Accuracy of intraocular lens power formulas in eyes with keratoconus: Multi-center study in Japan.

PURPOSE: To assess the accuracy of intraocular lens (IOL) power formulas, namely, SRK/T, Haigis, Barrett Universal II, Barrett True-K for keratoconus, Kane formula, and Kane formula for keratoconus, for cataract with keratoconus in Japanese eyes. SETTING: Five surgical sites in Japan. DESIGN: A retrospective case series. METHODS: Eyes with keratoconus undergoing cataract surgery were included. Postoperative refraction was compared with the prediction by the formulas. Visual acuity, manifest spherical equivalent, prediction error (PE), and mean absolute errors (MAEs) were determined 1 month postoperatively. The PE within 0.50 diopter (D), 1.00 D, and 2.00 D were compared between IOL formulas. Subgroup analysis based on the steepest keratometry (stage 1, ≤ 48 D; stage 2, > 48 D and ≤ 53 D; and stage 3, > 53 D) was performed. The relationship between PE and preoperative biometric data were assessed. RESULTS: Fifty eyes were included. The MAE of the Barrett True-K for keratoconus, Kane keratoconus, and Kane formulas were significantly lower than that of Haigis. A statistically significant difference in the prediction accuracy within ± 0.50 D was found between Kane keratoconus and Haigis. The prediction accuracy of the Barrett True-K for keratoconus, SRK/T, and Kane within ± 1.00 D was statistically significant compared with that of Haigis. In stage 3, the Barrett True-K for keratoconus had a significantly lower MAE than SRK/T and Haigis. CONCLUSION: Keratoconus-specific formulas were more accurate than existing formulas in Japanese eyes. The Barrett True-K formula for keratoconus had higher prediction accuracy in severe keratoconus.

Corneal endothelial density and morphology in long-term soft contact lens users in Japan: a retrospective cross-sectional study of 17,732 eyes.

PURPOSE: There is a lack of long-term and large-scale studies on the adverse effects of soft contact lenses (SCLs) on the corneal endothelia of Asian populations. Here, we aimed to examine the effects of long-term SCL use on corneal endothelial density and morphology. MATERIALS AND METHODS: This retrospective study involved consecutive patients at the Miyata Eye Hospital (Miyazaki, Japan), who had used SCLs for more than 1 year. Patients with ophthalmological disorders without refractive errors were excluded. The period of SCL use, SCL type, corneal endothelial cell density (ECD), appearance rate of hexagonal cells (HEX), and coefficient of variation of cells (CV) were analyzed. RESULTS: In total, 17,732 eyes of 8866 patients were included in the analysis (age, 26.0 ± 8.8 years). The mean period of SCL use was 6.3 ± 5.4 years. Multivariate regression analysis revealed that ECD and HEX were significantly negatively correlated with the period of SCL use, age, and sex (p < 0.001 for all). The CV was significantly positively correlated with the period of use (p < 0.001), sex (p = 0.002), and age (p < 0.001). CONCLUSIONS: Corneal ECD, HEX, and CV were significantly associated with the period of SCL use in long-term users. It is essential to regularly check the corneal endothelium in patients with a history of long-term SCL use.

Visual function in eyes with diffractive extended depth-of-focus and monofocal intraocular lenses: 2-year comparison.

PURPOSE: To compare long-term visual function after implantation of diffractive extended depth-of-focus (EDF) intraocular lenses (IOLs) using echelett optics and monofocal IOLs with the same platform. METHODS: In this prospective comparative case series, diffractive EDF or monofocal IOLs were implanted binocularly and followed up for 2 years. At the last visit, distance-corrected binocular visual acuities were measured at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m. Photopic and mesopic contrast sensitivity was also examined. Dynamic visual function was evaluated in terms of functional visual acuity (FVA), standard deviation of visual acuity (SDVA), visual maintenance ratio (VMR), mean response time, and number of blinks. The outcomes were compared between the two IOLs, and the influence of posterior capsule opacification (PCO) on contrast sensitivity and FVA was examined. RESULTS: Binocular visual acuity of eyes with EDF IOLs was better at distances of 0.5 and 0.7 m than that of eyes with monofocal IOL (P < 0.026). There were no differences in binocular visual acuity at other distances, contrast sensitivities, or dynamic visual functions. The influence of PCO on the visual functions was not found in eyes with EDF IOLs. CONCLUSION: Up to 2 years postoperatively, eyes with diffractive EDF IOLs sustained superior intermediate visual acuity together with visual function comparable to that of eyes with monofocal IOLs.

Early intervention for perioperative hypertension in cataract surgery.

PURPOSE: Although perioperative blood-pressure control is important, especially for high-risk patients, no previous report has examined early monitoring of perioperative blood-pressure changes before cataract surgery. In this single-center, retrospective, observational study, we evaluated the early intervention for perioperative hypertension in cataract surgery with topical anesthesia. METHODS: Hospitalized patients who underwent phacoemulsification and intraocular-lens insertion and whose blood pressure was controlled using standardized management to start early monitoring and control (standardized group; 134 eyes of 134 patients) were compared to age- and sex-matched patients who underwent the same cataract surgery and whose blood pressure was controlled using conventional means (control group; 134 eyes of 134 patients). The perioperative blood pressure, pulse pressure, and heart rate were compared preoperatively, upon entering the operation room, and at the beginning, end, and after the operation. RESULTS: Although there was no difference before the operation, the changes in systolic pressure in the standardized group were significantly lower at the point of entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, < 0.001, and < 0.001, respectively). No significant difference was observed between etizolam and nicardipine use. CONCLUSION: Early monitoring and control of blood pressure in cataract surgery could effectively control perioperative hypertension without additional drug use and could be widely applied in the clinical setting.

Changes in the preoperative ocular surface flora with an increase in patient age: A surveillance analysis of bacterial diversity and resistance to fluoroquinolone.

PURPOSE: This study analyzed the relationship between patient age and the prevalence and fluoroquinolone susceptibility of gram-positive cocci from the ocular surface flora before ophthalmic surgery. METHODS: This surveillance study included scraped samples from the conjunctival sac of 8923 eyes of 5490 patients (70.0 ± 13.7 years) without ocular infection before ophthalmologic surgery between August 2018 and December 2020. A review of microbiological records regarding patient age was used to determine the number of isolates and gram-positive species obtained, as well as their fluoroquinolone susceptibility. Fluoroquinolone susceptibility was determined using the Clinical and Laboratory Standards Institute protocols of broth microdilution. Statistical analysis was performed using a generalized additive model and a log-linear model. RESULTS: In total, 9,894 bacterial isolates obtained from scraped samples from the patients were analyzed. The detected species were Staphylococcus epidermidis (31.0%), Staphylococcus aureus (6.1%), Staphylococcus lugdunensis (3.9%), Enterococcus faecalis (5.8%), Corynebacterium species (31.7%), and Cutibacterium acnes (7.5%) and others. The number of species isolated from the ocular surface was increased at the rate of 1.018 per 10 years of age (p < 0.0001). S. epidermidis, S. lugdunensis, E. faecalis, and Corynebacterium species were isolated more often with an increase in patient age. The levofloxacin resistance ratio of methicillin-sensitive S. epidermidis and Corynebacterium species increased at the rate of 1.204 and 1.087 respectively with a 10-year increase in age (both p < 0.0001). CONCLUSION: Gram-positive bacteria in the ocular surface flora (OSF) exhibited gradual changes in diversity and fluoroquinolone resistance with an increase in patient age. It is important to monitor the OSF of the patients before ophthalmologic surgery to prevent refractory ocular postoperative infection.

Endothelial dysfunction of the cornea after exposure to sprayed venom from hornets.

PURPOSE: Ocular injuries due to Hymenoptera venom are uncommon and most injuries occur on the ocular surface. We reported two rare cases of corneal endothelial damage caused by hornet venom that was sprayed, not injected, through stinging in the eye. OBSERVATIONS: Case 1: A 57-year-old male patient was injured when a hornet sprayed venom into his left eye. He was referred to our hospital because the edoema and epithelial erosion of the cornea persisted. The patient presented with bullous keratopathy, asymmetrical iris atrophy, irreversible mydriasis, and glaucoma. His cataract progressed, and his best-corrected visual acuity was 0.03. Cataract surgery was performed after anti-inflammatory treatment with steroids, and Descemet-stripping automated endothelial keratoplasty was performed 6 months later. The patient recovered well postoperatively: his best-corrected visual acuity improved to 1.0 and he continued his glaucoma treatment. Case 2: A 75-year-old male patient had damage to his corneal epithelium, severe conjunctivitis, and conjunctival edoema when sprayed hornet venom entered his left eye. At initial presentation, the corneal endothelial cell density had decreased to 1042 cells/mm2. The conjunctival sac was washed, and steroid and topical antibacterial instillations were administered. His best-corrected visual acuity improved from 0.07 at the initial visit to 0.5. However, the corneal opacification and glaucoma persisted, and 3 months later the corneal endothelial cell density decreased to 846 cells/mm2. CONCLUSIONS AND IMPORTANCE: Corneal injuries caused by sprayed hornet venom are rare; however, they can cause intense anterior chamber inflammation and severe, irreversible corneal endothelial damage. In such cases, prompt initial treatment, the administration of adequate anti-inflammatory medication, and careful evaluation of the corneal endothelium are required.

Prognosis and etiology of traumatic and non-traumatic corneal perforations in a tertiary referral hospital: a 30-year retrospective study.

PURPOSE: To clarify the prognosis of corneal perforation, we compared the etiology and characteristics of patients with traumatic and non-traumatic corneal perforations. METHODS: This retrospective observational study included patients treated for traumatic or non-traumatic corneal perforations at a single tertiary hospital from 1989 to 2019. The variables collected included the primary cause of corneal perforation, final best-corrected visual acuity (BCVA), and treatment administered. The initial treatment administered and treatment success rates were compared between the traumatic and non-traumatic groups. Multivariate linear regression analysis was performed to determine the predictors of final visual acuity. RESULTS: Ninety eyes of 90 patients (mean age, 61.1 ± 19.7 years) were included. Traumatic and non-traumatic corneal perforations occurred in 40 (44.4%) and 50 eyes (55.6%), respectively. Among non-traumatic causes, infection and autoimmune disease were the causes for corneal perforation in 18 (20.0%) and 12 eyes (13.3%), respectively. The success rate for the closure of the perforated site with the initial procedure was significantly higher in traumatic corneal perforations than in non-traumatic corneal perforations (90.0% and 72.2%, respectively; p = 0.038). Patients with traumatic corneal perforation had significantly better final BCVA than those with non-traumatic corneal perforation (0.71 ± 1.18 and 1.52 ± 1.12, respectively; p = 0.0016). On multivariate analysis, older age and non-traumatic corneal perforation were significantly related to the final lower BCVA (p < 0.001 and p = 0.029, respectively). CONCLUSION: Traumatic corneal perforation demonstrated a significantly better prognosis than non-traumatic corneal perforation. It is critical to consider the primary cause of corneal perforation to anticipate prognosis.

Influence of implantation of diffractive trifocal intraocular lenses on standard automated perimetry.

BACKGROUND: This prospective comparative study aimed to investigate the influence of diffractive trifocal intraocular lenses (IOLs) implantation on standard automated perimetry. METHODS: Patients with no diseases affecting the visual field had undergone cataract surgery following the implantation of trifocal or monofocal IOLs from July 2019 to August 2020 were recruited. The normality of the anterior and posterior segments and absence of glaucomatous optic nerve cupping were confirmed preoperatively by slit-lamp examination. Standard automated perimetry was performed using Humphrey Visual Field 10-2 testing, 2-3 months after cataract surgery in only one eye per patient. The mean deviation (MD) and foveal sensitivity were compared between IOLs in eyes with acceptable reliability indices and best-corrected visual acuity of 20/25 or better. RESULTS: Among the 83 eyes of the 83 patients included, 39 and 29 eyes eligible for perimetry analysis had trifocal and monofocal IOLs, respectively. The mean MD and foveal sensitivity in eyes with trifocal IOLs were significantly lower than those in eyes with monofocal IOLs (P < 0.021), with mean differences of 0.77 and 1.01 dB, respectively. CONCLUSION: The comparison in nonglaucomatous eyes demonstrated that the influence of trifocal IOLs on standard automated perimetry was greater than that of monofocal IOLs.

Long-term outcome in corneal endotheliitis with molecular detection of herpes simplex virus 1 and human herpes virus 6: a case report.

BACKGROUND: Human herpesvirus 6B (HHV-6B) is known to cause exanthema subitem and has been detected in various ocular diseases, including keratitis, uveitis, optic neuritis, and endophthalmitis; however, the long-term outcome after the reactivation of HHV-6B has not been well-addressed. Sugita et al. previously reported the concomitant presence of HHV-6B with herpes simplex virus-1 (HSV-1) in the aqueous fluid at the onset of corneal endotheliitis. We focused on the same patient with corneal endotheliitis, in whom both HSV-1 and HHV-6B sequences were observed, and reported the clinical course and long-term outcomes. CASE PRESENTATION: A 64-year-old woman was referred to our center for visual disturbances in the left eye. Her best-corrected visual acuity in the left eye was 0.5 and the left intraocular pressure was elevated to 33 mmHg. Mid-sized keratic precipitates and 2+ cells were observed in the anterior chamber with corneal endothelial edema and reduction of the corneal endothelial cell density to 1828 cells/mm2. The patient was diagnosed with corneal endotheliitis with increased intraocular pressure. Polymerase chain reaction analysis revealed the concomitant presence of both HSV-1 and HHV-6B sequences in the left aqueous fluid. After treatment with oral valacyclovir and topical betamethasone, her intraocular inflammation gradually improved and has not recurred at 12 years after corneal endotheliitis onset although corneal opacity remained. CONCLUSIONS: Reactivation of HHV-6B infection might be associated with HSV-1 corneal endotheliitis; however, no serious late sequelae occurred after appropriate treatment for HSV-1 infection in this immunocompetent host.

Age factor in the fluoroquinolone susceptibility of gram-positive cocci isolates from bacterial keratitis cases between 2008 and 2016.

PURPOSE: To determine the relationship between fluoroquinolone susceptibility of gram-positive cocci (GPC) isolated from patients with bacterial keratitis and the age of the patients or the date of onset. METHODS: Bacterial isolates were obtained from corneal lesions of patients with infectious keratitis treated between January 2008 and December 2016. The fluoroquinolone susceptibility of GPC was assessed, and a retrospective review of microbiological records was performed. Fluoroquinolone susceptibility was measured through broth microdilution in accordance with protocols of the Clinical and Laboratory Standards Institute. Statistical analysis was performed using a generalized estimating equation and cubic spline to determine the association between fluoroquinolone susceptibility of GPC isolated from corneal lesions and patient age. RESULTS: Of the 1200 bacterial isolates, 471 GPC were identified. They included Staphylococcus epidermidis (45.6%), other coagulase-negative Staphylococcus sp. (17.8%), and Staphylococcus aureus (18.3%). Levofloxacin susceptibility of GPC exhibited a negative relationship with age and had an odds ratio of 0.893 (95% confidence interval, 0.825-0.967) for every 10 years of age. A non-adjusted cubic spline curve was well correlated with year-adjusted data in a generalized additive model, and the levofloxacin susceptibility of GPC was initially stable but gradually declined after 40 years of age, before re-stabilizing again after 70 years of age. CONCLUSION: The fluoroquinolone susceptibility of GPC isolated from corneal lesions of infectious keratitis is high in children under 15 years of age and declines with an increase in age of patients using a generalized estimating equation and cubic spline.

Functional visual acuity after implantation of diffractive extended depth-of-focus intraocular lenses using an echelett optics.

BACKGROUND: The prospective comparative case series aimed to evaluate all-distance visual acuity, contrast sensitivity, and functional visual acuity (FVA) of eyes with diffractive extended depth-of-focus (EDOF) intraocular lenses (IOLs) using an echelett optics and monofocal IOLs with the same platform. METHODS: Diffractive EDOF and monofocal IOLs were implanted in 27 eyes of 27 patients each. At 3 months after implantation, all-distance visual acuities at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5 m were measured under distance-corrected. Static visual function was also examined using photopic contrast sensitivity and area under the logarithmic contrast sensitivity function (AULCSF). Dynamic visual function was examined with FVA, and mean FVA value, visual maintenance ratio (VMR), mean response time, and number of blinks were evaluated. These outcomes were compared between the two IOLs. RESULTS: The mean distance-corrected visual acuities were better at distances of 0.7 m or nearer in eyes with EDOF IOLs. There was no difference in the contrast sensitivities (P > 0.22). In the FVA results, no difference was found in mean FVA and VMR (P > 0.68). CONCLUSION: The static and dynamic evaluations of postoperative visual functions demonstrated that the visual function of eyes with EDOF IOLs under photopic and distance-corrected conditions was comparable to eyes with monofocal IOLs.

Association of Rare CYP39A1 Variants With Exfoliation Syndrome Involving the Anterior Chamber of the Eye.

Importance: Exfoliation syndrome is a systemic disorder characterized by progressive accumulation of abnormal fibrillar protein aggregates manifesting clinically in the anterior chamber of the eye. This disorder is the most commonly known cause of glaucoma and a major cause of irreversible blindness. Objective: To determine if exfoliation syndrome is associated with rare, protein-changing variants predicted to impair protein function. Design, Setting, and Participants: A 2-stage, case-control, whole-exome sequencing association study with a discovery cohort and 2 independently ascertained validation cohorts. Study participants from 14 countries were enrolled between February 1999 and December 2019. The date of last clinical follow-up was December 2019. Affected individuals had exfoliation material on anterior segment structures of at least 1 eye as visualized by slit lamp examination. Unaffected individuals had no signs of exfoliation syndrome. Exposures: Rare, coding-sequence genetic variants predicted to be damaging by bioinformatic algorithms trained to recognize alterations that impair protein function. Main Outcomes and Measures: The primary outcome was the presence of exfoliation syndrome. Exome-wide significance for detected variants was defined as P < 2.5 × 10-6. The secondary outcomes included biochemical enzymatic assays and gene expression analyses. Results: The discovery cohort included 4028 participants with exfoliation syndrome (median age, 78 years [interquartile range, 73-83 years]; 2377 [59.0%] women) and 5638 participants without exfoliation syndrome (median age, 72 years [interquartile range, 65-78 years]; 3159 [56.0%] women). In the discovery cohort, persons with exfoliation syndrome, compared with those without exfoliation syndrome, were significantly more likely to carry damaging CYP39A1 variants (1.3% vs 0.30%, respectively; odds ratio, 3.55 [95% CI, 2.07-6.10]; P = 6.1 × 10-7). This outcome was validated in 2 independent cohorts. The first validation cohort included 2337 individuals with exfoliation syndrome (median age, 74 years; 1132 women; n = 1934 with demographic data) and 2813 individuals without exfoliation syndrome (median age, 72 years; 1287 women; n = 2421 with demographic data). The second validation cohort included 1663 individuals with exfoliation syndrome (median age, 75 years; 587 women; n = 1064 with demographic data) and 3962 individuals without exfoliation syndrome (median age, 74 years; 951 women; n = 1555 with demographic data). Of the individuals from both validation cohorts, 5.2% with exfoliation syndrome carried CYP39A1 damaging alleles vs 3.1% without exfoliation syndrome (odds ratio, 1.82 [95% CI, 1.47-2.26]; P < .001). Biochemical assays classified 34 of 42 damaging CYP39A1 alleles as functionally deficient (median reduction in enzymatic activity compared with wild-type CYP39A1, 94.4% [interquartile range, 78.7%-98.2%] for the 34 deficient variants). CYP39A1 transcript expression was 47% lower (95% CI, 30%-64% lower; P < .001) in ciliary body tissues from individuals with exfoliation syndrome compared with individuals without exfoliation syndrome. Conclusions and Relevance: In this whole-exome sequencing case-control study, presence of exfoliation syndrome was significantly associated with carriage of functionally deficient CYP39A1 sequence variants. Further research is needed to understand the clinical implications of these findings.

Regional comparison of preoperative biometry for cataract surgery between two domestic institutions.

PURPOSE: Regional variations of the preoperative biometry can affect the refractive accuracy of cataract surgery. We aimed to compare the preoperative biometric data for cataract surgery between two domestic institutions. METHODS: We retrospectively reviewed the preoperative biometric data of 673 consecutive eyes undergoing standard cataract surgery at Miyata Eye Hospital (Miyazaki; M group) and Kitasato University Hospital (Kanagawa; K group), and compared these data between the two groups. RESULTS: We found significant differences in the mean keratometric readings (44.39 ± 1.56 D vs. 44.09 ± 1.74 D) (unpaired t test, p = 0.034), the anterior chamber depth (3.14 ± 0.43 mm vs. 3.46 ± 0.62 mm) (p < 0.001), the axial length (23.98 ± 1.62 mm vs. 24.59 ± 1.82 mm) (p < 0.001), and the lens thickness (4.64 ± 0.48 mm vs. 4.37 ± 0.62 mm) (p < 0.001), in the M and K groups, respectively. Otherwise, we found no significant differences in corneal astigmatism (p = 0.104), or central corneal thickness (p = 0.480) between the two groups. For subgroup analysis, the prediction error (0.06 ± 0.47 D) in the M group was significantly more hyperopic than that (- 0.09 ± 0.54 D) in the K group (p = 0.006). CONCLUSIONS: There were significant differences in the mean keratometric readings, the anterior chamber depth, the axial length, and the lens thickness, by approximately 0.3 D, 0.3 mm, 0.6 mm, and 0.3 mm, respectively. Regional variations of the preoperative biometry did exist to some extent, and were not clinically negligible, in consideration of the precise IOL power calculation and the subsequent refractive accuracy of cataract surgery. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (000037994).

Activation of the Sphingosine 1 Phosphate-Rho Pathway in Pterygium and in Ultraviolet-Irradiated Normal Conjunctiva.

Sphingosine 1 phosphate (S1P) is a bioactive lipid that regulates cellular activity, including proliferation, cytoskeletal organization, migration, and fibrosis. In this study, the potential relevance of S1P-Rho signaling in pterygium formation and the effects of ultraviolet (UV) irradiation on activation of the S1P/S1P receptor axis and fibrotic responses were investigated in vitro. Expressions of the S1P2, S1P4, and S1P5 receptors were significantly higher in pterygium tissue than in normal conjunctiva, and the concentration of S1P was significantly elevated in the lysate of normal conjunctival fibroblast cell (NCFC) irradiated with UV (UV-NCFCs). RhoA activity was significantly upregulated in pterygium fibroblast cells (PFCs) and UV-NCFCs, and myosin phosphatase-Rho interacting protein (MRIP) was upregulated, and myosin phosphatase target subunit 1 (MYPT1) was downregulated in PFCs. Fibrogenic changes were significantly upregulated in both PFCs and UV-NCFCs compared to NCFCs. We found that the activation of the S1P receptor-Rho cascade was observed in pterygium tissue. Additionally, in vitro examination showed S1P-rho activation and fibrogenic changes in PFCs and UV-NCFCs. S1P elevation and the resulting upregulation of the downstream Rho signaling pathway may be important in pterygium formation; this pathway offers a potential therapeutic target for suppressing pterygium generation.

Genetic variants and cellular stressors associated with exfoliation syndrome modulate promoter activity of a lncRNA within the LOXL1 locus.

Exfoliation syndrome (XFS) is a common, age-related, systemic fibrillinopathy. It greatly increases risk of exfoliation glaucoma (XFG), a major worldwide cause of irreversible blindness. Coding variants in the lysyl oxidase-like 1 (LOXL1) gene are strongly associated with XFS in all studied populations, but a functional role for these variants has not been established. To identify additional candidate functional variants, we sequenced the entire LOXL1 genomic locus (∼40 kb) in 50 indigenous, black South African XFS cases and 50 matched controls. The variants with the strongest evidence of association were located in a well-defined 7-kb region bounded by the 3'-end of exon 1 and the adjacent region of intron 1 of LOXL1. We replicated this finding in US Caucasian (91 cases/1031 controls), German (771 cases/1365 controls) and Japanese (1484 cases/1188 controls) populations. The region of peak association lies upstream of LOXL1-AS1, a long non-coding RNA (lncRNA) encoded on the opposite strand of LOXL1. We show that this region contains a promoter and, importantly, that the strongly associated XFS risk alleles in the South African population are functional variants that significantly modulate the activity of this promoter. LOXL1-AS1 expression is also significantly altered in response to oxidative stress in human lens epithelial cells and in response to cyclic mechanical stress in human Schlemm's canal endothelial cells. Taken together, these findings support a functional role for the LOXL1-AS1 lncRNA in cellular stress response and suggest that dysregulation of its expression by genetic risk variants plays a key role in XFS pathogenesis.

Long-term follow-up of transplantation of preserved limbal allograft and amniotic membrane for recurrent pterygium.

PURPOSE: To conduct a long-term follow-up study evaluating the efficacy and safety of transplantation of preserved limbal allograft and amniotic membrane for recurrent pterygium. METHODS: This was a retrospective, non-comparative, interventional case series conducted at a private eye hospital. Eighty-four eyes of 80 patients with recurrent pterygium were included in the study. The mean number of previous surgeries for pterygium was 1.36 ± 0.98 (range, 1-8). All subjects received transplantation of preserved limbal allograft and amniotic membrane. RESULTS: The mean follow-up period was 73.0 ± 38.1 months (range, 12-154 months). Pterygium recurred in 10 eyes (11.9 %). The mean period to recurrence was 16.3 ± 11.3 months (range, 5-33 months). Symblepharon was cured in 21 eyes, persisted in 2 eyes, and newly occurred in 3 eyes. Diplopia was cured in eight eyes, persisted in five eyes, and newly occurred in one eye. As for complications, intraocular pressure elevations over 21 mmHg were recognized in ten eyes of nine cases, in which the intraocular pressure was controlled by reduction of topical steroid in four eyes and by addition of topical prostaglandin derivatives in six eyes. Twenty-four eyes (28.6 %) gained two lines or more of Landolt best spectacle-corrected visual acuity (BSCVA), 56 eyes (66.7 %) stayed within one line from preoperation, and four eyes (4.8 %) lost two lines or more. There were no major complications and no graft rejection. CONCLUSIONS: Transplantation of preserved limbal allograft and amniotic membrane is a safe and effective procedure for recurrent pterygium.

Topographic changes after excision surgery of primary pterygia and the effect of pterygium size on topograpic restoration.

OBJECTIVE: To assess the effect of pterygium size on time-course change of corneal topography after excision surgery of primary pterygium. METHODS: Retrospective case series included eyes that underwent excisions of primary pterygium. Pterygium size was graded according to the advancing edge position: less than one third of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Time-course changes in corneal refractive power, astigmatism, and irregularity (surface regularity and asymmetry indices) in corneal topographies over 12 months postoperatively were compared between the pterygium size grades. RESULTS: Pterygium excision was performed on 562 eyes, consisting of 119, 338, and 105 eyes with grades 1 to 3, respectively. Grade 1 did not change in corneal irregularity, and there was no difference between grades 1 and 2, except for corneal astigmatism at 6 months. Grade 3 showed significantly higher corneal refractive power and irregularity than grade 1 until 3 and 6 months, respectively, whereas corneal astigmatism was higher over 12 months. CONCLUSIONS: Topographic changes after primary pterygium excision were associated with pterygium size. Pterygium advancing over the pupillary area required 6 to 12 months for corneal topography restoration, resulting in slow recovery of visual acuity.

Management of preoperative hypertension and anxiety based on early monitoring of pulse rate before cataract surgery.

PURPOSE: Few studies have addressed the clinical impact of fluctuation in pulse rate before cataract surgery. This study aimed to determine the effectiveness of prior pulse monitoring and intervention to prevent blood pressure changes in patients undergoing cataract surgery under local anesthesia. STUDY DESIGN: Retrospective study METHODS: Patients who underwent cataract surgery under local anesthesia were included. In the pulse rate (PR) group, intervention was performed on the basis of early monitoring of blood pressure and PR changes. In the conventional group, blood pressure was managed on the basis of blood pressure alone. Systolic blood pressure, diastolic blood pressure, intraoperative nicardipine use, and physician consultation time were retrospectively compared between the groups. RESULTS: The study included 684 eyes from 684 patients aged 73.5 ± 9.5 years (PR group: 297 eyes, conventional group: 387 eyes). No intergroup differences were found in systolic blood pressure or pulse and heart rates; however, diastolic blood pressure was significantly lower in the PR group than in the conventional group at both the beginning and the end of surgery (P <.001 and P = .0028, respectively). Intravenous nicardipine administration in the operating room was significantly less frequent in the PR group (P = .041), and physician consultation time after entering the operating room and at the beginning of surgery was significantly shorter in the PR group (both P <.001). CONCLUSION: Early monitoring of PR with blood pressure and intervention were effective for preventing preoperative hypertension.

Outcomes of cataract surgeries performed in 8 eyes of centenarians.

Cataract surgery outcomes in centenarian patients have not previously been explored. This study aimed to examine characteristics and report clinical results of people aged ≥100 years undergoing cataract surgery. This was a retrospective observational study, including patients aged ≥100 years who underwent cataract surgery between 2003 and 2021 at Miyata Eye Hospital in Japan. Medical charts were reviewed for information on cataract severity, surgery type, anesthesia, as well as ocular and medical comorbidities. Using Mann-Whitney test, visual acuity, intraocular pressure, and corneal endothelial cell density were compared before and after surgery. Eight eyes of 5 patients were included in the study (mean age, 101.5 ±â€…1.2 years). Seven of these eyes (87.5%) belonged to women. All surgeries were performed under topical anesthesia using phacoemulsification and insertion of the intraocular lens fixed in the bag. All patients had multiple preoperative medical comorbidities; however, there were no intraoperative, postoperative ocular, or general complications. The postoperative best-corrected visual acuity was significantly improved compared to that before surgery (1.18 ±â€…0.74 and 0.29 ±â€…0.52, respectively, P = .004). Neither intraocular pressure nor corneal endothelial cell density demonstrated a significant difference postoperatively. Cataract surgery can be safely performed under topical anesthesia in centenarians without complications using proper perioperative medical control and preparation.

Debilitating ocular globe rupture due to a forklift accident: A case report.

We describe a case of globe rupture due to a forklift accident. A 64-year-old man presented to the ophthalmology hospital shortly after the jaws of a forklift struck his left eye. The left eye was shrunken with a full-thickness scleral laceration. B-scan ultrasonography revealed a hypotonic eyeball with antero-posterior shrinkage. We promptly performed scleral suturing to maintain the ocular shape. The patient's intraocular pressure improved to 7.1 mmHg, and visual acuity was limited to light perception. Despite this, intraocular hemorrhage in the anterior chamber persisted, and an electroretinogram demonstrated poor response to light. Subsequently, the patient underwent a vitrectomy with silicone oil tamponade to address the vitreous hemorrhage, proliferative membranes, and retinal detachment. However, proliferative vitreoretinopathy with tractional retinal detachment progressed postoperatively, resulting in the loss of light perception. Ocular trauma caused by forklifts accident is rare; however, the strong external forces they exert can cause severe and irreversible visual impairment. Therefore, it is necessary for forklift operators and other concerned individuals to exercise caution to prevent forklift-related ocular trauma. Moreover, ophthalmologists should be aware of the dangers of forklift-related ocular trauma and treatment and management of the same.