SARS-CoV-2 infection status in corneal preservation solution and COVID-19 prevalence after corneal transplantation.

The potential risks associated with organs from COVID-19-infected donors were unclear. To determine the SARS-CoV-2 infection status of corneas transplanted during the COVID-19 pandemic, we performed a polymerase chain reaction (PCR) using the corneal preservation solution that was used for corneal transplantation. We also examined the postoperative health status of the recipients. This study included 144 transplants in 143 eyes. Ninety-nine eyes of imported corneas and 10 of the 14 corneas donated in the prefecture were PCR tested at our hospital, and all were SARS-CoV-2 negative. All corneal transplants were performed after confirming their SARS-CoV-2 negativity by a PCR using a corneal preservation solution at our hospital or a nasopharyngeal swab at a previous facility. Despite postoperative steroid administration, no patient developed COVID-19 infection until discharge. Hence, if the donor's nasopharyngeal swab test is SARS-CoV-2 negative, COVID-19 infection in the recipient due to corneal transplantation may be prevented. Since corneal transplant recipients are susceptible to infection due to prolonged steroid administration and are at high risk for severe diseases if infection occurs, SARS-CoV-2 detection testing using nasopharyngeal swabs in donors should be performed.

Simultaneous Vitreoretinal Surgery and Sclerokeratoplasty for Keratoglobus with Intraocular Hemorrhage and Extensive Corneal Rupture.

We reported a case of simultaneous vitrectomy and sclerokeratoplasty (SKP) performed for keratoglobus with extensive corneal rupture and intraocular hemorrhage caused by trauma. A 73-year-old woman was treated for keratoglobus and glaucoma. She was punched in both eyes, her right eye showed corneal rupture and the left eye showed prolapse of the ocular contents due to eyeball rupture. She immediately underwent corneal sutures in the right eye and resection of the prolapsed ocular contents in the left eye at a nearby ophthalmological clinic. Three days after the injury, the patient was referred to our clinic for vision recovery. The best corrected visual acuity of the right eye was measured by counting fingers. Her right eye presented severe corneal edema with a sutured corneal wound in the upper periphery, which was positive in the Seidel test. B-mode ultrasound revealed choroidal detachment and subchoroidal hemorrhage. Fourteen days after injury, simultaneous corneal suture and posterior sclerotomy were performed in the right eye, but corneal fragility and corneal opacity were prominent, and B-mode examination revealed prolonged vitreous hemorrhage and retinal detachment. Twenty-one days after injury, we performed simultaneous SKP and 25-G pars plana vitrectomy (PPV). In this procedure, we initially performed SKP followed by 25-G PPV without a keratoprosthesis or endoscope. The visibility of the fundus through the corneoscleral graft was good during vitrectomy. Three months after surgery, her corrected visual acuity improved to 10/1,000. Although there was mild corneal stromal edema and khodadoust line, there were no obvious fundus complications. Simultaneous SKP and PPV for keratoglobus with extensive corneal rupture and vitreous diseases may be a good option.

Improving the effect of NaOCl pretreatment on bonding to caries-affected dentin using self-etch adhesives.

OBJECTIVE: To evaluate the effect of sodium hypochlorite pretreatment on adhesion to normal and caries-affected dentin using self-etch adhesives. METHODS: Forty extracted human molars with coronal carious lesions were used in this experiment. The occlusal dentin surfaces including the caries-affected dentin in each group were treated as follows: group 1, rinsed with water; group 2, treated with 6% NaOCl for 15s; group 3, treated with 6% NaOCl for 30 s; group 4, application with Accel for 30 s after NaOCl-30 s pretreatment. After rinsing with water and air-drying, the treated dentin surfaces were applied with self-etch systems (Bond Force and Clearfil Protect Bond) according to the manufacturers' instructions, and built-up with resin composite. After 37 degrees C water storage for 24 h, the bonded normal or caries-affected dentin areas were isolated to create an hourglass configuration with a cross-sectional area of approximately 1 mm(2). The specimens were subjected to tensile stress at a cross-head speed of 1.0 mm/min. RESULTS: NaOCl-15 s pretreatment significantly improved the muTBS of both self-etch adhesives to caries-affected dentin, while the 30 s pretreatment did not affect them. For normal dentin, NaOCl-30 s pretreatment significantly reduced the muTBS of both self-etch adhesives although the 15s pretreatment did not alter them. Furthermore, the application of Accel with a reducing effect increased the muTBS to normal and caries-affected dentin treated with NaOCl for 30 s. CONCLUSIONS: The effects of NaOCl pretreatment on bonding of both self-etch adhesives were dependent upon type of dentin (normal and caries-affected dentin) and the treatment time.

Penetration of silver nitrate into bleached enamel, dentin, and cementum.

OBJECTIVE: To observe the effect of 10% carbamide peroxide bleaching agent on the enamel, dentin, and cementum of human teeth. METHOD AND MATERIALS: Teeth were treated with one of two 10% carbamide peroxide bleaching agents (3M Zaris, 3M Espe; Nite White Excel, Discus Dental) for 2 hours/day for 7 or 14 days. Treated teeth and 10 additional nontreated teeth were immersed in 50% silver nitrate solution. The prepared surface was then viewed under a confocal laser scanning microscope, photomicrographs were taken, and the degree of penetration of silver nitrate into the structure of bleached teeth was determined. RESULTS: No penetration was seen in enamel of any group, and statistical analysis showed a significant difference in the degree of penetration only between treated and nontreated groups of dentin and cementum (P <.05). No significant difference was seen between 7 and 14 days. CONCLUSION: Although the effect was not significant, further investigation is needed to determine the effect of long-term treatment of carbamide peroxide on human tooth substance.

Shear bond strength of current adhesive systems to enamel, dentin and dentin-enamel junction region.

This study investigated the bonding of current resin adhesives to the region approximating the dentin-enamel junction (DEJ), where the etch pattern to enamel or dentin may be different. Three kinds of tooth substrates were chosen for testing: enamel, dentin and the DEJ region. A self-etching primer system (Clearfil SE Bond) and two total-etch wet bonding systems (Single Bond and One-Step) were used. Each tooth region was bonded with one of the adhesive systems, and a resin composite and was subjected to a micro-shear bond test. In addition, morphological observations were performed on debonded specimens and etched surfaces using confocal laser scanning microscopy (CLSM). CLSM observations showed that the DEJ region was etched more deeply by phosphoric acid gel than enamel or dentin, suggesting that the action of acid etch seemed to be more intense on the DEJ. However, no statistically significant differences of shear bond strength values were observed between the DEJ region and enamel or dentin, or the adhesive systems used (p>0.05). Bonding to the DEJ is potentially as good as that to enamel or dentin.

Fracture toughness of human dentin.

The purpose of this study was to determine the fracture toughness (K(IC)) of human dentin and to test the null hypothesis that K(IC) is not affected by the orientation of dentinal tubules relative to the plane of crack propagation. Triangular prisms (4 x 4 x 4 x 8 mm) were obtained from human molars and tested using the notchless triangular prism (NTP) specimen K(IC) test. Dentin prisms were prepared so that the plane of crack propagation would have three different orientations relative to the orientation of dentinal tubules: perpendicular (PE), parallel aligned (PAA), and parallel transverse (PAT). The prepared specimens were secured in the specimen holder and loaded in tension until fracture or crack arrest. The maximum load recorded was used to calculate K(IC). There was no significant difference between the K(IC) of PAA specimens (1.97 +/- 0.17 MPa/m(1/2)) and PAT (2.02 +/- 0.18 MPa/m(1/2)). The K(IC) for the PE specimens (1.13 +/- 0.36 MPa/m(1/2)) was significantly lower. The SEM images of the fractured surfaces showed distinct differences that were correlated with the determined K(IC) values. The fractured surfaces of PAA and PAT specimens were rougher compared to PE specimens. Both the hyper mineralized peritubular dentin and the orientation of collagen fibrils surrounding the tubules could be responsible for the significant differences in K(IC). The results of this study identified a significant anisotropy of dentin with respect to its K(IC).