Institute standards was routinely conducted at five facilities. The minimum inhibitory concentrations of the isolated strains were determined using SG17 at the Research Foundation for Microbial Diseases of Osaka University. The records of antimicrobial drugs used and the therapeutic course were evaluated for all cases. The susceptibility results from SG17 and routine methods used at each facility were compared. RESULTS: A total of 112 bacterial strains were isolated from 92 patients. Of these cases, keratitis was the most common (52.2%), followed by conjunctivitis (21.7%) and others (26.1%). Principal signs and symptoms resolved in all patients, indicating that therapeutic effects had been achieved. With SG17, drug susceptibility was determined in 98.9% of isolates compared with 30.4% of isolates determined using conventional methods. By adapting the Clinical Laboratory and Standards Institute standards to SG17 results, we found that 91.3% of patients were susceptible and 7.6% were resistant. In five patients, drugs with a resistant evaluation were initially administered with no effect, and the patients were then switched to drugs with a susceptible evaluation with final resolution, indicating agreement of clinical results with SG17. CONCLUSION: SG17 can be used to determine drug susceptibility to antimicrobial agents currently used in ophthalmic practice. SG17 is useful for selecting antimicrobial drugs.

Congenital microcoria associated with late-onset developmental glaucoma.

PURPOSE: To demonstrate that developmental glaucoma (instead of the term goniodysgenetic glaucoma is used in this paper), defined as glaucoma with goniodysgenesis resulting from a fetal maldevelopment of the iridocorneal angle, develops in association with congenital microcoria. METHODS: Three subjects descended from a family with autosomal dominant congenital microcoria and goniodysgenesis were followed up for more than 25 years. RESULTS: The extended family consisted of 3 generations including 8 males and 10 females. In the second generation, 2 of 7 subjects who presented with a history of congenital microcoria had late-onset goniodysgenetic glaucoma. In the third generation, all 3 descendants of the second generation subjects with congenital microcoria had congenital microcoria with goniodysgenesis. Two of these subjects developed late-onset goniodysgenetic glaucoma in both eyes during the 25-years follow-up period. They were both treated with a trabeculectomy in both eyes to control the glaucoma. Histologically, the iridocorneal angle tissues from the patients showed thick juxtacanalicular connective tissue with accumulations of a basement membrane-like extracellular matrix. CONCLUSION: Congenital microcoria are considered to be frequently associated with the incidence of late-onset goniodysgenetic glaucoma.

The rarity of Charles Bonnet syndrome.

Charles Bonnet syndrome (CBS) is characterized by complex visual hallucinations in otherwise psychologically normal people. Estimates of the prevalence of CBS in different samples vary from a small percentage (around 1%), to a relatively large percentage (about 10%). The purpose of the present study is to determine whether CBS is rare or not. One-thousand ophthalmologic and optometric outpatients at a university hospital were consecutively screened by a questionnaire to identify patients possibly experiencing visual hallucinations. The mean corrected visual acuity in the best eye was 1.1. Those who positively responded to the questionnaire were further investigated to determine whether their symptoms were consistent with CBS. As a result, the prevalence of CBS was 0.5% (5/1000). In subclass analyses, the prevalence was 3 of 372 (0.8%) in the low vision group, 2 of 346 (0.6%) in the elderly, and 1 of 120 (0.8%) in both conditions. These were not significantly different from each other or from the overall prevalence (0.5%). This low prevalence of CBS in our subjects may be due to their relatively good visual acuity because previous studies with high prevalence of CBS investigated patients with a visual acuity of less than 0.3. The prevalence of CBS may be low in patients with these particular characteristics, and this syndrome seems to be rare in even ophthalmologic and optometric patients if they do not have seriously low vision. Further studies are needed to investigate the prevalence of CBS in general population.

Cornea with Peters' anomaly: perturbed differentiation of corneal cells and abnormal extracellular matrix in the corneal stroma.

PURPOSE: We examined histopathologically the anterior ocular segment including the cornea and lens of an eye which had been enucleated in a patient with Peters' anomaly because of untreatable corneal perforation. Special effort was made to differentiate the corneal stromal and endothelial cells, and the stromal extracellular matrix. METHODS: Light microscopy, with hematoxylin and eosin staining, and transmission electron microscopy were employed. RESULTS: Corneal endothelial cells and Descemet's membrane were not detected in the central cornea, where there were immature cells with a fibroblastic configuration. The inner surface of the peripheral cornea was covered with cells containing pigment granules in the cytoplasm. Cell density in the central corneal stroma was relatively high. The diameter of the stromal collagen fibrils was not uniform. A mature collagen fibril-free area was also seen in the central corneal stroma. CONCLUSIONS: Differentiation of neural crest-derived cells in corneal stroma and endothelium might have been perturbed in the cornea of this patient with Peters' anomaly, inducing the defect in the corneal endothelium and the qualitative and quantitative abnormalities of the extracellular matrix.

[The accommodative characteristics of gazing at stereoscopic images on a 3-D display].

PURPOSE: We measured the accommodative response in order to investigate the influence of a visual function when gazing at stereoscopic images presented on a three dimensional display. METHODS: Accommodative step responses were measured using an infrared optometer, setting the far target at the distance of 1 m and the near target at the distance of 50 cm. The step response of the right eye was examined 6 times at 10-second intervals. The far target was a starburst as a real image and the near target was a white circle on a random dot background on a parallax barrier system three-dimensional display as a stereoscopic image generated with a 90-min arc binocular crossed disparity(+1.5 degrees) and a 90-min arc binocular uncrossed disparity (-1.5 degrees), and a 0-min disparity (0 degree). The near target was presented in 4 ways: 1. -1.5 degrees disparity alone, 2. 0-min disparity alone, 3. +1.5 degrees disparity alone, and 4. +1.5 degrees and -1.5 degrees disparity alternately. RESULTS: In conditions 1 to 3, the mean +/- standard deviation values of the accommodative response were 0.59 +/- 0.16 D, 0.72 +/- 0.11 D, and 1.03 +/- 0.21 D, respectively. The accommodative response was very large at the disparity of +1.5 degrees compared with the disparity of 0 degree (p = 0.0300). It was not significant although there was a tendency to become small at the disparity of -1.5 degrees (p = 0.0707). In condition 4, the mean +/- standard deviation values of the accommodative response were 0.62 +/- 0.12 D in the condition of -1.5 degrees and 1.03 +/- 0.26 D in condition +1.5 degrees with significant difference (p = 0.0122). CONCLUSIONS: The over accommodation response is induced when gazing at a stereoscopic image under the condition of binocular crossed disparity. This indicates that gazing at stereoscopic images has ill effects on the accommodative system.