Miraflow, Soft Contact Lens Cleaner: Activity Against Acanthamoeba Spp.

OBJECTIVE: Miraflow is a cleaner for soft contact lens which contains 20% isopropyl alcohol. The purpose of this study was to determine the activity against Acanthamoeba trophozoites and cysts for Miraflow. In addition, to determine the activity of combined Miraflow and multipurpose solutions (MPSs) against Acanthamoeba cysts. METHODS: Two simulated-use studies were conducted. The significance in the log reduction in the number of trophozoites and cysts of A. castellanii strains ATCC 50514 and ATCC 50370 or A. polyphaga ATCC 30461 after exposure to Miraflow alone was determined by the Spearman-Karber method. To examine the activity against Acanthamoeba of combined Miraflow and an MPS, the log reduction in the number of cysts after a 1-min exposure to Miraflow followed by a 4-hr exposure to MPS (ReNu fresh) was also determined. RESULTS: Short-time exposure of 30 sec to Miraflow demonstrated activity against the Acanthamoeba trophozoites. However, a 1-min treatment was only relatively effective (1.1 log reduction) against the cysts of A. castellanii ATCC 50514, but no statistically significant reduction was observed for the cysts of the other 2 strains. The combined use with Miraflow and MPS demonstrated activity against the cysts, and a 3.0, 1.0, or 1.5 log reduction in the numbers was obtained for A. castellanii ATCC 50514, A. castellanii ATCC 50370, and A. polyphaga ATCC 30461, respectively. CONCLUSIONS: Exposure to combined Miraflow and MPS resulted in reductions in the number of Acanthamoeba cysts.

Correlation Between Recurrent Subconjunctival Hemorrhages and Conjunctivochalasis by Clinical Profile and Successful Surgical Outcome.

OBJECTIVE: To characterize the clinical profile of patients with recurrent subconjunctival hemorrhages (SCHs) and evaluate the effect of conjunctivochalasis (CCh) surgery on disease recurrences. METHODS: Three hundred and sixty-two patients with SCHs (mean age, 56.4±16.0 years) were enrolled in this multicenter epidemiologic study. The severity of CCh, lifestyle at the time of SCH onset, and the frequency of previous SCHs were compared. Thirty-eight patients with 2 or more episodes of SCHs (mean age, 68.2±8.9 years) underwent surgery for CCh. The effectiveness of surgery was evaluated by comparing the frequency of SCH preoperatively and postoperatively. RESULTS: Patients with three or more recurrent SCHs showed a significantly (P=0.003) higher grade of CCh and tended to be engaged in activities that require visual concentration, such as watching a visual display terminal, knitting, reading, and driving. More than 80% of eyes that underwent surgery to CCh showed no recurrence of the hemorrhages, and the frequency of SCH significantly (P<0.0001) decreased postoperatively. CONCLUSIONS: Moderate or severe CCh and activities that may cause dry eye can be considered to be risk factors for recurrent SCHs. Surgery to treat CCh is a useful option for patients with frequent recurrences of SCHs.

Evaluation of allergic conjunctivitis by thermography.

PURPOSE: To evaluate ocular surface temperature in assessing the efficacy of anti-allergic eye drops. METHODS: Thirteen asymptomatic patients (24.7 ± 2.8 years) with proven seasonal allergic conjunctivitis due to cedar pollen were studied. A 0.025% levocabastine ophthalmic suspension was instilled in one eye (levocabastine eye) and artificial tears in the other eye (artificial tear eye) in a masked fashion 10 min prior to a conjunctival allergen challenge (CAC). Then, a drop of cedar pollen solution was dropped into the conjunctival sac to induce the allergic reaction. The surface temperature of the inferior bulbar conjunctiva was measured before and 30 min after the CAC with a newly developed non-contact ocular surface thermographer (OST). The degree of conjunctival injection and chemosis was also determined by slit-lamp biomicroscopy. The changes in the symptoms were evaluated by a questionnaire. RESULTS: After the CAC, the temperature increased by 0.67 ± 0.10°C in the artificial tear eyes but by only 0.21 ± 0.06°C in the levocabastine eyes (p < 0.05). The score for conjunctival injection was 1.38 ± 0.24 and the chemosis score was 0.85 ± 0.25 for the artificial tear eyes and 0.62 ± 0.27 and 0.08 ± 0.08 in the levocabastine eyes (p < 0.01). The temperature increase was significantly correlated with the conjunctival injection scores (r = 0.63; p < 0.001). CONCLUSION: The significant correlation of the conjunctival surface temperature with the severity of the conjunctival allergic reaction indicates that the temperature measured by the OST can be used to objectively evaluate the efficacy of topical anti-allergic agents.

New side-view imaging technique for observing posterior chamber structures during cataract surgery in porcine eyes.

BACKGROUND: To develop a side-view imaging technique for observing the dynamic behavior of posterior chamber structures (PCSs) in porcine eyes which mimics closed-eye cataract surgery in humans. METHODS: Enucleated porcine eyes were placed into liquid nitrogen for 5 seconds and immediately bisected at about a 45-degree angle to the equatorial plane. The anterior portion was attached firmly to a glass slide with superglue and sprinkled with wheat flour. Phacoemulsification and aspiration (PEA) was performed as in humans on 10 consecutive porcine eyes. The movements of the PCSs were monitored through the glass slide with a high-resolution video camera set below the cut surface of the eye. The intraocular pressure (IOP) was monitored during the surgery. The highest IOP, operation time, and volume of irrigation fluid of 10 whole eyes were compared to that obtained from the bisected eyes glued to a glass slide. In a second set of experiments, the strength of the seal between the bisected eye and the glass slide was tested in three sets of eyes: 1) frozen eye fixed with superglue with wheat flour for 3 min; 2) frozen eye fixed with superglue for 3 min; and 3) non-frozen eye fixed with superglue for 30 min. The highest IOP that led to a disruption of the seal was compared among the three groups. RESULTS: PEA was successfully performed on 9 of 10 (90%) eyes with the movements of the PCSs clearly observed. The average maximum intraocular pressure of the 9 bisected eyes was 55.8 ± 4.7 mmHg and that for the 10 unbisected eyes was 55.3 ± 5.0 mmHg (P = 0.650). The frozen eye fixed with superglue in combination with wheat flour (Group 1) had the strongest sealing strength with an average IOP at the breaking point of 117.3 ± 36.2 mmHg. CONCLUSIONS: Our side-view imaging technique can be used to evaluate the changes of the PCSs during intraocular surgery and for surgical training of new residents.

Antimicrobial efficacy tests of multipurpose contact lens care solutions simulating poor contact lens hygiene behaviors.

PURPOSE: The aim of this study was to simulate the biofilm formation in contact lens (CL) case under poor hygiene behaviors; antimicrobial efficacies of multipurpose solutions (MPSs) against biofilm on the lens case were evaluated. METHODS: Five MPSs (Epica Cold, Complete 10 min, ReNu MultiPlus, SoftOne Mois, and OPTI-FREE Plus) were tested. Lens cases containing ACUVUE2 were inoculated with 1×10, 10, or 10 colony-forming units (CFUs) of Staphylococcus epidermidis (SE). Each lens case was treated with 1 MPS for 4 hrs followed by the estimation of the number of SE by the CFU method. Disinfection efficacies of MPSs against SE biofilm were evaluated by biomicroscopy with safranin staining and scanning electron microscopy. RESULTS: Lens cases, inoculated with 1×10 CFU, were disinfected by all MPSs. Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE showed almost a 2-log reduction of the CFU, whereas SoftOne Mois effect was almost a 1 log reduction, significantly lower than other MPSs (P<0.05). No biofilm formations were observed in Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE Plus-treated groups unlike significant biofilm formation in the SoftOne Mois-treated group (P<0.01). CONCLUSIONS: Greater efforts to educate patients regarding compliant lens care behavior are needed to reduce the incidence of CL-associated microbial keratitis.

[Sustained effects of sodium hyaluronate solution on tear film stability evaluated by Tear Stability Analysis System].

PURPOSE: To investigate the sustained effects of sodium hyaluronate solution (HA) on tear film stability using a Tear Stability Analysis System (TSAS), a method enabling quantitative evaluation of tear film stability. METHODS: Eighteen eyes of 18 normal subjects (N group) and 21 eyes of 21 dry eye patients (D group) were examined. Dry eye was diagnosed by the 2006 diagnostic criteria. In each subject, artificial tears (AT), 0.1% sodium hyaluronate solution (H 01) or 0.3% sodium hyaluronate solution (H 03) were instilled into both eyes, and tear film stability in the right eye before and 1, 5, 15, 30, 60 and 120 minutes after instillation was compared using a break up index (BUI: 0-100), the TSAS's index of tear film stability. RESULTS: N group: In both the AT and H 01 subgroups, no significant change was found in the BUI ratios (BUI after instillation/before instillation) at any point during the 120 minute period after instillation. However, in the H 03 subgroup, the BUI ratio temporarily decreased to 0.650 one minute after H 03 instillation (p = 0.0038). D group: In the AT subgroup, the BUI ratio significantly increased to 1.568 five minutes after AT instillation (p = 0.0259), but began to decrease 15 minutes after instillation and returned to the initial value 30 minutes after instillation. In the H 01 subgroup, the BUI ratio significantly increased to 1.531 five minutes after H 01 instillation (p = 0.0087), and was maintained at 1.347 120 minutes after instillation (p = 0.0088). In the H 03 subgroup, the BUI ratio rose to 1.544 15 minutes after H 03 instillation (p = 0.0009), and was maintained at high levels of 1.413 30 minutes after (p = 0.0122), 1.629 60 minutes after (p = 0.0008), and 1.407 120 minutes after instillation (p = 0.0008). CONCLUSION: The current study confirms that both 0.1 and 0.3% sodium hyaluronate solution effectively improve tear film stability in dry eyes for up to two hours after instillation.

[Survey of severe contact lens-associated microbial keratitis in Japan].

PURPOSE: To understand the current state of severe contact lens (CL)-associated microbial keratitis in Japan. METHOD: The survey was conducted by the Japan Contact Lens Society and the Japanese Association for Ocular Infection in 224 facilities from April 2007 to March 2009. Patients who were diagnosed with CL-associated microbial keratitis and hospitalized for treatment were enrolled. Clinical characteristics of the keratitis, microbiologic findings and the status of CL hygiene were studied. RESULTS: A total of 350 patients were investigated, with an average age of 28.0 (9-90) years. Acanthamoeba was identified in 85 (24.3%) corneal specimens and Pseudomonus aeruginosa in 70 (20.0%) cases. One hundred ninety six (56.0%) patients were frequent replacement soft CL users. Extended wearing of daily-use CLs was found in 77 (22.0%) patients. Only 67 cases maintained good CL hygiene by daily rubbing-washing and the poor CL care situation was reviewed. CONCLUSION: The most frequently detected pathogenic microorganism was Acanthamoeba, followed by Pseudomonus aeruginosa. Our survey showed the importance of keeping good CL hygiene by proper lens care, and improvement of CL-related social regulations is urgently needed.

Association of foveal avascular zone with the metamorphopsia in epiretinal membrane.

This study was to investigate the relationship between the metamorphopsia and foveal avascular zone (FAZ) parameter in eyes with epiratinal membrane (ERM). We studied patients with an ERM visited retinal service unit at the Kagoshima University Hospital or Shirai Hospital. The best-corrected visual acuity (BCVA), and the degree of metamorphopsia by M -CHARTS™ were evaluated. The 3 × 3 mm optical coherence tomography angiography (OCTA) images of the superficial layer were obtained. Area (mm2), the circularity, eigen value were calculated using ImageJ software. The relationship between visual function, such as best corrected visual acuity (BCVA) and metamorphopsia, and FAZ parameters were studied by Pearson's correlational coefficient. Fifty-four eyes of 51 patients (24 men and 27 women) with an ERM were studied. The mean age of the patients was 69.6 ± 8.20 years. The mean BCVA and metamorphopsia score was 0.31 ± 0.29 logMAR units and 0.49 ± 0.42. There was no significant relationship between BCVA and FAZ parameters. While, metamorphopsia score was significantly and negatively correlated with all of FAZ parameters (area R = - 0.491, P < 0.001; circularity R = - 0.385, P = 0.004; eigenvalue ratio R = - 0.341; P = 0.012). Multiple regression analysis showed the FAZ area was solely and significantly correlated with metamorphopsia score (ß - 0.479, P < 0.001). The size but not the shape of the FAZ was significantly correlated with the degree of metamorphopsia suggesting that it could be an objective parameter of metamorphopsia in ERM patients.

Effects of multipurpose contact lens care solutions on the adhesiveness of Acanthamoeba to corneal epithelial cells.

PURPOSE: To study the adhesion of Acanthamoeba castellanii treated with multipurpose contact lens care solutions (MPSs) to human corneal epithelial cells. METHODS: Cell suspensions of A. castellanii (ATCC50514) trophozoites were mixed with six MPSs: MPS-A (polyhexamethylene biguanide [PHMB], macrogolglycerol hydroxystearate, propylene glycol), MPS-B (PHMB, poloxamine, boric acid), MPS-C (polyquad, poloxamine, boric acid), MPS-D (PHMB, poloxamer, propylene glycol), MPS-E (PHMB, poloxamer), or MPS-F (PHMB, poloxamer) for 4 hr. Morphologic changes of A. castellanii after exposure with MPSs were observed with scanning electron microscopy. A. castellanii cells treated with MPS for 4 hr were inoculated onto cultured SV40-immortalized human corneal epithelial cells. After 2-hr incubation, the number of adherent A. castellanii was assessed by 18S-rDNA quantification using real-time polymer chain reaction. RESULTS: After 4-hr incubation, MPS-A- and MPS-B-treated A. castellanii have changed from trophozoite morphology into cyst form; however, MPS-E- and MPS-F-treated A. castellanii maintained trophozoite morphology. In contrast, both cyst and trophozoite forms were observed in MPS-C- and MPS-D-treated A. castellanii. The adherence rate of A. castellanii was approximately two times higher in MPS-E (not significant), and more than three times higher in MPS-F (P<0.05) compared with MPS-A, which produced the lowest adhesiveness as estimated by real-time polymer chain reaction. CONCLUSIONS: Taken together, these results support the possibility that chronic use of MPS with the lowest efficacies on promoting encystment of A. castellanii (MPS-E and MPS-F) by hydrogel contact lens wearers may increase adhesiveness of A. castellanii to corneal epithelial cells.

Cytomegalovirus as an etiologic factor in corneal endotheliitis.

PURPOSE: To investigate clinical manifestations and response to antiviral therapy of 8 patients with cytomegalovirus (CMV)-induced corneal endotheliitis who were diagnosed and treated at 2 university hospitals in Japan. DESIGN: Retrospective, consecutive, multicenter case series. PARTICIPANTS: Eight eyes of 8 patients diagnosed with active CMV corneal endotheliitis at Kyoto Prefectural University of Medicine and Ehime University School of Medicine. The diagnosis was made based on the detection by polymerase chain reaction assay of CMV, but not herpes simplex virus (HSV) and varicella zoster virus (VZV) DNA, in the aqueous humor from the affected eye. METHODS: Retrospective review of the clinical manifestations and responses to antiviral treatment. MAIN OUTCOME MEASURES: Patient profiles, including duration of corneal endotheliitis, systemic disease, intraocular pressure, and clinical manifestation of anterior and posterior segments. The clinical response to systemic and topical antiviral treatment was evaluated by slit-lamp examination. Corneal endothelial density was examined by specular microscopy. RESULTS: The average observation period after CMV detection was 10.4 months (range, 2-24 months). None of the patients had systemic immunodeficiency. Corneal manifestations included linear keratic precipitates associated with multiple coin-shaped lesions and local corneal stromal edema. Of the 8 patients, 4 had undergone penetrating corneal transplantation. Systemic ganciclovir therapy was used in 7 patients, and in 1 patient, valacyclovir was administered, with the corneal endotheliitis responding quickly to the early administration of galovir. At the final examination, 6 eyes had a clear cornea, but 2 eyes had bullous keratopathy. CONCLUSIONS: Besides HSV and VZV, CMV must be considered as an etiologic agent in patients with corneal endotheliitis. Cytomegalovirus corneal endotheliitis may be a newly identified clinical entity of reactivated CMV in the anterior chamber of individuals free of accompanying systemic symptoms.

Incidence of endophthalmitis and the perioperative practices of cataract surgery in Japan: Japanese Prospective Multicenter Study for Postoperative Endophthalmitis after Cataract Surgery.

PURPOSE: To prospectively survey the incidence of endophthalmitis following cataract surgery and investigate the current perioperative practices in Japan. METHODS: Patients who underwent cataract surgery from January 2012 to December 2013 were included. Information on perioperative practices were recorded prospectively. Clinical characteristics were examined in cases with endophthalmitis. RESULTS: A total of 63,244 patients who underwent cataract surgery in 205 facilities were enrolled. The detailed information about the current perioperative scenario surrounding cataract surgery in Japan was evaluated for the preoperative, intraoperative, and postoperative practices, i.e., patient background, prophylactic antibiotic regimen, modes of disinfection or disinfectant use, preoperative procedure, surgical method, surgical materials, surgical complication, or others. Postoperative endophthalmitis developed in 25 patients within 8 weeks postoperatively (incidence 0.04%). However, since outbreaks of toxic anterior segment syndrome (TASS) after implantation of intraocular lenses contaminated with aluminum (HOYA iSert 251 and 255) were reported, 10,261 cases implanted with the lenses had been excluded (as having a risk for non-infectious late-onset TASS). In the remaining 52,983 cases, postoperative endophthalmitis developed in 13 cases within 8 weeks postoperatively (incidence 0.025%). CONCLUSIONS: This prospective survey identified the current perioperative practices representing cataract surgery and the incidence of endophthalmitis following cataract surgery (0.025%) in Japan. We believe this information can serve as a guide for future improvement in risk-reduction strategies.

Demonstration of "owl's eye" morphology by confocal microscopy in a patient with presumed cytomegalovirus corneal endotheliitis.

PURPOSE: To report confocal microscopic observations of characteristic corneal endothelial lesions in a patient with presumed cytomegalovirus (CMV) corneal endotheliitis. DESIGN: Case report. METHODS: A 77-year-old, immunocompetent man was admitted with corneal edema, keratic precipitates, and coin-shaped lesions in the right eye. Confocal microscopy was performed to examine the corneal endothelium. Polymerase chain reaction (PCR) was used to identify viral DNA in an aqueous humor sample. RESULTS: CMV DNA was detected by PCR. Confocal microscopy showed large corneal endothelial cells with an area of high reflection in the nucleus surrounded by a halo of low reflection. This "owl's eye" morphology is characteristic of CMV infection. Topical and intravenous ganciclovir treatment resulted in rapid resolution of the corneal precipitates and edema, followed by disappearance of the owl's eye morphology. CONCLUSIONS: Confocal microscopy can detect the owl's eye morphology in the corneal endothelium of patients with presumed CMV corneal endotheliitis.

DNA of cytomegalovirus detected by PCR in aqueous of patient with corneal endotheliitis after penetrating keratoplasty.

PURPOSE: Corneal endotheliitis often leads to severe endothelial dysfunction and can be caused by herpes simplex virus (HSV), varicella zoster virus (VZV), and other viruses (eg, the mumps virus). We report a case of corneal endotheliitis caused by cytomegalovirus (CMV) that developed after a penetrating keratoplasty. METHODS: A complete ophthalmologic examination was performed on a patient with corneal endotheliitis that developed after a penetrating keratoplasty. To determine the cause of the endotheliitis, polymerase chain reaction (PCR) was used to amplify the DNA of HSV, VZV, and CMV in samples of the aqueous humor. RESULTS: Slit-lamp biomicroscopy showed a moderate stromal edema in the upper temporal part of the transplanted cornea along with keratic precipitates (KPs) arranged in a coin-shaped pattern. Repeated treatments with steroids and acyclovir were only temporarily successful. PCR detected the DNA of CMV in an aqueous sample, and the treatment was switched to topical and systemic application of ganciclovir. This resulted in the disappearance of the KPs and resolution of the stromal edema within 2 weeks. CONCLUSIONS: From the PCR results and the favorable response to ganciclovir, the corneal endotheliitis was most likely caused by cytomegalovirus in this case.

National survey on bullous keratopathy in Japan.

PURPOSE: To present the results of a national survey on bullous keratopathy (BK) in Japan. METHODS: A cross-sectional national survey was conducted for 963 eyes with BK seen between 1999 and 2001 by members of the Japan Cornea Society. Demographic characteristics, type of surgery, complications, and postoperative outcome were analyzed. RESULTS: BK accounted for 24.2% (963 eyes) of total keratoplasties performed during the period. Graft clarity was maintained in 77.4% of cases, and immunologic rejection and elevated intraocular pressure was noted in 10.8% and 15.3%, respectively. Cataract surgery was the most common cause of BK (n = 428, 44.4%), and phacoemulsification and aspiration were performed in approximately 40% of cases. BK secondary to laser iridotomy (LI) was the second most common cause of BK (n = 225, 23.4%). LI was performed as a prophylactic measure in approximately one half of these cases. BK developed with a mean duration of 6.8 years after LI. Fuchs dystrophy was the cause of BK in 18 eyes (1.9%). CONCLUSIONS: The causes of BK in Japan are considerably different from those in other Western countries. LI-related BKs showed a remarkably high number, whereas Fuchs dystrophy was observed only rarely.

Incidence of endophthalmitis after cataract surgery in Japan.

PURPOSE: To estimate the incidence rate of endophthalmitis after cataract surgery performed by Japanese surgeons. METHODS: A sample of 20% of members of the Japanese Society of Ophthalmic Surgeons was randomly selected. Each member was sent a postal survey asking for information on the number of cataract surgeries performed in 2003 and the number of postsurgery cases of endophthalmitis. RESULTS: Replies were received from 78.7% (513/652) of survey recipients. The total number of cataract surgeries was 100 539, among which 52 cases of endophthalmitis occurred, resulting in an overall incidence rate of 0.052%. Incidence rates were 0.049% (38/78 170) for scleral incision phacoemulsification and 0.043% (9/20 894) for clear corneal incision phacoemulsification, with no significant difference between groups. The average annual volumes of surgery were 210 and 280 cases for surgeons who preferred scleral incision and clear corneal incision, respectively. There was a significant difference between volumes (Student's t-test, p < 0.01). The incidence of endophthalmitis was significantly lower with high-volume (> 300 cases/year) surgeons than with low-volume (< or = 300 cases/year) surgeons (0.040% versus 0.066%, chi-square test, p < 0.05). CONCLUSIONS: The incidence of endophthalmitis after cataract surgery in Japan as estimated by a postal survey was low (0.052%) and consistent with rates reported previously. Surgeons who preferred clear corneal incision performed significantly more surgeries annually, but the incidence of endophthalmitis was similar between scleral and clear corneal incision phacoemulsification surgery.

Demonstration of aqueous streaming through a laser iridotomy window against the corneal endothelium.

OBJECTIVE: To determine the pathogenesis of the bullous keratopathy that is frequently observed in patients after argon laser iridotomy (ALI) by comparing the changes in aqueous flow after ALI with those that follow peripheral iridectomy in rabbit eyes. METHODS: Silicone particles were injected into the anterior chamber of rabbit eyes as tracers to monitor aqueous flow. Particle tracking velocimetry with image analysis was used to determine the direction and speed of aqueous flow in 5 pigmented rabbits that underwent ALI and 5 that underwent peripheral iridectomy. RESULTS: In the ALI group, silicone particles were found to stream through the iridotomy window against the corneal endothelium immediately after the pupil was constricted by a light stimulus. The mean +/- SD speed of the particles was 2.97 +/- 1.51 mm/s. In contrast, the mean +/- SD flow rate through the iridectomy window in the peripheral iridectomy group was significantly slower at 0.36 +/- 0.30 mm/s (P = .01). CONCLUSION: Constriction of the pupil elicited marked aqueous streaming through the ALI window against the corneal endothelium. Clinical Relevance The mechanical stress to the corneal endothelium by the abnormal aqueous stream may be partially responsible for the corneal decompensation that follows ALI.

Marx line: fluorescein staining line on the inner lid as indicator of meibomian gland function.

PURPOSE: To determine whether the location of a fluorescein-stained line, the Marx line (ML), which runs along the inner eyelid, is correlated with meibomian gland function. DESIGN: Prospective observational case series. METHODS: After applying fluorescein dye solution to the eye, the ML score was calculated for the outer, middle, and inner thirds of the lower eyelid margin. ML scoring was as follows: 0, entirely on the conjunctival side of the meibomian orifices (MOs); 1, part of the ML touches the MOs; 2, ML runs through all of the MOs; and 3, ML runs on the eyelid-margin side of the MOs. Correlations were calculated between the total ML score and age for 251 randomly recruited subjects without acute ocular surface diseases, and between age and the ML score for the three regions of the lower eyelid. Correlations between the regional ML score and the meibographic score, and the meibomian gland secretion score were also determined. The total ML scores of 15 subjects without meibomian gland dysfunction (MGD) were compared with 15 age-matched patients with MGD. RESULTS: The three regions of the lower eyelid had significantly different ML scores. Strong correlations were found between the ML score and age, the meibographic score, and the meibomian gland secretion score. The total ML score of MGD group was significantly higher than that of the non-MGD group. CONCLUSIONS: The strong correlation between the ML score and the meibomian gland scores indicates that the ML score can be used as a simple and rapid screening score for meibomian gland function.

[Comparison of minimum inhibitory concentration and postantibiotic effect of eyedrops on isolates in National Surveillance of Infectious Keratitis in Japan].

PURPOSE: To determine the minimum inhibitory concentration (MIC) and postantibiotic effect (PAE) of antibiotic eyedrops against various isolates from infectious keratitis samples. METHOD: MIC and postantibiotic bactericidal effect (PABE)/postantibiotic fungicidal effect (PAFE) after 4 min of exposure to nine antibacterial eyedrops or four antifungals were examined using 100 clinical isolates collected by the National Surveillance of Infectious Keratitis in Japan in 2003. RESULT: The PABEs of tobramycin and micronomicin sulfate showed better results than other drugs, and the other drugs demonstrated various PABEs depending on the bacterial strains; in particular most drugs showed low PABE against Serratia marcescens. There were no significant differences between PABEs of methicillin-resistant and methicillin-susceptible Staphylococci. Also there was no statistical correlation between MIC and PABE of Staphylococci. All the antifungals demonstrated low PAFE against Candida spp. CONCLUSION: PABE/PAFEs vary among species of microorganisms, and since they have no relation with the usual MIC, various other factors, including species of isolates, actual clinical effects, and prevention of drug-resistance induction, should be considered in the selection of drugs.