Central and Peripheral Corneal Endothelial Cell Analysis With Slit-Scanning Wide-Field Contact Specular Microscopy: Agreement With Noncontact Specular Microscopy.

PURPOSE: The prospective case series aimed to examine the agreement between the use of a slit-scanning contact specular microscope and a noncontact specular microscope in corneal endothelial cell (CEC) analysis and to evaluate the differences between the central and peripheral regions in normal corneas. METHODS: After confirming normal corneal endothelium with slit-lamp microscopy, CEC images of 56 eyes of 56 cataractous patients were analyzed in the central and 4 peripheral regions using a slit-scanning contact specular microscope. A noncontact specular microscope was used for the analysis in the central region. The endothelial cell density (ECD), the percentage of hexagonal shape cells (HEX), and the coefficient of variation (CV) in the central region were compared. Differences between central and peripheral CECs were also evaluated. RESULTS: The mean ECD was 2778 cell/mm and was not different from the results using the noncontact specular microscope (2736 cell/mm, P = 0.051). There was a significant correlation (P < 0.001, R = 0.72). The analysis of HEX resulted in larger values with the slit-scanning contact microscope (53.13% vs. 48.89%, P < 0.001), whereas there was no difference in the CV (38.48 vs. 38.04, P = 0.56). On comparing the central and peripheral regions, there was no significant difference in the ECD, whereas significant differences were found in the superior region in the HEX and CV (P < 0.001) and in the nasal region in CV (P = 0.023). CONCLUSIONS: The analysis of ECD with the use of the slit-scanning contact specular microscope did not differ from the noncontact specular microscope, and the results demonstrated no difference between the central and peripheral ECD.

Sustainability of Pain Relief After Corneal Collagen Cross-Linking in Eyes With Bullous Keratopathy.

PURPOSE: This study aimed to examine the efficiency and sustainability of pain relief produced by corneal collagen cross-linking (CXL) in eyes with bullous keratopathy (BK) and to explore the histopathological changes in the stroma by using in vivo confocal microscopy. DESIGN: Prospective observational case series. METHODS: Fourteen eyes of 14 consecutive BK patients were treated with CXL with dehydration of the corneal stroma and followed up for 1 year after treatment. The best-corrected visual acuity (BCVA), intraocular pressure, and central corneal thickness (CCT) were examined before the treatments and up to 1 year after. The intensity and frequency of pain were graded on a scale from 0 (minimum) to 10 (maximum). At 1 year after CXL, the corneal stroma was observed using confocal microscopy at depths of 100 and 200 µm. RESULTS: The BCVA and CCT did not change significantly. The mean pain intensity and frequency scores were 5.6 and 4.6, respectively, before treatment. The intensity score significantly decreased at 1 week and onward, and the frequency score significantly decreased over 6 months after treatment. The confocal microscopy images showed that keratocytes and nerve fibers were rare and sparsely distributed in the stroma 1 year after CXL. CONCLUSIONS: The CXL efficiently relieved pain due to BK for 1 year after treatment. The in vivo confocal microscopy observations and unchanged CCT demonstrated that the persistence of pain relief was due to the inadequate regeneration of nerve fibers in the corneal stroma.

Supplemental psyllium fibre regulates the intestinal barrier and inflammation in normal and colitic mice.

Our previous study demonstrated that supplemental psyllium fibre increased cytoprotective heat-shock protein (Hsp) 25 levels in the intestinal cells of mice. Here, we examined the effect of psyllium fibre on colonic gene and protein expression and faecal microbiota in normal and colitic mice to improve the understanding of the preventive role of the supplement. DNA microarray analysis revealed that a 10 % psyllium fibre diet administered for 5 d up-regulated eleven extracellular matrix (ECM)-associated genes, including collagens and fibronectins, in normal mice. Acute colitis was induced using dextran sodium sulphate (DSS) in mice that were administered a pre-feeding 5 to 10 % psyllium fibre diet for 5 d. Psyllium fibre partially ameliorated or resolved the DSS-induced colon damage and inflammation characterised by body weight loss, colon shortening, increased levels of pro-inflammatory cytokines and decreased tight junction protein expression in the colon. Analysis of faecal microbiota using denaturing gradient gel electrophoresis of the PCR-amplified 16S rRNA gene demonstrated that psyllium fibre affected the colonic microbiota. Intestinal permeability was evaluated by growing intestinal Caco-2 cell monolayers on membrane filter supports coated with or without fibronectin and collagen. Cells grown on collagen and fibronectin coating showed higher transepithelial electrical resistance, indicating a strengthening of barrier integrity. Therefore, increased Hsp25 levels and modification of colonic ECM contribute to the observed psyllium-mediated protection against DSS-induced colitis. Furthermore, ECM modification appears to play a role in the strengthening of the colon barrier. In conclusion, psyllium fibre may be useful in the prevention of intestinal inflammatory diseases.

Transient Left Ventricular Contractile Dysfunction during the Treatment of Rhabdomyolysis: A Case Report and Literature Review.

Transient left ventricular contractile dysfunction (TLVCD) is often observed as a result of stress-related cardiomyopathy; however, recent reports suggest that rhabdomyolysis and eating disorders can also induce the development of TLVCD. We report a 52-year-old malnourished man who developed acute heart failure on day 4 of treatment for rhabdomyolysis. Transthoracic echocardiogram revealed severe hypokinesis at the apical and mid-ventricular segments, except for the basal segments of the left ventricular wall, which recovered within one week. We discuss the pathogenesis of TLVCD with sympathetic nerve activation in association with rhabdomyolysis or refeeding syndrome.

Dietary psyllium fiber increases intestinal heat shock protein 25 expression in mice.

Heat shock proteins (HSPs) protect intestinal epithelial cell function, integrity and viability against many forms of stress. We hypothesized that dietary fibers (DFs) in the diet may increase HSP expression, since DFs are known to exhibit beneficial effects on intestinal health. The present study investigated the regulation of intestinal HSP expression by DFs, particularly psyllium fiber. Feeding psyllium fiber for 5 d increased HSP25 expression, but not HSP32 and HSP70 expression in the jejunum, ileum, and colon of mice at both the protein and mRNA levels. The increases in HSP25 expression did not correlate with cecal organic acid production by microbial fermentation. The water-insoluble fraction of psyllium fiber largely contributed to the induction of HSP25 expression, but feeding with other water-insoluble DFs from beet, wheat, and oats failed to induce intestinal HSP25 expression. Although the water-holding capacity of psyllium fiber was much higher than those of the other water-insoluble DFs examined, the increase in HSP25 expression induced by feeding polycarbophil, which possesses a high water-holding capacity similar to that of psyllium fiber, was much lower than that induced by psyllium fiber. Finally, induction of malondialdehyde production by hydrogen peroxide, an oxidant, in the colon of mice fed psyllium fiber was lower than that in mice fed with the control diets. Taken together, feeding psyllium fiber, especially the water-insoluble fraction, increases intestinal HSP25 expression and suppresses oxidant-induced malondialdehyde production.

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.

Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery.

PURPOSE: To examine the clinical utility of femtosecond laser-assisted astigmatic keratotomy (FSL-AK) for eyes after cataract surgery. METHODS: Eight eyes of 6 patients with an intraocular lens and corneal astigmatism of 2.0 diopters (D) or more underwent FSL-AK. The mean preoperative manifest cylindrical refraction was 2.88 ± 0.64 D and the mean corneal astigmatism was 2.84 ± 0.83 D. Paired symmetrical arcuate incisions were created with the same settings, except for the incision depth. Uncorrected distance visual acuity (UDVA), manifest cylindrical power, and surgically induced astigmatism (SIA) were measured at 1 day, 1 week, and 1 month postoperatively. Fourier analysis of corneal topography and incision depths measured with anterior-segment optical coherence tomography were evaluated 1 month postoperatively. RESULTS: In all eyes, the UDVA improved at 1 week and 1 month postoperatively, and the manifest cylinder also decreased postoperatively, while the SIA showed overcorrections in 6 eyes. Fourier analysis showed decreases in spherical and regular astigmatic components and increases in higher-order irregularity. The mean incision depth was measured as 60 µm deeper than the intended depth. CONCLUSION: The FSL-AK effectively reduced corneal astigmatism and improved the UDVA, although it was demonstrated that the deeper incisions led to overcorrection.

Influences of cycloplegia with topical atropine on ocular higher-order aberrations.

PURPOSE: To investigate the influence of cycloplegia with topical atropine on higher-order aberrations (HOAs) of the eye in children. DESIGN: Prospective, noncomparative study. PARTICIPANTS: Twenty-three eyes of 23 subjects (11 boys and 12 girls) with hyperopia, ranging in age from 3 to 12 years (average, 5.74 years), were enrolled in this study. METHODS: Refraction and wavefront aberration were evaluated before and after cycloplegia with topical instillation of 1% atropine solution administered twice daily for 1 week. Ocular and corneal HOAs were measured simultaneously, and individual Zernike components were analyzed for a 6-mm pupil up to the 6th order. All these parameters were compared before and after cycloplegia. MAIN OUTCOME MEASURES: Ocular and corneal HOAs before and after cycloplegia. RESULTS: Cycloplegia with topical atropine significantly increased spherical equivalent refraction from +1.92±1.53 diopters (D) to +3.10±1.61 D (P<0.01, paired t test). Ocular HOAs significantly increased from 0.282±0.086 µm to 0.316±0.087 µm for coma-like aberrations (P=0.02), from 0.169±0.058 µm to 0.192±0.076 µm for spherical-like aberrations (P=0.02), and from 0.333±0.093 µm to 0.377±0.095 µm for total HOAs (P=0.01). Corneal HOAs did not change after cycloplegia. As for individual Zernike components, significant changes were found in C3(1) and C4(0) after cycloplegia (P<0.05). The induced changes in C4(0) were correlated significantly with those in spherical equivalent refraction (Pearson's correlation coefficient, R=0.45; P=0.03). CONCLUSIONS: Cycloplegia with atropine induced significant hyperopic shift and increases in ocular HOAs in children, leading to reduction in optical quality of the eye. It may be that physiologic tonic accommodation plays a role in improving retinal image quality by decreasing HOAs and refractive errors. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparison of central corneal thickness measurements by rotating Scheimpflug camera, ultrasonic pachymetry, and scanning-slit corneal topography.

PURPOSE: To compare central corneal thickness measurements and their reproducibility when taken by a rotating Scheimpflug camera, ultrasonic pachymetry, and scanning-slit corneal topography/pachymetry. DESIGN: Experimental study. PARTICIPANTS: Seventy-four eyes of 64 subjects without ocular abnormalities other than cataract. METHODS: Corneal thickness measurements were compared among the 3 methods in 54 eyes of 54 subjects. Two sets of measurements were repeated by a single examiner for each pachymetry in another 10 eyes of 5 subjects, and the intraexaminer repeatability was assessed as the absolute difference of the first and second measurements. Two experienced examiners took one measurement for each pachymetry in another 10 eyes of 5 subjects, and the interexaminer reproducibility was assessed as the absolute difference of the 2 measurements of the first and second examiners. MAIN OUTCOME MEASURES: Central corneal thickness measurements by the 3 methods, absolute difference of the first and second measurements by a single examiner, absolute difference of the 2 measurements by 2 examiners, and relative amount of variation. RESULTS: The average measurements of central corneal thickness by a rotating Scheimpflug camera, scanning-slit topography, and ultrasonic pachymetry were 538+/-31.3 microm, 541+/-40.7 microm, and 545+/-31.3 microm, respectively. There were no statistically significant differences in the measurement results among the 3 methods (P = 0.569, repeated-measures analysis of variance). There was a significant linear correlation between the rotating Scheimpflug camera and ultrasonic pachymetry (r = 0.908, P<0.0001), rotating Scheimpflug camera and scanning-slit topography (r = 0.930, P<0.0001), and ultrasonic pachymetry and scanning-slit topography (r = 0.887, P<0.0001). Ultrasonic pachymetry had the smallest intraexaminer variability, and scanning-slit topography had the largest intraexaminer variability among the 3 methods. There were similar variations in interexaminer reproducibility among the 3 methods. CONCLUSIONS: Mean corneal thicknesses were comparable among rotating Scheimpflug camera, ultrasonic pachymetry, and scanning-slit topography with the acoustic equivalent correction factor. The measurements of the 3 instruments had significant linear correlations with one another, and all methods had highly satisfactory measurement repeatability.