Cyclin-dependent kinase inhibitor p16 and p21 expression, and cell cycle change in human lens epithelial cell line SRA 01/04 following contact inhibition in normal culture.

PURPOSE: To describe the pattern of expression of the cyclin-dependent kinase inhibitors (CDKIs) p16, p21 and p27, and the cell cycle in SRA 01/04 cells relative to contact inhibition. METHODS: SRA 01/04 cells were grown to overconfluence under normal conditions. At various phases of the cell growth, cells were assayed by flow cytometry and Western blotting for the expression of CDKIs. RESULTS: Expression of p16 was detected from early logarithmic growth to stationary phases, during which the number of cells in G(0)/G(1) increased from 46 to 69%. Expression of p21 was detected only during the overgrowth phase, when 60% of the cells were in G(0)/G(1). Expression of p27 was not observed in SRA 01/04 cells. CONCLUSIONS: p16 expression was likely mediated by G(0)/G(1) arrest to induce contact inhibition in SRA 01/04. p21 expression may be related to withdrawal, and p27 deficiency may be related to the immortality of this cell line. It is possible for p16 to stop proliferation of lens epithelial cells like progressing posterior capsular opacification, by overexpression to mimic contact inhibition.

UV-B exposure to the eye depending on solar altitude.

PURPOSE: To assess the validity of the solar ultraviolet index (UVI) as a determiner of eye risk under different conditions of facial profiles and orientation, and reflected light. METHODS: Ocular UV radiation (UVR) exposure was measured as a function of the time of the day (solar altitude) using a two-dummy-type mannequin dosimetry system with embedded UVR (260-310 nm) sensors, in September and November in Kanazawa, Japan, on a motorized sun-tracking mount with one dummy face directed toward the sun and the other away from the sun. RESULTS: A bimodal distribution of UV-B exposure was found in September for the face directed toward the sun, which differed dramatically from the pattern of ambient UVR exposure and measurements taken on the top of the head and those for the eye taken later in the year. Although the overall level was lower, a higher solar altitude is associated with higher UVR exposure in the condition facing away from the sun. CONCLUSIONS: The UVI is based on ambient solar radiation on an unobstructed horizontal plane similar to our measures taken on the top of the head, which differed so much from our measures of ocular exposure that UVI as a determiner of eye risk is deemed invalid. The use of the UVI as an indicator for the need for eye protection can be seriously misleading. Doctors should caution patients with regard to this problem, and eye protection may be warranted throughout the year.

Computational model for calculating body-core temperature elevation in rabbits due to whole-body exposure at 2.45 GHz.

In the current international guidelines and standards with regard to human exposure to electromagnetic waves, the basic restriction is defined in terms of the whole-body average-specific absorption rate. The rationale for the guidelines is that the characteristic pattern of thermoregulatory response is observed for the whole-body average SAR above a certain level. However, the relationship between energy absorption and temperature elevation was not well quantified. In this study, we improved our thermal computation model for rabbits, which was developed for localized exposure on eye, in order to investigate the body-core temperature elevation due to whole-body exposure at 2.45 GHz. The effect of anesthesia on the body-core temperature elevation was also discussed in comparison with measured results. For the whole-body average SAR of 3.0 W kg(-1), the body-core temperature in rabbits elevates with time, without becoming saturated. The administration of anesthesia suppressed body-core temperature elevation, which is attributed to the reduced basal metabolic rate.

Computation of temperature elevation in rabbit eye irradiated by 2.45-GHz microwaves with different field configurations.

This study calculated the temperature elevation in the rabbit eye caused by 2.45-GHz near-field exposure systems. First, we calculated specific absorption rate distributions in the eye for different antennas and then compared them with those observed in previous studies. Next, we re-examined the temperature elevation in the rabbit eye due to a horizontally-polarized dipole antenna with a C-shaped director, which was used in a previous study. For our computational results, we found that decisive factors of the SAR distribution in the rabbit eye were the polarization of the electromagnetic wave and antenna aperture. Next, we quantified the eye average specific absorption rate as 67 W kg(-1) for the dipole antenna with an input power density at the eye surface of 150 mW cm(-2), which was specified in the previous work as the minimum cataractogenic power density. The effect of administrating anesthesia on the temperature elevation was 30% or so in the above case. Additionally, the position where maximum temperature in the lens appears is discussed due to different 2.45-GHz microwave systems. That position was found to appear around the posterior of the lens regardless of the exposure condition, which indicates that the original temperature distribution in the eye was the dominant factor.

Efficacy of alpha-lipoic acid against diabetic cataract in rat.

PURPOSE: alpha-Lipoic acid (LA) is well known as a powerful antioxidant. The efficacy of dihydrolipoate-LA for oral administration against streptozotocin (STZ)-induced diabetic cataract in rat was investigated. METHODS: Rats were divided into three groups, control, diabetes mellitus (DM), and DM treated with LA (DM+LA). Diabetes was induced by intravenous injection of 50 mg/kg STZ. DM+LA rats were fed 30 mg/rat per day LA in their diet. Lens changes were assessed using Scheimpflug images (EAS-1000) and by measuring light-scattering intensity. RESULTS: Increase in lens light scattering was less (P < 0.05) in DM+LA rats than in DM rats 5 weeks after induction of diabetes. DM rats had the highest and control rats the lowest blood glucose levels at every measurement point up to 111 days (P < 0.05). CONCLUSION: LA treatment delayed development and progression of cataract in rats with streptozotocin-induced diabetes.

Prevalence and risk factors for cornea guttata in the Reykjavik Eye Study.

PURPOSE: To establish the age- and gender-specific prevalence of cornea guttata (CG) in citizens of Reykjavik, Iceland, 55 years and older. DESIGN: Cross-sectional, random, population-based study. PARTICIPANTS: The 774 participants were those participating in the second examination of the Reykjavik Eye Study. At baseline, we had a response rate of 75.8%, and at the 5-year follow-up, 88% of the survivors participated. METHODS: We used slit-lamp and non-contact specular microscopy and endothelial specular photography as well as computer-assisted morphometry. We used a standardized grading system for CG. MAIN OUTCOME MEASURES: Diagnosis of primary central CG. RESULTS: The prevalence of CG is 11% for females and 7% for males both for right eyes and left eyes. Higher weight and higher body mass index are found to be associated with decreased risk of CG. Having smoked more than 20 pack-years increased the risk of CG more than 2-fold (P<0.02). CONCLUSIONS: Cornea guttata seem to be found more commonly in women than in men. Smoking for more than 20 pack-years increases the risk of developing CG more than 2-fold.

Risk factors for five-year incident age-related macular degeneration: the Reykjavik Eye Study.

PURPOSE: To establish risk factors for five-year incidence of age-related macular degeneration (AMD). DESIGN: Population-based, prospective cohort study, and risk analysis. METHODS: A random sample from the Reykjavik Population Census for individuals 50 years and older was selected. We took fundus stereo color photographs and used standard grading system to study the five-year incidence of drusen, pigmentary abnormalities, and AMD and to examine possible risk factors. A questionnaire including information on disease, medication, diet, and lifestyle from the Reykjavik Eye Study database provided additional information. RESULTS: Current alcohol consumption decreased the risk for drusen. Being married rather than divorced or widowed decreased the risk for soft drusen; being single decreased the risk of hypopigmentation as compared with being divorced or married. Both consuming dietary fiber-rich vegetables and meat and meat products once a week or less frequently was a risk factor for developing soft drusen and decreased the risk of pigmentary abnormalities. Those who had smoked 20 pack-years or more as compared with nonsmokers had decreased survival rate over the five years (odds ratio (OR) 0.46, 95% confidence interval (CI) 0.27 to 0.80; P = .006). CONCLUSIONS: Risk factors for drusen appear to differ from risk factors for pigmentary abnormalities. The effect of smoking on developing AMD is partly masked by selective mortality.

Prognostic Factors of Oral Intake After Endoscopic Gastroduodenal Stent Placement for Advanced Gastric Cancer.

Gastroduodenal stents are effective for gastric outlet obstruction (GOO) due to gastric cancer. However, some patients are unable to eat again soon. We retrospectively analyzed the cause of short-feeding periods. Between 2011 and 2015, we performed stent placement in 22 patients who could not eat solids. The effects of clinical characteristics on duration of oral intake were analyzed using Cox proportional hazards models. Univariate analyses revealed that the degree of GOO [no oral intake/liquids only; hazard ratio (HR), 10.9; 95% confidence interval (CI), 2.5-48.1; P=0.003], performance status score (2 or 3/0 or 1; HR, 5.7; 95% CI, 1.8-16.9; P=0.004), and poststenting chemotherapy (no/yes; HR, 5.7; 95% CI, 1.9-18.9; P=0.002) were significant factors for cessation of oral intake. Multivariate analysis showed that GOO and chemotherapy were significant factors. Gastroduodenal stents were less effective for patients with severe stenosis or without poststenting chemotherapy.

5-year incidence of age-related maculopathy in the Reykjavik Eye Study.

PURPOSE: To examine the age- and gender-specific 5-year incidence of age-related maculopathy (ARM) and age-related macular degeneration (AMD) in citizens of Reykjavik. DESIGN: Population-based, prospective cohort study. PARTICIPANTS: The cohort was a population-based random sample of citizens 50 years and older. Of 1379 eligible subjects, 1045 had a baseline examination in 1996; 846 of the 958 survivors (88.2%) had a 5-year follow-up examination in 2001. METHODS: The incidence of various characteristics of drusen and pigmentary changes that are typical of ARM were determined using the international classification and grading system for ARM and AMD. MAIN OUTCOME MEASURES: Early ARM and AMD were assessed by masked grading of stereo fundus photographs. RESULTS: Hypopigmentation developed at 5 years in 10.7% of people 50 to 59 years of age (95% confidence interval [CI], 6.9-14.4) and in 25.7% those 70 to 79 years of age (95% CI, 18.4-33.0) at baseline. Age-related macular degeneration developed in no one who was 50 to 59 years of age at baseline. Geographic atrophy (GA) developed in 4.6% (95% CI, 1.2-7.9) and exudative AMD in none of those who were 70 years and older at baseline. CONCLUSIONS: Geographic atrophy is the predominant type of AMD in Iceland, and the ratio of GA to neovascular AMD is higher than in racially similar populations.

Low vitamin E level as a subliminal risk factor in a rat model of prednisolone-induced cataract.

PURPOSE: To investigate the relationship between vitamin E deficiency and prednisolone-induced cataract formation, long-term examination of lens changes was performed in rats under the condition of vitamin E deficiency or supplementation and administration of prednisolone. METHODS: Rats were divided into six groups: normal chow (N), vitamin E-deficient chow (ED), normal chow with prednisolone instillation (NP), vitamin E-deficient chow with prednisolone instillation (EDP), NP treatment with vitamin E supplementation (NP+VE), and EDP treatment with vitamin E supplementation (EDP+VE). Prednisolone (1 mg/kg small middle dot d) and vitamin E (5%; 10 microL per administration per eye, 1 mg/kg small middle dot d) were applied in the cul-de-sac. Lens changes were documented and analyzed. Vitamin E status was confirmed by measuring peroxide-induced hemolysis. RESULTS: After 15 months, 91.7% of the eyes in the EDP group showed development of anterior and posterior cortical cataracts. Supplementation with vitamin E significantly reduced cataract formation (to 38.9% of eyes). Neither a vitamin E-deficient diet nor prednisolone treatment alone significantly increased cataract formation. Hemolysis-susceptibility tests confirmed the expected vitamin E status of rats fed vitamin E-deficient chow and rats supplemented with eye drops containing vitamin E. CONCLUSIONS: Vitamin E deficiency and long-term prednisolone treatment together cause cataracts. Singly, however, both conditions are subliminal cataractogenic risk factors.

Localization of cortical cataract in subjects of diverse races and latitude.

PURPOSE: To compare the characteristics of early cortical cataract localization in three groups in cataract epidemiologic surveys performed in Reykjavík, Melbourne, and Singapore. METHODS: Individuals who had right eyes with an area of cortical opacity less than 20% of the pupil when dilated 7 mm or more were selected as subjects. This included 197 subjects from the Reykjavík Eye Study, 231 from the Vitamin E, Cataract, and Age-Related Maculopathy (VECAT) study in Melbourne, and 92 from the Singapore-Japan Cooperative Cataract Study, all showing early-stage cataract in pupils dilated to 7 mm or more. Scheimpflug and retroilluminated photographs were used to locate opacities. Localization of cortical cataract was determined by dividing the retroillumination image into seven concentric circles with diameters of 1 through 7 mm, and eight sections of 45 degrees radial octants. The positive rate of opacification was then calculated for each quadrant. RESULTS: The highest positive rate of opacification was observed in the lower nasal quadrant in all groups. The relative risk of the prevalence of cortical opacity in the lower nasal oblique hemisphere to the upper temporal oblique hemisphere was the highest in the Singaporean subjects followed by those of Melbourne and then of Reykjavík. CONCLUSIONS: The prevalence of cortical cataract was higher in the lower nasal quadrant than in the other quadrants for all subjects of diverse race in three climatically different locations. This higher prevalence was most pronounced in subjects living at low latitude. These results support the view that solar UV exposure is a possible risk factor for development of human cortical cataract.

The prevalence of age-related maculopathy in iceland: Reykjavik eye study.

OBJECTIVE: To examine the age- and sex-specific prevalence of age-related maculopathy (ARM) and age-related macular degeneration (AMD) in citizens of Reykjavik, Iceland, who were 50 years and older. DESIGN: Random sample, cross sectional. MATERIALS AND METHODS: Response rate was 75.8%. The presence and severity of various characteristics of drusen and pigmentary changes that are typical of ARM and AMD were determined by grading stereoscopic color fundus photographs, using the international classification and grading system for ARM and AMD. RESULTS: We were able to evaluate 1021 right-eye and 1020 left-eye macular photographs. There was no statistically significant difference between right and left eyes. In people aged 50 to 59 years, 4.8% of participants (95% confidence interval [CI], 2.6-7.0) were found to have intermediate soft drusen measuring 63 to 125 micro m in either eye; 1.2% (95% CI, 0.0-2.3) had large soft distinct drusen larger than 125 micro m; and 0.6% (95% CI, 0.0-1.4) had large soft, crystalline, or semisolid drusen. The same figures for those 80 years and older were 18.2% (95% CI, 9.8-26.6), 10.9% (95% CI, 4.0-17.8), and 25.5% (95% CI, 18.4-32.6), respectively. Geographic atrophy was found in either eye in 9.2% of those participants 70 years and older (95% CI, 5.6-12.7), and exudative macular degeneration was found in 2.3% of participants 70 years and older (95% CI, 0.5-4.1). CONCLUSION: Geographic atrophy was found to be more common in our study than in other population-based studies.

Increased disk size in glaucomatous eyes vs normal eyes in the Reykjavik eye study.

PURPOSE: To evaluate the use of disk diameter as an indicator in the identification of glaucomatous optic neuropathy. METHODS: We evaluated all available stereofundus photographs for 1,040 right eyes obtained in the Reykjavik Eye Study. Horizontal and vertical disk diameters were determined in a masked manner by a glaucoma specialist (K.F.D.). All disk diameters were corrected for refractive error. RESULTS: There were significant differences (P <.05) between the corrected vertical disk diameters of normal subjects (0.189 +/- 0.018 inches) and those suspected of having glaucoma (0.202 +/- 0.020 inches) as well as between the normal and the glaucoma groups (0.206 +/- 0.029 inches). The corrected horizontal measurement showed the same pattern. CONCLUSIONS: In the Reykjavik Eye Study, optic disks meeting structural criteria for glaucoma are significantly larger than normal nerves.

Environmental temperature and cataract progression in experimental rat cataract models.

PURPOSE: To clarify whether or not ambient temperature relates to cataract development or the progression of cataract formation. MATERIALS AND METHODS: 36 Brown Norway rats were divided into two groups, a high-temperature (35 +/- 2 degrees C, H = high) breeding group and a regular-temperature (24 +/- 2 degrees C, L = low) group. Each group was further divided into an experimentally induced diabetic cataract subgroup (50 mg/kg streptozotocin, DM), an ultraviolet B exposure-induced cataract subgroup (200 mJ/cm2, UV), and a normal control subgroup (C = control). Slit-lamp microscopy and an anterior image analysis system (EAS-1000) were used to evaluate lens changes. RESULTS: Both the HC and HUV groups in the 35 degrees C conditions showed higher light scattering than that of the 24 degrees C conditions (LC and LUV) 3 weeks after the start of the experiment. Nine weeks after the start of the experiment, all the rats of the UV subgroups (HUV and LUV) developed anterior subcapsular cataract. The temperature did not have much influence on the progression of the UV-B-induced cataract. From 18 days after the start of the experiment, the HC subgroup showed a wider light scattering area than the LC. An increase in abnormal nuclear scattering light in the crystalline lens of group HC was found in 9 weeks after the start of the experiment, and at the end of the experiment (78 weeks later), dense abnormal nuclear light scattering was found including the prenuclear area. In contrast, the HDM group in the 35 degrees C conditions showed slower cataract progression than that of the LDM group at 24 degrees C room temperature. CONCLUSIONS: Although further experiments are necessary before we can draw any conclusions about temperature and nuclear changes, paying attention to the effects of temperature on the lens is worthwhile.

Risk factors for nuclear lens opacification: the Reykjavik Eye Study.

PURPOSE: The purpose of this study is to examine risk factors for nuclear lens opacification in citizens of Reykjavik. METHODS: 1,045 persons, 583 females and 462 males aged 50 years and older, were randomly sampled and underwent a detailed eye examination and answered a questionnaire. In all Scheimpflug photography of the anterior eye segment was done including the lens as well as retroilluminated photography of the lens. These photographs were used for the diagnosis of lens opacification. The data was analyzed using a logistic regression model. RESULTS: An increased risk for all grades of nuclear opacifications was found with ageing (OR = 1.228, 95% CI = 1.192-1.264, p = 0.000), cigarette smoking for more than 20 pack/years (OR = 2.521, 95% CI = 1.521-4.125, p = 0.000) and pipe or cigar smoking (OR = 2.478, 95% CI = 1.200-5.116, p = 0.014). Outdoor exposure, cortical lens opacification grade II and III and computer usage were not found to be linked to higher risk of nuclear opacification. No correlation was found between nuclear opacification and the consumption of vitamins, herring, sardines and shrimps, cod-liver oil or plant oil, nor were iris color, hyperopia, systemic steroid use, cardiovascular disease, diabetes, glaucoma and pseudoexfoliation found to have a significant effect. CONCLUSIONS: Ageing is a major risk factor for nuclear lens opacification, and smoking is a major modifiable risk factor. Cortical and nuclear lens opacifications do not share the same modifiable risk factors.

The effects of protective eyewear on glare and crystalline lens transparency.

PURPOSE: Sunglasses have generally been used to protect against glare. Various kinds of sunglasses which correspond to the visual environment are on the market (e.g. for driving, fishing, skiing, etc.). As for the spectral transmission factor of sunglasses, the differences that occur in user's eyes with aging have not been fully considered. We investigated the relationship between different levels of crystalline lens transparence and the effects of glare protection using two kinds of filters. SUBJECTS AND METHODS: A Tri-Blocker filter (TB) and general driving filter (ActiveDrive, ADR) were used. The TB absorbs three spectral wavelengths (below 400 nm, blue light, 575 nm) and can be transparent for other visible light. The ADR reduces the light below 650 nm. TB and ADR transmit 52.5 and 29.0% of the visible light, respectively. Twenty-five normal volunteers with transparent lenses (n = 48 eyes, aged from 22 to 68 years) and 10 cortical cataract patients (n = 18 eyes, aged from 48 to 71 years) were selected. The visual acuity of all subjects was 1.0 or better with the best correction. Contrast sensitivity function (CSF) was measured in four simulated light conditions (daylight, daylight with peripheral glare, twilight, twilight with central glare) by MCT8000 (Vistech). The light scattering intensity of the crystalline lens was measured by EAS-1000 (Nidek). RESULTS: The TB improved the CSF of the elderly volunteers under daylight conditions and of 1 of the cataract patients under all conditions. In the younger group, the CSF did not change under daylight conditions and deteriorated under twilight conditions. Although the ADR was effective for glare protection in the young volunteers, the protective effects of the TB were better than those of ADR for the middle-aged group. CONCLUSION: Sunglasses not only protect against glare but also stabilize visual quality under various light conditions (e.g. passing through a tunnel while driving). Aging changes in lens transparency should be specially considered when developing protective eyewear.

High prevalence of nuclear cataract in the population of tropical and subtropical areas.

The authors have conducted cataract epidemiological studies in four climatically and racially different places and compared the data. The survey places were Noto and Amami in Japan, Reykjavik in Iceland, and Singapore. The evaluation and grading of lens opacities were done using graphic analysis of Scheimpflug and retro-illumination images. The prevalence of nuclear opacity was extremely high in the Singapore group, followed by Amami. The main type of lens opacity was nuclear in the Singapore group and cortical in the Noto and Icelandic groups. The characteristic lens opacity in Amami was in between the above two groups. No significant difference was seen in the prevalence of nuclear opacity between males and females in any of the groups. Although the common factors of the living conditions in the subjects with a high prevalence of nuclear opacity appear to be high UV exposure and high ambient temperature, future investigations should be made to disclose the possible cause.

General purpose antimicrobial ophthalmic solutions evaluated using new pharmacokinetic parameter of maximum drug concentration in aqueous.

PURPOSE: In order to determine whether the one-component method for calculating drug concentration in the aqueous (AQC(max)) is useful for selecting an appropriate ophthalmic solution, six general purpose antimicrobial ophthalmic solutions already on the market were investigated. METHODS: The drugs examined were levofloxacin (LVFX), chloramphenicol (CP), erythromycin lactobionate (EM), micronomicin sulfate (MCR), cefmenoxime hydrochloride (CMX), and disodium sulfobenzyl penicillin (SBPC). Fifty microliters of each solution was instilled into the cul-de-sac of New Zealand White rabbit eyes three times at 15-minute intervals. The drug concentrations in the aqueous humor 10, 30, 60, 120, and 240 minutes after the final instillation were examined by high performance liquid chromatography (HPLC) and/or bioassay. The AQC(max) was calculated using the one-compartment method. RESULTS: The calculated AQC(max) was 2.5 microg/mL (HPLC method) and 2.28 microg/mL (bioassay method) for LVFX, 2.17 microg/mL for CP, and 0.45 microg/mL for EM. The AQC(max) for CMX, MCR, and SBPC could not be calculated by the one-compartment method. CONCLUSIONS: The AQC(max) of LVFX was higher than that of the two other general purpose antimicrobial ophthalmic solutions. The AQC(max) of these drugs might be a useful parameter for selecting an appropriate ophthalmic solution for the treatment of infected eyes.

The effect of the corneal epithelium on the intraocular penetration of fluoroquinolone ophthalmic solution.

PURPOSE: Pharmacokinetic studies of antibacterial agents for infectious eye diseases have usually been performed on normal rabbit eyes. In this study, the intraocular penetration of fluoroquinolone ophthalmic solutions was determined in normal rabbit eyes and in rabbit eyes that had the corneal epithelium intentionally removed. METHODS: We determined the intraocular penetration of ofloxacin (OFLX), levofloxacin (LVFX), and norfloxacin (NFLX), fluoroquinolone ophthalmic solutions that are already on the market and undergoing clinical studies, by injecting 50 microl of each solution into the cul-de-sacs of rabbit eyes three times at 15-min intervals. The drug concentration at 10, 30, 60, 120, and 240 min after final instillation was determined by high-performance liquid chromatography. RESULTS: The maximum concentration in the aqueous humor of normal rabbit eyes was 2.09 +/- 1.56 microg/ml (60 min, OFLX), 2.57 +/- 1.00 microg/ml (30 min, LVFX), and 0.42 +/- 0.12 microg/ml (120 min, NFLX). The drug concentration in the aqueous humor of eyes with intentionally removed corneal epithelium was 12.50 +/- 5.62 microg/ml (30 min, OFLX), 9.02 +/- 2.45 microg/ml (60 min, LVFX), and 8.54 +/- 5.17 microg/ml (30 min, NFLX). The drug penetration of the eye drops into eyes with removed corneal epithelium was around 6 times (OFLX), 3.5 times (LVFX), and 20 times (NFLX) higher than the penetration into the eye with normal cornea. CONCLUSION: Among the pharmacokinetic parameters of the three ophthalmic solutions according to the one-compartment model, the maximum concentration in the aqueous and the area under the concentration-time curve in the aqueous tended to be higher in the eyes with intentionally removed corneal epithelia than in those with normal corneas.

Influence of cyclosporin on steroid-induced cataracts after renal transplantation.

PURPOSE: To study the effect of cyclosporin (CsA) on steroid-induced cataracts in patients following renal transplantation. METHODS: The subjects comprise 140 patients who had undergone renal transplantation at Kanazawa Medical Hospital. These subjects had received ophthalmologic examinations prior to their surgery and subsequently over the span of 12 months following surgery. The charts of these patients were re-examined for this study. The subjects were divided into two groups: the conventional therapy group (Group C) that received azathioprine and methylprednisolone; and the triple therapy group (Group T) that received azathioprine, methylprednisolone, and CsA. There were 73 and 67 patients in Groups C and T, respectively. The cataracts were classified according to Crews' classification. Steroid-induced cataract was diagnosed when vacuoles were observed or opacity was evident in the posterior subcapsular region. Subjects who exhibited any lens opacity before renal transplantation were excluded from this study. RESULTS: The total amounts of systemic steroid administered during the first year and at the final observation period were significantly lower in Group T than in Group C. The prevalence of steroid-induced cataracts of grade 1 and above was 55% and 63% for the first year, 73% and 89% for the second year, 74% and 92% for the third year, and 83% and 96% for the fifth year in Groups C and T, respectively. By the third year, the percentage of subjects exhibiting corrected visual acuity <0.8 or receiving cataract surgery was significantly higher in Group T than in Group C. There was no significant difference in the total dose of steroids, in subjects with cataracts over grade 1 and those with grades 0 and 1, between these groups. In Group C, the total steroid pulse therapy dose was significantly higher in subjects with steroid-induced cataracts over grade 1 than in those with grades 0 and 1. CONCLUSIONS: The observed rate of steroid-induced cataracts increased with the use of cyclosporin, despite a decrease in the total dose of systemic steroids. From this finding we suggest that the additional use of CSA may contribute to the development of steroid-induced cataracts. Steroid pulse therapy is considered a risk factor for the development of steroid-induced cataracts.