Treatment for Intracorneal Hematoma by Anterior Chamber Gas Tamponade Combined With Keratocentesis.

PURPOSE: To report a new surgical method for intracorneal hematoma removal using combination of keratocentesis and gas tamponade in the anterior chamber. METHODS: We reviewed the clinical course and outcomes of surgical intervention. RESULTS: An 82-year-old woman visited our department because of a sudden decline in visual acuity (20/800 on the Snellen chart) in her left eye. We observed neovascularization from the superior corneal limbus and a hematoma near the Descemet membrane, deep in the stroma of the corneal center. Filtered air was injected into the anterior chamber, keratocentesis was performed at four locations from the corneal epithelium through the stroma, and the hematoma was removed from the puncture sites. The corneal hematoma disappeared, and the best-corrected visual acuity reached 20/20 at postoperative month 4. DISCUSSION: Combination of keratocentesis and gas tamponade in the anterior chamber is a simple and effective method for removing intracorneal hematomas.

Early Clinical Outcomes of the First Commercialized Human Autologous Ex Vivo Cultivated Oral Mucosal Epithelial Cell Transplantation for Limbal Stem Cell Deficiency: Two Case Reports and Literature Review.

The first product in the world for ex vivo cultivated oral mucosal epithelial cell transplantation (COMET) to treat limbal stem cell deficiency (LSCD), named Ocural®, was launched in June 2021 in Japan. COMET was performed on two patients, including the first case in the post-marketing phase of Ocural®. Pathological and immunohistochemical examinations were also carried out using specimens obtained before and after COMET and the spare cell sheet. In case 1, the ocular surface remained free from epithelial defects for approximately six months. In case 2, although defect of the cornea-like epithelia was observed after COMET for one month, it was resolved after the insertion of lacrimal punctal plugs. In case 1, adjuvant treatment was interrupted due to an accident during the second month after COMET, resulting in conjunctival ingrowth and corneal opacity. Eventually, a lamellar keratoplasty was required at six months after COMET. Immunohistochemistry revealed the presence of markers for stem cells (p63, p75), proliferation (Ki-67), and differentiation (Keratin-3, -4, and -13) in both the cornea-like tissue after COMET and a cultivated oral mucosal epithelial cell sheet. In conclusion, Ocural® can be accomplished without major complications, and the stem cells derived from oral mucosa might be successfully engrafted.

A Comprehensive Assessment of Tear-Film-Oriented Diagnosis (TFOD) in a Dacryoadenectomy Dry Eye Model.

Tear film instability is a major cause of dry eye disease. In order to treat patients with short tear film breakup time (TBUT)-type dry eye, the development of tear film stabilizing agents is essential. However, the lack of an appropriate animal model of tear film instability has made drug development difficult. Although rabbit dry eye models have been reported in the past, there are only a few reports that focus on tear film instability. Herein, we assessed the tear film stability of a rabbit dry eye model induced by dacryoadenectomy. A clinical evaluation of the ocular surface, interferometry, and histological assessments of the cornea and conjunctiva were performed. Following the removal of the lacrimal glands, TBUT was shortened significantly, with dimple and random breakup patterns prominently observed. Furthermore, the blink rate in this model increased after dacryoadenectomy, suggesting that this model partially captured the phenotypes of human short TBUT-type dry eye and may be useful as an animal model for investigating potential drug candidates.

Severe Ocular Complications Associated With Wearing of Contact Lens in Japan.

OBJECTIVES: To examine the severe ocular complications associated with contact lens wearing in Japan. METHOD: A questionnaire was sent to 964 ophthalmologist training facilities inquiring for cases of contact lens-associated complications from April 2016 to March 2018. The inclusion criteria were as follows: (1) corrected distance visual acuity ≤0.1 decimal after treatment for 3 months, (2) corneal perforation observed during follow-up, and (3) requiring surgery. A secondary analysis was conducted, inquiring for further information on the type of contact lens, clinical manifestations, and course of treatment. RESULTS: Forty-two patients with infectious keratitis met the inclusion criteria. Eight patients were users of rigid gas-permeable contact lens, and 34 were users of soft contact lens. Microbiological tests were positive in 73.0%. The organisms isolated in microbiological culture were bacteria in 11 patients (Pseudomonas aeruginosa in 9 patients), fungi in 2 patients, and Acanthamoeba in 14 patients. Ten patients were treated with local antibiotics, 11 with a combination of systemic antibiotics, and 21 with a combination of surgical approaches, including 13 with corneal transplantation. CONCLUSIONS: The major cause of serious contact lens-associated ocular complications was microbial keratitis, and P. aeruginosa and Acanthamoeba were the major pathogens in Japan.

Surgical Punctal Occlusion; Combined Lacrimal Canaliculi Cauterization and Punctal Suturing for Severe Dry Eye.

Purpose: To evaluate the treatment outcome of surgical punctal occlusion with combined canaliculi ablation and punctal suturing in patients with severe dry eye. Methods: Eleven eyes of seven patients were diagnosed with severe dry eye with decreased lacrimal secretion and were refractory to treatment with various eye drops and/or had repeatedly experienced loss of punctal plugs, and continued to experience subjective symptoms received surgical punctal occlusion. In 20 puncta, lacrimal canaliculi ablation was performed along the entire length of the lacrimal canaliculus where a diathermy needle could be inserted. After resection of the annulus fibrosus in the peri-punctal area, tight cross-stitch suturing of the puncta was performed with 8-0 absorbent thread. Visual acuity, corneal staining score according to the area (A) and density (D) classification, and Schirmer tear test (STT); tear break up time (tBUT); and subjective symptoms assessed by the University of North Carolina (UNC) and Dry Eye Management Scale were compared before and one year after surgery. Results: Recanalization occurred in 1/20 puncta (5.0% at month 5) in 1/11 eyes. Student's t-test showed significant improvement at one year compared with preoperative values for LogMAR value (P = 0.019), corneal staining score A (P = 0.00003) and D (P = 0.0003), STT (P = 0.004), and subjective symptoms (P = 0.015). No change was shown in tBUT and no serious adverse event occurred. Conclusion: This improved, minimally invasive surgical procedure has a low recanalization rate and achieves both objective and subjective improvements at one year.

Burkholderia Cepacia-Induced Bilateral Microbial Keratitis in a Wearer of Colored Cosmetic Contact Lenses.

In this report, we present a case of ​​​​​​Burkholderia cepacia (B. cepacia)-induced bilateral microbial keratitis in a patient who wore colored contact lenses (CLs) on both eyes. The patient was a 19-year-old woman who presented to our hospital with pain, discharge, and photophobia affecting both eyes while she was wearing colored cosmetic CLs. There were corneal ulcers in both of her eyes without refractive correction. Although impairment of vision was not detected at the first visit, both eyes showed neovascularization of the upper part of the cornea and had relatively well-demarcated corneal ulcers associated with corneal stromal opacity. Cultures of cornea grew B. cepacia in both eyes. She received antimicrobial agents to which this organism was sensitive, resulting in the healing of the corneal ulcers with scarring after approximately one month. Improper fitting of colored cosmetic CLs, contamination of lenses or solutions, and inadequate lens care can be risk factors for developing this condition.

Use of Ketotifen Fumarate-Eluting Daily Disposable Soft Contact Lens in Management of Ocular Allergy: Literature Review and Report of Two Cases.

We present two cases in which the drug-eluting daily disposable soft contact lens (DDSCL) Acuvue® TheravisionTM with Ketotifen (Johnson & Johnson Vision Care, Inc., Jacksonville, Florida, USA) (ATK), which contains the anti-allergic drug ketotifen fumarate, alleviated ocular allergic symptoms. Case 1 was a 57-year-old woman with a history of allergic conjunctivitis in the spring and fall. In the summer and winter, the patient used frequent replacement soft contact lenses, but in the allergy seasons, she used DDSCLs in combination with anti-allergic eye drops. She agreed to start wearing ATK lenses from before the next fall season. The lenses suppressed her allergic signs and symptoms, and she felt comfortable wearing them and continued their use throughout the season. Her symptoms were suppressed, providing her comforts that enabled uses of the CLs for some time. She successfully used the lenses again from the beginning of the next spring season. Case 2 was a 31-year-old woman with a history of cedar pollinosis. The patient previously used DDSCLs and was prescribed ATK lenses at her regular clinic. About one month later, she was referred to our department. With ATK lenses, she did not experience any subjective symptoms during the pollinosis season. At a subsequent visit, hyperemia had decreased compared with the initial visit. In these two cases, the use of ATK lenses from before until the end of both the spring and fall allergy seasons suppressed the symptoms of allergic conjunctivitis, allowing the patients to continue to wear contact lenses.

A Case of Herpetic Keratitis in an Orthokeratology Contact Lens Wearer.

We report a case of herpetic keratitis in an orthokeratology lens wearer. A 17-year-old man who wore an overnight orthokeratology lens for correction of myopia presented to our hospital with pain, lacrimation, and blurred vision affecting the left eye. His corrected visual acuity decreased to 18/20, and he showed dendrites and decreased corneal sensitivity in the left eye. The herpes simplex virus (HSV) immunochromatographic assay kit for the diagnosis of herpes epithelial keratitis was positive. As these findings were suggestive of HSV keratitis, topical acyclovir ointment was administered five times daily. All findings disappeared and visual acuity recovered to 20/20 at 14 days after the first visit. Herpetic keratitis rarely develops in orthokeratology lens wearers as well as contact lens (CL) wearers, although Acanthamoeba keratitis is sometimes erroneously diagnosed as herpetic keratitis in CL wearers with dendrites.

Refractive Correction After Penetrating Keratoplasty by a New Soft Contact Lens with a Special Design for Astigmatism: A Case Report.

YOUSOFT is a new soft contact lens (CL) specifically designed for the correction of astigmatism. It is a conventional FDA Group II soft contact lens (SCL) and the optical zone in its centre is thick, and on its rear surface it has a prism ballast structure to prevent rotation. This lens was prescribed for a 59-year-old male on the eye with irregular corneal astigmatism after receiving penetrating keratoplasty (PKP) for refractive correction, whose eye was difficult to wear hard CLs (HCLs). After following the directions in the fitting manual provided by the manufacturer, fitting was good in the right eye and corrected visual acuity was 20/25 in Snellen Chart. He could continue wearing without CL discomfortable YOUSOFT may be useful in patients who have received PKP.

Distribution of goblet cells and MUC5AC mRNA in the canine nictitating membrane.

This study evaluated the distribution of goblet cells and the expression of MUC5AC mRNA in the canine nictitating membrane. The distribution of goblet cells in the nictitating membrane and temporal bulbar conjunctiva of beagle dogs was examined by histochemical analysis of impression cytology specimens and frozen sections. MUC5AC mRNA was detected by the reverse transcription polymerase chain reaction (RT-PCR). The distribution of MUC5AC mRNA was also examined by in situ hybridization using digoxigenin-labeled antisense and sense RNA probes. Histochemical analysis showed that the canine nictitating membrane epithelium contained many more periodic acid-Schiff positive goblet cells, particularly on the palpebral side, compared with the temporal bulbar conjunctiva. RT-PCR revealed that MUC5AC was expressed in both the nictitating membrane and in conjunctival tissue. When the distribution of MUC5AC mRNA was assessed by in situ hybridization, its expression was high on the palpebral side of the nictitating membrane and low in the temporal bulbar conjunctiva. MUC5AC mRNA expression corresponded with the distribution of goblet cells by histochemical examination. In conclusion, there were numerous goblet cells in the canine nictitating membrane epithelium, particularly on the palpebral side, and MUC5AC mRNA was expressed in the nictitating membrane epithelium at locations corresponding to the goblet cells.

Topographical Central Island-Like Pattern After 24 Hrs of Continuous Intraocular Pressure Monitoring with a Contact Lens Sensor.

With development of the contact lens sensor (CLS), it has become possible to monitor the intraocular pressure (IOP) for 24 hrs continuously. Wearing of CLS often brings blurred vision with transient aggravation of myopia and changes in corneal shape. The author, a 51-year-old man with myopic astigmatism, wore a CLS for 24 hrs on the right eye, and the fellow eye served as a contra-lateral control eye. After wearing, his corrected visual acuity on the right eye decreased from 20/16 to 20/25 with blurred vision, and subjective spherical power and cylindrical power aggravated. Topographical analysis revealed that the instantaneous power increased on the central cornea but decreased on the mid-peripheral cornea. Differential instantaneous map of pre- and post-wearing CLS showed a specific pattern similar to the central island pattern, which is known as the results of steeper fitting of the orthokeratology lens. A surface imprint was observed on the bulbar conjunctiva, corresponding to the edge of the contact lens. These findings seemed due to orthokeratological effects by the steeper fitting of CLS. All of them resolved within 24 hrs after the removal of the CLS.

An atypical case of microcysts associated with silicone hydrogel contact lens: findings on in vivo confocal laser microscopy.

PURPOSE: To report a case of microcysts in the cornea of a female who wore silicone hydrogel contact lenses (CLs) including observation by an in vivo confocal laser microscope. METHODS: A 31-year-old woman who wore Acuvue Oasys CLs was referred to our hospital because of reduced visual acuity, eye pain, and photophobia in both eyes. The patient's history and clinical presentation were reviewed. In vivo investigation was also performed by using HRT II Rostock Cornea Module. RESULTS: Slitlamp microscopy revealed corneal haze and a number of microcysts in both eyes. The cysts were less obvious on fluorescein staining than on corneal observation. Observation with the HRT II Rostock Cornea Module showed a number of irregular oval-shaped cysts in the basal layer of the corneal epithelium. The cysts were much larger than those induced by infection with Acanthamoeba, so the possibility of Acanthamoeba keratitis was ruled out. Based on these findings, treatment with betamethasone phosphate eye drops and levofloxacin eye drops (both five times daily) were started for the microcysts. After about 10 days of treatment, all of the cysts resolved. CONCLUSIONS: Microcysts may occur in persons who wear silicone hydrogel CLs caused by inflammatory, mechanical etiology, or a toxic reaction from the solution/lens interaction that the patient was using. In vivo Confocal laser microscope is useful for making a definite diagnosis of microcysts.

In vivo observation of rigid gas-permeable contact lens fragments embedded in cornea.

PURPOSE: Fragments of a rigid gas-permeable contact lens embedded in the corneal subepithelial superficial stroma were observed with an in vivo confocal laser microscope. CASE REPORT: A 22-year-old man suffered damage to the contact lens in his left eye by the strap of his bag during baggage inspection at airport. Although he developed ocular pain, simply treated it with an artificial tears. He was then referred to and examined at our clinic. RESULTS: Slitlamp microscopy revealed many bright particles in the subepithelial superficial stroma, but no conjunctival injection or positive vital staining of the keratoconjunctival epithelium. In vivo Confocal laser microscopy revealed a large number of very fine bright particles in the corneal subepithelial superficial stroma, which showed an arrangement like the Milky Way. Because there were no inflammatory cells and no evidence of infection and no influence of these fragments on his vision, it was decided that he would be followed up without removal of the particles. CONCLUSIONS: In vivo Confocal laser microscope visualized contact lens fragments embedded the subepithelial superficial stroma as very bright particles. Since the presence of inflammatory cells and pathogen could also be denied, microscopy was useful for selecting the treatment.

Effects of topical application of ibudilast for seasonal allergic conjunctivitis in patients wearing soft contact lenses.

PURPOSE: To assess the influence of topical application of ibudilast for seasonal allergic conjunctivitis in patients wearing soft contact lenses (SCLs). MATERIALS AND METHODS: There were 16 SCL wearers (32 eyes) with allergic conjunctivitis due to cedar pollen, who were studied from February to April 2007. Before enrollment, informed consent to participation in this study was obtained from all subjects. A frequent replacement SCL (2 Week Pure) was worn for 2 weeks, and ibudilast was applied topically four times daily during this period. The severity of allergic symptoms and the severity of SCL-related symptoms were assessed by scoring using two questionnaires, and before and after topical application of ibudilast results were compared. The severity of objective ocular findings was also scored and compared in the same way. After the final examination, the SCLs were collected and immersed in physiologic saline. Then morphologic changes and drug adsorption were investigated. RESULTS: Among the allergic symptoms, itching and a dry sensation improved after topical application of ibudilast ophthalmic solution (both P<0.05). Phlyctenular conjunctivitis was noted in one eye after topical application, but there were no significant differences of SCL-related symptoms and objective ocular findings between before and after application. There were also no morphologic changes of the contact lenses, and the ibudilast concentration in the lenses was below the detection limit. CONCLUSIONS: These results suggest that topical application of ibudilast while using 2 Week Pure lenses can improve subjective symptoms without influencing drug adsorption or lens morphology.

Effect of retinol palmitate eye drops on experimental keratoconjunctival epithelial damage induced by n-heptanol in rabbit.

PURPOSE: To investigate ability of vitamin A (VA, retinol palmitate) to promote wound healing after injury in rabbit eye. METHODS: After keratoconjunctival injury by 20 microL of n-heptanol, VA eye drops at 500, 1000, or 1500 IU/mL were started 6 times a day for 11 days. Fluorescein and rose bengal staining and histological analysis were performed. RESULTS: Fluorescein staining was significantly reduced by 1000 and 1500 IU/mL of VA and rose bengal staining by all concentrations. Histological examination revealed acceleration of wound healing after 7 days (1500 IU/mL). CONCLUSIONS: VA may be useful in treatment of keratoconjunctival injury.

Preganglionic Parasympathetic Denervation Rabbit Model for Innervation Studies.

PURPOSE: Tear secretion from the main lacrimal gland (LG) is mainly regulated by parasympathetic nerves. We performed several innervation studies to investigate lacrimation. METHODS: In male rabbits, we performed a retrograde dye-tracing study of LG innervation, evaluated preganglionic parasympathetic denervation, and administered glial cell-derived neurotrophic factor (GDNF) in the surgical area after parasympathetic denervation. RESULTS: Accumulation of fluorescent dye was observed in the pterygopalatine ganglion cells on the same side as the dye injection into the main LG. Fewer stained cells were observed in the cervical and trigeminal ganglia. After parasympathetic denervation surgery, tear secretion was decreased, and fluorescein and rose bengal staining scores were increased at day 1 after surgery and remained increased for 3 months on the denervated side only. Most of the effects in rabbits with parasympathetic denervation were not recovered by administration of GDNF. CONCLUSIONS: The main LG is primarily innervated by parasympathetic nerves to stimulate tear secretion. After preganglionic parasympathetic denervation, lacrimation was decreased, resulting in dry eyes, and this was maintained for at least 3 months. Administration of GDNF only minimally altered the effects of denervation.

Papilloma and sebaceous gland hyperplasia of the lacrimal caruncle: a case report.

OBJECTIVE: To report a case of coincidence of sebaceous gland hyperplasia and papilloma with detection of human papillomavirus-51 in the apical portion by in situ hybridization. CASE PRESENTATION: A 75-year-old man noted discomfort at the inner canthus of his left eye when he blinked. A tumor of the lacrimal caruncle was identified and resected. The base of the tumor had a smooth surface and was whitish. In addition, a "navel-like structure" was seen, and the findings strongly suggested sebaceous gland hyperplasia of the lacrimal caruncle. The apical portion of the tumor was a papillomatous lesion. Histological examination of the resected tumor led to a diagnosis of sebaceous gland hyperplasia. Human papillomavirus-51 was detected in the apical portion by in situ hybridization. Based on these results, the final diagnosis was sebaceous gland hyperplasia with papilloma. No recurrence of either tumor has been observed up to 3 years postoperatively. CONCLUSION: This might be the first report of a case of coincidence of sebaceous gland hyperplasia and papilloma, even though the association between these two lesions was unclear, including which developed first.

Evaluation of novel dry eye model: preganglionic parasympathetic denervation in rabbit.

PURPOSE: To evaluate ocular surface status after interruption of preganglionic, parasympathetic neural control after surgical removal of the greater superficial petrosal nerve (GSPN). METHODS: New Zealand White rabbits underwent unilateral section and removal of a 5-mm portion of the GSPN by a route through the inner ear; no ocular or orbital tissue was involved. Before and 7 days after surgery, all animals underwent preliminary examination, including fluorescein staining, rose bengal instillation, blink rate, tear breakup time (BUT), tear flow, and impression cytology. Total tarsorrhaphy was carried out in four additional rabbits, and another four animals underwent unilateral sham procedures. The GSPN, pterygopalatine ganglion, lacrimal gland, and conjunctiva were evaluated by light and transmission electron microscopy (TEM). RESULTS: GSPN sectioning resulted in significant changes of the ocular surface after 7 days: intense rose bengal staining of the conjunctiva, fluorescein staining of the cornea, increased blink rate (P < 0.05), decreased BUT (P < 0.005), decreased tear flow by 26% (P < 0.005), and decreased goblet cell density (P < 0.01). TEM revealed massive accumulation of secretory granules in lacrimal acinar cells. The changes were also seen after tarsorrhaphy. Neither the contralateral control nor the sham eyes were affected. CONCLUSIONS: The effects of GSPN nerve section led to the rapid onset of a dry eye condition in the rabbits that continued for at least 1 week. The authors suggest that continuous neural drive of the pterygopalatine ganglion is necessary to maintain adequate tear flow and mucin secretion. It is likely the trigeminal system is the afferent origin of this continuous neural tone.

Influence of the signal-to-noise ratio on the accuracy of IOLMaster measurements.

PURPOSE: To evaluate the relationship between the sound-to-noise ratio (SNR) and the reliability of axial length (AL) measurements obtained with the IOLMaster (Carl Zeiss Meditec AG). SETTING: Department of Ophthalmology, Saiseikai Kurihashi Hospital, Saitama, Japan. METHODS: In a clinical prospective study, 216 consecutive eyes of 144 patients scheduled for cataract surgery were evaluated for the type and severity of cataract using the Lens Opacities Classification System III. Preoperative and postoperative AL measurements were performed with the IOLMaster. The preoperative SNR values were used to divide the eyes into 5 groups. The following were compared between the groups: preoperative logMAR best spectacle-corrected visual acuity (BSCVA), difference in AL between preoperatively and postoperatively, error in the postoperative predicted refraction, and type and severity of cataract. RESULTS: The preoperative logMAR BSCVA was significantly worse in eyes with an SNR <2 (P<.05). The AL was longer preoperatively than postoperatively in all groups, and there was a significant difference in the <2 SNR group and the 2 to <5 group (P<.05). There were no significant differences in the error in postoperative predicted refraction. The percentage of patients with P4 or worse posterior subcapsular cataract (PSC) increased significantly with a decrease in the SNR (P<.01). However, there was no correlation between nuclear color grade and the SNR. CONCLUSION: The SNR value was useful in confirming the good quality of AL readings taken with the IOLMaster, even though the SNR value correlated significantly with the preoperative logMAR BSCVA and PSC severity.

In vivo observations of a case of chlorpromazine deposits in the cornea using an HRT II Rostock corneal module.

PURPOSE: In vivo study of corneal deposits in a patient receiving chlorpromazine therapy was done by using a confocal microscope, the HRT II Rostock corneal module (RCM). METHODS: A 23-year-old woman who had been on chlorpromazine therapy for 5 years complained of bilateral photophobia and was referred to our clinic. She had suffered from light sensitivity for 4 years. RESULTS: Slit-lamp microscopy revealed white deposits, particularly in the layers of the endothelium and Descemet membrane, which were concentrated in the center of both corneas. Deposition of many white granules was observed in the superficial subepithelial stroma of the cornea by HRT II RCM. Granular deposits were observed at the center of most cells in the corneal endothelium. CONCLUSIONS: The HRT II RCM could clearly detect deposits in the corneal endothelium, as well as in other regions such as the corneal epithelium and stroma.