Endobronchial Topical Amphotericin B Instillation for Pulmonary Chromomycosis After Lung Transplantation: A Case Report.

We report a very rare case of pulmonary chromomycosis caused by Scedosporium prolificans that developed after lung transplantation and was successfully treated with endobronchial topical amphotericin B instillation. The subject was a woman in her 50s with a history of bilateral lobar lung transplantation from living donors for idiopathic pulmonary hypertension. Eight years after the lung transplantation, chest radiography X-ray and computed tomography showed an abnormal shadow in the right lung. Bronchoscopic findings showed obstruction by a fungal component at the laterobasal bronchus B9. She was diagnosed with pulmonary chromomycosis after S. prolificans was detected in the bronchial aspirate. Systemic antifungal treatment with itraconazole was ineffective. Therefore, we administered topical amphotericin B weekly via endobronchial instillation and replaced oral itraconazole with voriconazole. The endobronchial procedure was safe and tolerable. Bronchial obstruction improved after three 3 instillations. We continued topical amphotericin B instillation once every 3 months for 2 years, and the abnormal shadow nearly disappeared. This case report describes infection by S. prolificans, which rarely becomes an etiologic agent in lung transplant patients, and shows that endobronchial topical amphotericin B instillation is a therapeutic option when systemic antifungal treatment is ineffective.

Image-guided robotic stereotactic radiotherapy for synchronous cancer of maxillary gingiva and lung.

The use of stereotactic body radiation therapy is rapidly increasing among patients with lung cancer not amenable to surgery. The authors report their experience using the CyberKnife system (Accuray Inc., Sunnyvale, CA, USA) as a treatment option for synchronous cancer of oral squamous cell carcinoma and a malignant lung tumour. An 88-year-old woman with two cancers (oral and lung masses) underwent CyberKnife treatment, with fiducial gold pins implanted using bronchoscopy. Toxicity was limited, and at the 2-year follow-up the lesions had not recurred.

Transplantation of cultivated autologous oral mucosal epithelial cells in patients with severe ocular surface disorders.

BACKGROUND/AIMS: To determine outcomes of transplants of cultivated autologous oral epithelial cells in patients with severe ocular surface disorders. METHODS: The eyes (n = 6) of four patients with Stevens-Johnson syndrome (three eyes) or chemical burns (three eyes) were studied. Autologous oral epithelial cells, grown for 2-3 weeks on a denuded amniotic membrane carrier in the presence of 3T3 fibroblasts, were air lifted. The resultant sheet was transplanted onto the damaged eye, and acceptance of the sheet by the corneal surface was confirmed 48 hours after surgery. The success of ocular surface reconstruction, graft survival, changes in visual acuity, and postoperative complications were assessed and the quality of the cultivated oral epithelial sheet was evaluated histologically. RESULTS: At 48 hours after transplant, the entire corneal surface of all six eyes was free of epithelial defects indicating complete survival of the transplanted oral epithelium. Visual acuity was improved in all eyes. During follow up (mean 13.8 (SD 2.9) months), the corneal surface remained stable, although all eyes manifested mild peripheral neovascularisation. CONCLUSIONS: Autologous oral epithelial cells grown on denuded amniotic membrane can be transplanted to treat severe ocular surface disorders.

Apoptosis and lens vesicle development.

PURPOSE: To study the development of the rat lens vesicle in relation to apoptosis. MATERIALS AND METHODS: Fetuses of Wistar Kyoto rats were removed by laparotomy on day 10-15 of gestation. Some fetuses were fixed in 2% paraformaldehyde and embedded in paraffin for a TUNEL technique examination of DNA fragmentation. Macrophages were stained immunohistochemically with antibody. Some fetuses were fixed in 4% glutaraldehyde and 1% osmic acid and embedded in Luveak 812, then examined with a transmission electron microscope (TEM). RESULTS: On day 11 of gestation (E11) before the start of lens invagination, apoptotic changes were noted in the cells between the surface ectoderm and optic vesicle, with the appearance of phagocytic cells. Apoptotic cells were present at the junction of the surface ectoderm and the lens placode, in the ventral and dorsal thirds of the lens placode and in the outer layer of the optic vesicle in the same axes on E12. Apoptotic changes appeared in the lens stalk, surface ectoderm and the anterior lens epithelium on E12.5. The lens vesicle was detached completely from the surface ectoderm by E13 and some cells had the typical characteristics of macrophages in the extracellular space between the surface ectoderm and the anterior lens epithelium. Apoptotic changes were confirmed by the TUNEL method, and macrophages were stained immunohistochemically. CONCLUSIONS: Apoptosis may have a major role during the whole process of lens vesicle development. Apoptosis may eliminate the cells between the surface ectoderm and the optic vesicle, help trigger invagination and facilitate separation from the ectoderm. Apoptosis might aid in the bowing of the optic vesicle during lens invagination.

Long-term effect on optic nerve of silicone oil tamponade in rabbits: histological and EDXA findings.

PURPOSE: Side-effects after intravitreal use of silicone oil (SO) are not well defined and elucidated. The object of this study was to examine the influence and toxicity of SO on the optic nerve after vitrectomy with SO tamponade. METHODS: We injected medical grade SO and emulsified SO into rabbit eyes after gas-mediated vitreous compression and examined the eyes by light microscopy (LM), transmission electron microscopy (TEM) and energy dispersive X-ray analysis (EDXA) (point analysis and area analysis) 6 months after injection. We compared the findings in the non-treated eyes and eyes with only gas-mediated vitreous compression with those in SO-injected eyes. RESULTS: Vacuole-like structures were seen in the optic nerve posterior to the lamina cribrosa. In the group treated with only gas-mediated vitreous compression, the myelin structures were shown by TEM to be destroyed and replaced by glial tissue, while in groups injected with medical grade or emulsified SO severe destruction of the myelin sheath (myelinolysis) was observed. Silicone was identified at the electron-dense edges of the vacuoles by EDXA point analysis, but not in the vacuoles without electron-dense deposits. Dots of Si K alpha were not seen in the control groups, and dense dots were observed in SO-injected groups, by EDXA area analysis. CONCLUSIONS: Some of the vacuoles might be artefacts caused by insufficient fixation or the operative procedure, but TEM showed almost no artefacts in the control optic nerve. Thus, most vacuoles may be SO storage sites. SO uptake into the optic nerve might play a role in the pathogenesis of optic nerve atrophy after SO injection.

Ultrastructural study of primary lacrimal adenocarcinoma.

PURPOSE: Primary adenocarcinoma of the lacrimal gland is a rare malignant tumor of the orbit. Up to now, there has been no presentation of its ultrastructural features. The histopathological findings and fine structures of one case of adenocarcinoma of the lacrimal gland are described in the present work. METHODS: The patient was a 59-year-old Japanese man with proptosis that had persisted for one month. A tumor was extirpated, and the tissues were prepared for light and electron microscopic examination. RESULTS: Electron microscopic examination demonstrated that the tumor cells had well-developed microvilli and lumens. These ultrastructure features are similar to those seen in adenocarcinomas at other sites. CONCLUSIONS: These observations suggest that the accurate diagnosis of rare malignant adenocarcinoma depends not only on routine techniques such as light microscopy of hematoxylin-eosin and PAS-diastase stained slides, but also on electron microscopic findings.

Immunohistochemical study of p53, p21 and PCNA in pterygium.

Since mutated p53 is one of the most frequent gene abnormalities in human cancer, we hypothesized that mutation of p53 may play an important role in growth and recurrence of pterygia, a dysplasia of the conjunctiva. Therefore, we compared pterygia of Japanese and Tunisian patients using antibodies against p53, p21 and proliferating cell nuclear antigen (PCNA). In Nagasaki, 21 pterygia of Japanese individuals were removed and in Gabes, 19 primary pterygia of Tunisian individuals. Positive staining of wild type p53 was not found in the Japanese pterygia, whereas 38.1% were positive for mutant p53, none were positive for p21 and 76.2% were positive for PCNA. The incidence of mutant p53-positive staining was 50.0% in males and 22.2% in females, which was statistically significant. In the 19 Tunisian patients, positive staining of wild type p53 was not found, whereas 36.8% were positive for mutant p53, 0% for p21 and 63.1% for PCNA. Differences between Japanese patients and Tunisian patients were not significant. There were 2 types of pterygium. One type did not show mutant p53 and the other showed mutant p53 caused by ultraviolet light. However, damage caused by p53-dependent programmed cell death of pterygium cells may lead to mutations in other genes which may allow the progressive multistep development of limbal tumors. It is possible that mutant p53-positive pterygia can develop into limbal tumors.

Choroidal detachment after vitreous surgery.

BACKGROUND AND OBJECTIVE: To study the frequency and clinical features of choroidal detachment (CD) after vitreous surgery, because there have been no reports on this problem. PATIENTS AND METHODS: We studied the clinical features of 14 patients (15 eyes) with CD from a total of 380 patients treated with vitrectomy at the Nagasaki University Hospital from January 1994 to August 1997. RESULTS: The incidence of CD after vitreous surgery was 3.9% (15/380). The reasons for vitrectomy were 6 retinal detachments, 4 proliferative diabetic retinopathies, and 5 others. During vitrectomy, 4 eyes were treated with scleral buckling, 11 with endolaser photocoagulation, and 3 with cryoretinopexy. Retinal detachment as a postoperative complication was seen in 8 patients, and in 5 of them the retina remained detached after the final treatment. CONCLUSIONS: CD may be caused by scleral buckling, panphotocoagulation, or stress on the ciliary body. Some patients with CD have a poor outcome.

Cardiopulmonary complications during gastroscopy in patients with chronic respiratory failure undergoing long-term home oxygen therapy.

BACKGROUND AND STUDY AIMS: Gastric ulcer and hemorrhage are major complications in patients with chronic respiratory failure, but upper GI endoscopy tends to be avoided because of possible cardiopulmonary events. This study was designed to evaluate hypoxemia and subsequent cardiac complications during gastroscopic procedures in patients with chronic respiratory failure undergoing long-term home oxygen therapy (LHOT). PATIENTS AND METHODS: Gastroscopy was carried out in 10 patients undergoing LHOT and 10 age-matched control subjects without pulmonary diseases. Oxygen saturation and cardiac arrhythmias before and during gastroscopy were monitored. Patients were given 10 mg intramuscular scopolamine butylbromide and local anesthesia using 100-300 mg lidocaine gel 15 minutes before the procedure. Each patient continued to receive oxygen via a nasal cannula in the same dosage as their daily use. RESULTS: Decrease in oxygen saturation during endoscopic procedure was significantly greater in patients undergoing LHOT (from 95.9+/-0.9 to 93.4+/-1.7%) compared with control subjects (from 96.7+/-0.4 to 96.2+/-0.4%). There was a significant correlation between the degree of hypoxemia and the oxygen dosage required for their daily treatment in the patients (r = 0.727, P<0.02). CONCLUSIONS: These results indicate that the degree of respiratory failure influences the degree of decrease in oxygen saturation during gastroscopy. It is suggested that use of the nasal route for oxygen supply may be one of the major causes of the hypoxemia.

Analysis of Galpha protein recognition profiles of angiotensin II receptors using chimeric Galpha proteins.

Receptors with a heptahelical structure initiate signal transduction by interacting with specific Galpha proteins. The aim of this study was to analyze the ability of type 1 (AT1) and type 2 (AT2) angiotensin receptors to recognize the receptor coupling regions of Galpha proteins using our previously described technique (Ikezu, T., Okamoto, T., Komatsuzaki, K., Matsui, T., Martyn, J.A.J., Nishimoto, I., 1996. Negative transactivation of cAMP response element by familial Alzheimer's mutants of APP. EMBO J. 15, 2468-2475; Komatsuzaki, K., Murayama, Y., Giambarella, U., Ogata, E., Seino, S., Nishimoto, I., 1996. A novel system that reports the G-proteins linked to a given receptor: a study of the type 3 somatostatin receptor. FEBS Lett. 406, 165-170). Chimeric Galphas protein constructs, whose receptor binding regions contained sequences from the four major families of Galpha proteins (Galphaq, Galphai, Galpha12, Galphas), were cotransfected with AT1 or AT2 receptors in COS cells, then stimulated with angiotensin II (Ang II). Changes in cellular cAMP were assayed on cell lysates by enzyme immunoassay. In the case of the Galphaq family, cotransfection of AT1 with Galpha11/Galphas, Galpha14/Galphas, Galpha16/Galphas, elicited significant increases in cAMP after agonist stimulation. Confirmatory results were found using an independent [35S]GTPgammaS binding assay. Further examination using chimeric G proteins for Galpha12 proteins and Galphai family proteins provided evidence that the AT1 receptor can recognize sequences from Galpha12, Galphai1/i2, Galphaz, Galphao, while both receptors interacted with Galphai3. These results provide a Galpha protein recognition database for both AT1 and AT2 receptors, which may be important for understanding the full spectrum of cellular responses mediated by the hormone Ang II.

In vivo airway eosinophil accumulation does not enhance antigen- or propranolol-induced bronchoconstriction in guinea pigs.

BACKGROUND: Chronic airway eosinophil accumulation is characteristic of asthma. However, it remains unclear whether airway eosinophils enhance or reduce release of chemical mediators and/or action of the released mediators in the airways in vivo, because previous investigators have indicated that eosinophil-derived factors such as histaminase and arylsulfatase may alter the allergic reaction by metabolizing chemical mediators. Recently, we have developed a guinea pig model of propranolol-induced bronchoconstriction (PIB), which is mediated by lipid mediators such as thromboxane A2 (TxA2), cysteinyl leukotrienes (cLTs) and platelet activation factor (PAF). This study was conducted to explain the influence of airway eosinophil accumulation on antigen-induced bronchoconstriction and the following PIB, both of which are mediated by lipid mediators. METHODS: Guinea pigs were transnasally treated with 75 microg/kg of polymyxin-B or vehicle twice a week for a total of 3 weeks. Guinea pigs were anesthetized and treated with diphenhydramine hydrochloride, and then artificially ventilated 24 h after the last administration of polymyxin-B or vehicle followed by passive sensitization. Propranolol at a concentration of 10 mg/ml was inhaled 20 min after an aerosolized antigen challenge. RESULTS: The proportion of eosinophils in bronchoalveolar lavage fluid obtained 15 min after the propranolol inhalation was significantly increased in guinea pigs treated with polymyxin-B compared with the vehicle. The polymyxin-B treatment did not affect antigen-induced bronchoconstriction or the following PIB. CONCLUSIONS: We conclude that eosinophils accumulated in the airways by polymyxin-B does not affect release of chemical mediators induced by antigen or propranolol inhalation, or action of released mediators in vivo.

Vascular endothelial growth factor activates MAP kinase and enhances collagen synthesis in human mesangial cells.

UNLABELLED: Vascular endothelial growth factor activates MAP kinase and enhances collagen synthesis in human mesangial cells. BACKGROUND: Vascular endothelial growth factor (VEGF) is an endothelial mitogen that is constitutively expressed in normal human glomeruli, but its role in the kidney is still unclear. In this study, we examined the effects of VEGF on human mesangial cells (HMCs). Methods and Results. Reverse transcription-polymerase chain reaction analysis demonstrated the presence of VEGF receptor mRNA (flt-1 and KDR) in HMCs. The treatment of HMCs with VEGF did not cause a change in 3H-thymidine incorporation or cell numbers. In contrast, VEGF caused a dose- and time-dependent increase in collagen synthesis, with threefold to fivefold increases in both cell-associated and secreted collagen synthesis seen after treatment with 200 ng/ml VEGF. The effects of VEGF were attenuated by treatment of HMCs with the tyrosine kinase inhibitor herbimycin A or the MEK inhibitor PD 98059, but not with the protein kinase C (PKC) inhibitor chelerythrine. VEGF treatment also caused a marked increase in p42/p44 mitogen-activated protein kinase (MAPK) activity, but had no significant effect on HMC superoxide production. Finally, an increase in collagen synthesis was also seen in rat mesangial cells treated with VEGF. CONCLUSIONS: These results suggest that VEGF is not a mitogenic signal in HMCs, but may be involved in the regulation of the mesangial matrix in humans by a MAPK-dependent mechanism.

Cataract induced by short-term administration of large doses of busulfan: a case report.

Busulfan is a carcinostatic which is used for myelocytic leukemia. A 42-year-old Japanese woman given high doses of busulfan for a short time was referred to us because of decreased visual acuity and blurred vision in both eyes. She received 212 mg/day of busulfan for only 4 days. Ophthalmoscopic examination demonstrated a posterior polar subcapsular opacity of the lens in both eyes. Although the occurrence of cataract due to busulfan has been reported after long-term administration of busulfan, this is the first clinical case of cataract caused by high doses of busulfan for a short period. It is necessary to pay more attention to busulfan cataract.

Photodynamic therapy of atherosclerosis using YAG-OPO laser and Porfimer sodium, and comparison with using argon-dye laser.

We performed photodynamic therapy (PDT) using the Yttrium Aluminium Garnet-Optical Parametric Oscillated (YAG-OPO) laser in cases of atherosclerosis, and examined its efficacy in vivo. We also performed PDT using an Argon-dye (Ar-dye) laser with the same output, and compared the efficacies. Following balloon denudation injury of the thoracoabdominal aorta, rabbits were raised on a cholesterol diet for 16 weeks, producing atheroma in that region. At 24 h following the administration of Photofrin 5 mg/kg, PDT was performed, and animals were sacrificed at 1 day, 1 week, and 2 weeks following the procedure to examine its efficacy. This was compared with the efficacy of PDT using the Ar-dye laser. Following PDT using a YAG-OPO laser, an increase in the vessel lumen was seen due to reduction of the hypertrophic intima and media, without the appearance of inflammatory cells. This result was seen more strongly in PDT using the pulse wave YAG-OPO laser than with the continuous wave Ar-dye laser, affecting not just the intima but also the media. These data demonstrated that PDT can effectively regress atherosclerotic lesions.

Eosinophilic granuloma (Kimura's disease) of the orbit: a case report.

BACKGROUND: Eosinophilic granuloma of the soft tissue, Kimura's disease, is a benign slow-growing tumor that is manifested clinically by one or more inflammatory nodules involving mainly the face and scalp, but rarely the eye. CASE REPORT: The patient was a 32-year-old male with swelling of the left lower eyelid, marked peripheral blood eosinophilia and increased serum immunogloblin E. MRI revealed swelling of all rectus muscles of the left eye, but no tumor mass. Corticosteroid treatment reduced the swelling of the eyelid, but it recurred after corticosteroid was discontinued. Eight years later the patient returned with a complaint of increased swelling of the left lower eyelid. An elastic, nontender, soft tumor mass was palpable subcutaneously in the left lower eyelid extending into the orbit. MRI revealed a tumor mass in the left orbital space. The parotid gland was also swollen and palpable. Both tumors were resected surgically, and histopathological study revealed prominent proliferation of lymphoid follicles with germinal centers showing interfollicular infiltration by eosinophils. The pathological findings in the parotid gland were similar. The diagnosis was Kimura's disease. CONCLUSION: This patient is unique in that he had no tumor at the first examination, only swelling of the rectus muscles, and a tumor mass appeared many years later. Unilateral swelling of the rectus muscles may be one of the first signs of Kimura's disease. Not only tumor but also swelling of the rectus muscles limited ocular movement.

Emulsion type new vehicle for soft gelatin capsule available for preclinical and clinical trials: effects of PEG 6000 and PVP K30 on physicochemical stability of new vehicle.

To prevent temperature-dependent gel-sol transformation of an o/w emulsion type new vehicle system for a soft gelatin capsule, which may be available for both preclinical and clinical trials, the basic new vehicle formulation (PEG 400:purified water:medium chain triglyceride:polyoxyethylene (20) cetylether = 77:10:10:3) was modified by partially (1, 2 or 3%) replacing PEG 400 with PEG 6000 or PVP K30. When 2 or 3% of PEG 400 was replaced with PEG 6000, temperature-dependent gel-sol transformation was prevented at temperatures below 40 degrees C, and the vehicle appeared to be stable during 8 weeks of storage at 4 to 40 degrees C; the particle size distribution remained unchanged. When 1% of PEG 400 was replaced with PEG 6000, gel-sol transformation was not prevented, though phase separation was not observed at sol state, and the particle size distribution was shifted to be in a larger particle size range after 2 weeks of storage. When PEG 400 was partially (1, 2 or 3%) replaced with PVP K30, temperature-dependent gel-sol transformation was not prevented and, after 2 weeks of storage at 40 degrees C, the particle size distributions of the vehicles were shifted to be in a larger particle size range and the vehicles were separated into two layers. These results suggested that a small amount of PEG 6000 plays an important role in preventing temperature-dependent gel-sol transformation of our developed vehicle system.

Fluorescence spectrum analysis of atherosclerotic plaque using doxycycline.

Using doxycycline (DOXY), fluorescence spectrum analysis was performed on arteriosclerotic lesions, and the efficacy of this method was examined in basic and clinical studies. In the basic study, DOXY 50 mg was administered intravenously to arteriosclerotic rabbits, and the thoracoabdominal aorta removed. Fluorescence spectral analysis was performed on each specimen, and the fluorescence spectral pattern, peak intensity and degree of intimal hypertrophy were studied. In the clinical study, DOXY 200 mg was administered intravenously to 6 human subjects with stable angina and coronary arterial stenosis of greater than 90%, and coronary angiography, coronary angioscopy and fluorescence spectral analysis were performed. DOXY accumulation in the arteriosclerotic intima of rabbit aortae was confirmed. The fluorescence spectrum was monomodal, peaking at around 532 nm. In the noncalcification group, significant correlation was observed between peak intensity and arteriosclerotic intimal thickness. Using DOXY as a fluorescent marker, it was possible to assess the level of arteriosclerotic intimal hypertrophy. Clinically, it was possible to obtain the DOXY spectrum of the coronary arteries.

Conradi-Hünermann syndrome with ocular anomalies.

We report a Japanese girl with the Conradi-Hünermann form of chondrodysplasia punctata and anterior segment malformations characteristic of Axenfeld-Rieger syndrome. The patient also had cataracts and unilateral optic atrophy. A possible role for homeobox-containing genes in the etiology of this type of chondrodysplasia punctata is suggested as an explanation for the coincidence of these two syndromes.

Adrenal angiotensin II type 1 and type 2 receptors in Cushing's and Conn's syndromes.

Cushing's and Conn's syndromes are well recognised endocrine diseases, but the pathobiology of the tumors causing these disorders is unclear. In this study we examined AT1 and AT2 gene expression in adrenal adenomas of Cushing's and Conn's syndromes. AT1 and AT2 receptor mRNA, as well as alternatively spliced AT1 transcripts, were detected by RT-PCR using adjacent adrenal cortex tissue as controls. Whereas no consistent differences in AT1 mRNA were seen compared to control adrenal cortex, AT2 mRNA levels were significantly decreased in the adenomas of Cushing's and Conn's syndromes. No changes in alternative splicing of AT1 mRNA were observed in the adrenal tumors. The fact that no consistent changes were seen in AT1 mRNA or its splicing, whereas AT2 mRNA were reduced in both forms of hormone producing adrenal tumor suggests that the AT2 receptor, rather than the AT1 subtype, may be correlated with adrenal tumorigenesis.

Anticoagulation therapy and ocular surgery.

BACKGROUND AND OBJECTIVE: It is not rare for patients receiving anticoagulant therapy to undergo ocular surgery; however, there are no clear guidelines with reference to the operative management of the eye. This study examines the complications in patients receiving anticoagulant therapy who undergo ocular operations and suggests a management regimen for these patients. PATIENTS AND METHODS: The authors retrospectively analyzed 52 patients receiving anticoagulant therapy who underwent ocular surgery between 1993 and 1995. Data included sex, age, reason for anticoagulant therapy, operative procedure, complication rate, and length of time anticoagulant therapy was stopped or reduced prior to surgery. To show the base-line complication rate at their institution, data of patients not receiving anticoagulation therapy were added. RESULTS: Ticlopidine hydrochloride, an antiplatelet drug, was administered to 24 patients. Warfarin sodium was administered to 8 patients, heparin was administered to 8 patients, and other anticoagulants were administered to 20 patients. There were no significant differences in complications between the groups that stopped or reduced anticoagulant therapy and those that did not, but speech disturbance due to thrombotic complication occurred in 1 of 10 patients in whom ticlopidine hydrochloride was stopped or reduced. Hemorrhagic complications occurred in 50% of those who continued ticlopidine hydrochloride, but in none of those who discontinued it (P = .019). There was a significant difference in hemorrhagic complications after cataract surgery between the phacoemulsification, aspiration, and intraocular lens implantation (PEA + IOL) and the planned extracapsular cataract extraction and intraocular lens implantation (PECCE + IOL) groups that continued the drug (P = .0011). No patients showed visual acuity reduction due to hemorrhagic complications. CONCLUSIONS: To avoid life-threatening systemic complications, one need not always stop anticoagulant therapy before performing only cataract surgery. Cataract surgery in patients receiving ticlopidine hydrochloride should be performed with PEA + IOL via a small sclerocorneal or a corneal incision. In cataract surgery for patients receiving anticoagulant therapy, hemorrhagic complications are more frequent than in patients not receiving anticoagulant therapy.