Contrast dependence of scattering profiles for poly(ethylene glycol) in water: Investigation by small-angle neutron scattering with 3He spin filter and small-angle x-ray scattering.

The small-angle neutron scattering (SANS) and small-angle x-ray scattering (SAXS) measurements were performed for deuterated and non-deuterated poly(ethylene glycol) (d-PEG and h-PEG, respectively) in D2O and a D2O/H2O mixed solvent (Mix) to compare the scattering profiles. To determine the coherent scattering intensity of SANS, a 3He spin filter was utilized. The scattering profiles determined by the SANS measurements were analyzed in terms of the wormlike chain model with touched beads along the contour of the chain. However, the SAXS profiles were not explained by the same model with uniform beads but with beads each consisting of a core and a shell having different electron densities. To explore the chain thickness determined from the SANS profile, the scattering intensities for different combinations of d-PEG/D2O, d-PEG/Mix, h-PEG/D2O, and h-PEG/Mix were also examined.

Stiffness parameter of brush-like polymers with rod-like side chains.

The stiffness parameter λ(-1) of brush-like polymers having rod-like side chains with the hard core potential was calculated. Side chains are, first, assumed to be connected with a free joint to the main chain. The free energy per molecule F was calculated invoking the single contact approximation in which only the interaction between two side chains is considered and the higher interactions are ignored. In the calculation, the contact is assumed to occur when the two side chains are in a plain and the condition for the angles between the side chain and the main chain to make a triangle by two side chains and the main chain was exactly taken into account. The change of F after bending the main chain with a certain curvature from the straight state was calculated to obtain λ(-1). The resulting λ(-1) came close to the experimental value for brush-like polymers with a poly(methacrylate) main chain and poly(hexylisocyanate) (PHIC) side chains if we add a constant as the intrinsic stiffness of the main chain, λ0 (-1), to it. By considering the potential function having a minimum when the angle between the side and main chains equals π/2, the data for brush-like polymers with a poly(styrene) main chain and PHIC side chains were also closely fitted by the theoretical values with an appropriate value of λ0 (-1) and the force constant of the angle.

Comparative Study of Seven-year Outcomes Following Laser In Situ Keratomileusis with those of Trans-epithelial Photorefractive Keratectomy.

Purpose: To compare the long-term outcomes of laser-assisted in situ keratomileusis (LASIK) and trans-epithelial photorefractive keratectomy (tPRK). Methods: In this retrospective study, 23 eyes of LASIK patients were compared with 23 eyes of patients who underwent tPRK; none of who underwent retreatment. The cases were matched for refractive power and patient age. In all patients, visual acuity (VA), refractive power and corneal topography were evaluated between 6-months and 7-years postoperative. Results: At 7-years postoperative, uncorrected VA was 20/20 or better in 71.9% of the LASIK-treated eyes and in 68.7% of the tPRK-treated eyes. From 6-months to 7-years postoperative, both the LASIK- and tPRK-treated eyes developed a slight myopia (-0.18 D and -0.36 D, p=0.24), and a difference in corneal power change was observed between the LASIK (0.23 D steeper) and tPRK (0.57 D steeper) (p=0.05) eyes. Conclusion: At 7-years postoperative, a good surgical outcome was found in both the LASIK- and tPRK-treated eyes, yet myopic regression was more pronounced in the tPRK-treated eyes than in the LASIK-treated eyes.

[Patient-reported Outcomes after Laser In Situ Keratomileusis Surgery].

PURPOSE: To evaluate patient-reported quality of vision before and after laser in situ keratomileusis (LASIK) surgery. SUBJECTS AND METHODS: This study involved 140 patients who underwent LASIK surgery at Baptist Eye Clinic, Kyoto, Japan. Each patient was asked to respond to the Refractive Status and Vision Profile (RSVP) questionnaire prior to surgery and at 6-months and 5.5-years postoperative. In each patient, we defined the eye with better uncorrected visual acuity (VA) or with less refractive error as the better eye, and the other eye as the worse eye. RESULTS: Even in the worse eyes, the percentage of eyes with an uncorrected VA of decimal 0.5 or greater was 93.5% at 6-months and 88.6% at 5.5-ears postoperative. The mean preoperative total RSVP score was 37.1, yet that score significantly improved at 6-months postoperative (p< 0 .001) and remained the same throughout the 5.5-year follow-up period. CCONCLUSION The patient-reported quality of vi-ion post LASIK surgery was improved and remained improved throughout the 5.5-year follow-up period.

Identification of cis- and trans-acting factors involved in the localization of MALAT-1 noncoding RNA to nuclear speckles.

MALAT-1 noncoding RNA is localized to nuclear speckles despite its mRNA-like characteristics. Here, we report the identification of several key factors that promote the localization of MALAT-1 to nuclear speckles and also provide evidence that MALAT-1 is involved in the regulation of gene expression. Heterokaryon assays revealed that MALAT-1 does not shuttle between the nucleus and cytoplasm. RNAi-mediated repression of the nuclear speckle proteins, RNPS1, SRm160, or IBP160, which are well-known mRNA processing factors, resulted in the diffusion of MALAT-1 to the nucleoplasm. We demonstrated that MALAT-1 contains two distinct elements directing transcripts to nuclear speckles, which were also capable of binding to RNPS1 in vitro. Depletion of MALAT-1 represses the expression of several genes. Taken together, our results suggest that RNPS1, SRm160, and IBP160 contribute to the localization of MALAT-1 to nuclear speckles, where MALAT-1 could be involved in regulating gene expression.

Surgical outcomes of re-excimer laser phototherapeutic keratectomy (re-PTK).

To assess the surgical outcomes of re-excimer laser phototherapeutic keratectomy (re-PTK) for recurrent disease after initial PTK. Retrospective cohort study with historical comparison group. This study involved 56 patients who underwent re-PTK (mean follow-up period: 47.9 ± 36.2 months) at the Baptist Eye Institute, Kyoto, Japan. In all subjects, corrected-distance visual acuity (CDVA) before and after re-PTK was compared. Postoperative recurrence of corneal lesion with a decrease of CDVA of two lines or more was compared with postoperative best CDVA deemed as a significant relapse. The Kaplan-Meier method was used to compare the recurrence rate post-re-PTK with that after the initial PTK. The disease classification in the 78 eyes was heterozygous-type GCD (hetero-GCD, n = 47 eyes), homozygous-type GCD (homo-GCD, n = 13 eyes), band keratopathy (n = 7 eyes), lattice corneal dystrophy (n = 6 eyes), and other (n = 5 eyes). After re-PTK, homo-GCD recurred statistically significantly earlier than hetero-GCD (P = 0.0042). No significant difference was found in the recurrence rate for all diseases between post-re-PTK and post initial PTK (P > 0.05). Surgical outcomes after re-PTK were nearly equal to those after initial-PTK.

Clinical study on the effect of multifocal contact lenses on myopia progression in myopia school children : Multifocal contact lens study for suppression of myopia progression.

BACKGROUND: The efficacy of peripheral low add multifocal soft contact lenses (SCLs) for suppressing the progression of myopia is controversial. The aim of the on-going present clinical study is to investigate whether or not multifocal SCLs with + 0.50 diopters (D) addition suppress the progression of myopia in myopic elementary school children. DESIGN: Prospective randomized controlled trial. SUBJECTS AND METHODS: The study plans to include a total of 100 myopic school children. Target subjects are primary school male and female students with mild to moderate myopia. Children who have eye-related diseases other than myopia are excluded from the study, because they may affect the evaluation of the outcome. Subjects will be randomly assigned to wear daily disposable multifocal contact lenses with + 0.50D addition or daily disposable SCLs. Subjects will wear contact lenses on both eyes and will be observed for 2 years under a double-masked examination. Primary outcome is a change in the axial length over the 2-year period. OBJECTIVES: The purpose of this study is to identify whether or not multifocal SCLs with + 0.5D addition suppress the progression of myopia in myopic elementary school children as compared with standard SCLs. TRIAL REGISTRATION: 1. UMIN (University Hospital Medical Information Network) UMIN000027940. Registered on July 21, 2017 2. JRCT (Japan Registry of Clinical Trials) jRCTs052180172. Registered on March 26, 2019.

Comparison of myopia progression between children wearing three types of orthokeratology lenses and children wearing single-vision spectacles.

PURPOSE: To evaluate factors related to myopia progression in children wearing either orthokeratology (OK) lenses or single-vision spectacles (SVS) for 2 years. STUDY DESIGN: Pooled-analysis retrospective intervention study. METHODS: This study involved 105 school-aged children wearing SVS who participated in the multi-center Myovision Study and 89 school-aged children wearing one of 3 OK lens types [Menicon Z Night (M, n = 27), αORTHO®-K (A, n = 32), and Emerald™ (E, n = 30)]. In the OK-lens patients, last examination was performed at ≥ 3-weeks post lens-wear discontinuation. Of the subjects, 102 SVS-Group and 79 OK-Group (M: n = 24, A: n = 28, and E: n = 27) children completed all examinations. A relationship between refractive error (RE) change and 7 factors (correction methods, baseline age, baseline RE, baseline axial length, gender, right or left eye, and follow-up period) was derived by multiple regression modeling. Via those same methods, we investigated the relationship between RE change and 7 factors including 3 OK-lens corrections. RESULTS: Related influence factors were correction method (0.85 D myopia reduction in the OK Group, P < 0.001), baseline age (0.16 D myopia reduction in older-age patients, P < 0.001), and baseline RE (0.12 D myopia reduction per 1 D myopia, P = 0.01). No relationship was found between RE change and OK-lens type. No serious adverse events occurred. CONCLUSION: Regardless of OK lens design, myopia progression in school-aged children was suppressed. The effect was examined not only via axial-length elongation but also RE change, and the myopia control effect by OK lenses was found to be 0.85 D over the 2-year period.

A multicenter clinical trial of orthokeratology in school-aged children and adolescents in Japan.

PURPOSE: This study investigated the safety and efficacy of orthokeratology in myopic children in Japan. STUDY DESIGN: Prospective clinical trial. METHODS: This study enrolled myopic children aged 6-16 years with a spherical equivalent of -1.00 D to -4.00 D and astigmatism of -1.5 D or lower, whose parents could manage contact lens use and could provide written informed consent. The children were treated with orthokeratology lenses (BREATH-O CORRECT R, Universal View Co., Ltd.) for 3 years. Slit-lamp findings, visual acuity, intraocular pressure, subjective refraction, corneal topography, corneal endothelial cell density, corneal thickness, and axial length were regularly assessed. RESULTS: This study included 96 eyes of 48 patients (average age, 10.7 ± 2.08 years). The average baseline spherical equivalent was -2.46 ± 0.97 D. The average baseline uncorrected visual acuity was 0.74 ± 0.32 logMAR, with significant improvement to -0.08 ± 0.18 logMAR at 4 weeks and 0.02 ± 0.21 logMAR at 3 years (both p < 0.001, Dunnett's test). The average baseline corneal endothelial cell density was 3053 ± 181 cells/mm2 and 3028 ± 213 cells/mm2 at postoperative 3 years (p = 0.9933, Dunnett's test). The average axial length was 24.70 ± 0.78 mm at baseline, 24.77 ± 0.80 mm at 12 weeks, and 25.32 ± 0.85 mm at 36 months. Although mild corneal epithelial disorders occurred in 18% of eyes, they were successfully treated with eye drops, enabling resumption of lens usage. No serious adverse events were observed. CONCLUSION: Orthokeratology lens (BREATH-O CORRECT R) use in children demonstrated good efficacy and safety during 3 years of follow-up.

Efficacy and safety of 0.01% atropine for prevention of childhood myopia in a 2-year randomized placebo-controlled study.

PURPOSE: Atropine eye drops prevent the progression of myopia, but their use has not been tested in the Japanese schoolchildren population. Here, we evaluate the efficacy and safety of 0.01% atropine eye drops for myopia control in Japanese children. STUDY DESIGN: Multicenter (7 university hospitals), randomized, double-masked, placebo-controlled trial. METHODS: Participants were 171 Japanese schoolchildren aged 6 to 12 years, with progressive myopia, spherical equivalence (SE) of -1.00 to -6.00 diopters (D), and astigmatism of ≤1.5 D. They were randomized to receive either 0.01% atropine (n=85) or placebo (n=86) eye drops once nightly OU for 24 months. Primary and secondary efficacy endpoints were changes in SE and axial length (AL), respectively, from baseline to month 24. RESULTS: Data from 168 subjects were analyzed. At month 24, compliance was similar in both groups (atropine: 83.3%; placebo: 85.7%). The least squares mean change in SE and AL from baseline were, respectively, -1.26 D (95% confidence interval [CI]: -1.35, -1.17) and 0.63 mm (0.59, 0.67) for atropine and -1.48 D (- 1.57, -1.39) and 0.77 mm (0.73, 0.81) for placebo. Inter-group differences were 0.22 D (95% CI: 0.09, 0.35; P < 0.001) for SE and - 0.14 mm (-0.20, -0.08; P < 0.001) for AL. Three patients experienced mild allergic conjunctivitis side effects, with no inter-group difference in incidence (atropine: 2.4%; 2/84 patients; placebo: 1.4%; 1/84 patients). CONCLUSION: With good compliance, 0.01% atropine is effective and safe for preventing the progression of childhood myopia.

Long-term course of contrast sensitivity in eyes after laser-assisted in-situ keratomileusis for myopia.

PURPOSE: To evaluate the long-term contrast sensitivity (CS) after laser in-situ keratomileusis (LASIK) for myopia. METHODS: This retrospective, single-center, cohort study involved 190 eyes of 95 patients who underwent bilateral LASIK between January 2001 and October 2007. This study includes patients who underwent CS and higher-order aberration (HOA) measurements in a five-year postoperative period. For all enrolled patients, visual acuity, refractive error (RE) in diopters (D), CS at 3-, 6-, 12-, and 18-cycles per degree (cpd), and HOA in a 4 mm area of the dilated pupil were measured before surgery and 6 months, 1 year, and 5 years after it. RESULTS: The mean RE measured before the surgery and after 6 months, 1 year, and 5 years after was -6.08 ± 2.50D, -0.26 ± 0.65D, -0.28 ± 0.65D, and -0.48 ± 0.80D, respectively. There were no clinically significant changes between preoperative results and the measures taken 6 months, 1 year, and 5 years after surgery. The slight increase in HOA had little effect on CS over the mid to long-term postoperative period. CONCLUSION: Our findings show that CS does not clinically change post LASIK. Although we were unable to identify the specific mechanism, we theorize that after LASIK there is a possibility for the compensation of HOA.

Patient-reported vision-related quality of life after laser in situ keratomileusis, surface ablation, and phakic intraocular lens: The 5.5-year follow-up study.

To evaluate the long-term efficacy of refractive surgery of all cases in a single center via the use of a patient-reported outcome (PRO) refractive status questionnaire using descriptive statistics. This study was prospective, single-center, cohort study that involved 1422 patients who underwent refractive surgery (laser in situ keratomileusis, surface ablation, and phakic intraocular lens) at Baptist Eye Institute, Kyoto, Japan. The patients were asked to answer the Refractive Status and Vision Profile (RSVP) questionnaire before the surgery after 6 months (n = 1133 patients) and after 5.5 years (n = 232 patients). During the same period, examination by slit-lamp biomicroscopy and visual acuity tests were performed. Moreover, the patients were asked to rate their satisfaction with the surgery 6 months and 5.5 years after it. We examined overall RSVP scale (S), 8 RSVP subscales, rate of satisfaction with surgical outcome, slit-lamp biomicroscopy findings, and refractive error. The mean preoperative S was 36, yet that score significantly improved to 19 at 6 postoperative months postoperatively (P < .01), and basically remained the same (i.e., 20) throughout the 5.5-year postoperative period. During the 5-year follow-up period, mean refractive error became slightly myopic (0.3 D). No change in the rate of satisfaction was observed at both 6 months and 5.5 years postoperative period. The findings of this study help to clarify long-term PRO quality of vision (QOV) postrefractive surgery in a single center, and show that minor change in refractive error during 5 years postoperative period had no influence on the mean RSVP scores among outpatients. Nearly all patients reported short-term improvement of QOV, which continued throughout the long-term follow-up period.

Anterior and posterior ratio of corneal surface areas: A novel index for detecting early stage keratoconus.

PURPOSE: To evaluate the diagnostic ability of the ratio of anterior and posterior corneal surface areas (As/Ps) comparing with other keratoconus screening indices in distinguishing forme fruste keratoconus (FFKC) from normal eyes. METHODS: In this comparative study, 13 eyes of 13 patients with FFKC, 29 eyes of 29 patients with keratoconus (KC) and 88 eyes of 88 patients with normal subjects were involved. The As/Ps measured by the anterior segment optical coherence tomography (AS-OCT) and other indices measured by AS-OCT and rotating Scheimpflug-based corneal tomography were evaluated. The area under receiver-operating-characteristics (AU-ROC) was calculated to assess the diagnostic ability in discriminating FFKC from normal eyes. RESULTS: The As/Ps, the Belin/Ambrosio display enhanced ectasia total derivation value (BAD-D) and posterior and anterior elevation values showed the AU-ROC 0.9 or more in differentiating FFKC from normal eyes (0.980, 0.951, 0.924 and 0.903, respectively). The sensitivity and specificity were 0.92 and 0.96 for the As/Ps, 1.00 and 0.90 for BAD-D, 0.85 and 0.86 for posterior elevation value, and 0.85 and 0.96 for anterior elevation value, respectively. CONCLUSIONS: Among the several indices for keratoconus screening which we evaluated, the As/Ps obtained by AS-OCT had the large AU-ROC with high sensitivity and specificity in detecting FFKC, which was comparable with BAD-D obtained by rotating Scheimpflug-based corneal tomography. The As/Ps may provide information for improving the diagnostic accuracy of KC, even in the initial stage of the disease.

Multiple Linear Regression Analysis of the Impact of Corneal Epithelial Thickness on Refractive Error Post Corneal Refractive Surgery.

PURPOSE: To evaluate the influence of corneal epithelial thickness (CET) on the deviation from the targeted refraction (refractive error [RE]) post corneal refractive surgery. DESIGN: Retrospective, single-center, cross-sectional study. METHODS: This study involved 211 eyes of 211 patients who previously underwent laser-assisted in situ keratomileusis (LASIK) or epipolis LASIK for the correction of myopia and myopic astigmatism from August 2000 to May 2014 at the Baptist Eye Institute, Kyoto, Japan, and who subsequently underwent examination of CET via optical coherence tomography imaging of 17 zones (central: n = 1 zone, paracentral: n = 8 zones, and midperipheral: n = 8 zones) within a 6.0-mm-diameter area of the central cornea from April 2014 to February 2015. The relationship between CET and RE was evaluated using Spearman coefficient in 5 parameters: CET in the (1) central, (2) paracentral, and (3) midperipheral zones, and the difference between the (4) central and paracentral zones and the (5) central and midperipheral zones. The influence of CET on RE was evaluated in the CET parameter that showed a significant correlation with RE using multiple liner regression analysis. RESULTS: The correlation coefficient with RE was (1) -0.238 (P < .01), (2) -0.172 (P < .05), (3) -0.002 (P = .98), (4) -0.186 (P < .01), and (5) -0.266 (P < .01), respectively. Multiple liner regression analysis revealed that the difference of mean CET between the central and midperipheral zones had a significant influence on RE (ß coefficient = -0.028, P < .01). CONCLUSIONS: The difference between CET at the central and midperipheral zones may play a role in the final RE post corneal refractive surgery.

Involvement of anterior and posterior corneal surface area imbalance in the pathological change of keratoconus.

Keratoconus (KC) is an ectatic disorder with a high prevalence rate. However, the exact cause of the disease and possible underlying mechanisms of development remain unclear. In this present study, we aimed to investigate the anterior and the posterior corneal surface area in normal, forme fruste keratoconus (FFKC), and keratoconic eyes (as a reference group) using anterior segment optical coherence tomography (AS-OCT) in order to assess the pathological change of KC. The surface areas of the anterior or posterior cornea, and the anterior-posterior (As/Ps) ratio of corneal surface area, were measured at the central 5.0 mm-, 6.0 mm-, and 7.0 mm-diameter areas via AS-OCT, and a comparison between the normal eyes and FFKC eyes was then performed using the Mann-Whitney U test. The posterior surface area at the central 5.0 mm areas in the FFKC eyes (20.430 mm2) and KC eyes (20.917 mm2) seemed to become larger than that of normal eyes (20.389 mm2) (normal vs FFKC; P = 0.06). Moreover, the As/Ps of the corneal surface area in the FFKC eyes (0.986) and the KC eyes (0.976) was significantly smaller than that of the normal eyes (0.988) (normal vs FFKC; P < 0.01). Anterior and posterior corneal surface area imbalance may reflect keratoconic eyes at the early stage of the disease.

Sialic Acid in human tear fluid decreases in dry eye.

PURPOSE: To evaluate the association between tear mucin and dry eye, we compared tear fluid sialic acid concentration in dry eye patients with that in normal volunteers. We also compared the sialic acid concentration with the results of several different types of dry eye examinations. METHODS: Subjects comprised 16 age-matched, normal healthy controls and 45 dry eye patients. Dry eye examinations included fluorescein staining, rose bengal staining, Schirmer I test, cotton thread test, and fluorescein breakup time. Tear samples were collected with a micropipette after the instillation of 50 microl saline. The sialic acid concentration was measured by high-performance liquid chromatography. RESULTS: The sialic acid concentration was significantly lower in the dry eye group (5.3 +/- 4.3 microg/ml) than in the control group (37.1 +/- 28.3 microg/ml) (P < 0.001). Also, the sialic acid concentration correlated significantly with the results of dry eye examinations (P < 0.0002). CONCLUSIONS: The different sialic acid levels in the control and dry eyes may imply differences in the quantity or quality of glycoprotein in tears between these two groups. Thus, sialic acid, a component of mucin, may play a key role in the dry eye condition.

[Outcome of punctal plug occlusion therapy for severe dry eye syndrome].

PURPOSE: Punctal occlusion using a silicone plug is one way of treating tear-deficient dry eye and it has been reported to be effective. We studied the outcome of punctal plug occlusion therapy for severe dry eye syndrome at our dry eye clinic. SUBJECTS AND METHODS: Subjects were 76 eyes of 51 patients [6 eyes of 5 males, 70 eyes of 46 females, mean age: 58.6 +/- 13.4 (mean +/- standard deviation), 49 eyes of 30 patients with Sjögren's syndrome, 27 eyes of 21 patients without Sjögren's syndrome] with severe tear-deficient dry eye who underwent punctal occlusion using a silicone plug (Punctal plug, FCI Co. Ltd, France) during the period of Nov. 1996 to Mar. 2000 at our dry eye clinic. They were under observation for 632 +/- 405 days (mean +/- standard deviation). We studied if there is difference in tolerance between the sizes of punctal plug, compared epithelial damage before and after plug insertion, and studied relief in symptoms using self-assessment. RESULTS: In tolerance of punctal plugs, 55.9% of all plugs were lost during our follow up, but there was no difference in time to loss between the sizes. Epithelial damage was reduced (p < 0.001). Dryness was the most reduced symptom: 26 patients (79%) got better, and only epiphora was increased, with 12 patients (36%) complaining slightly. CONCLUSION: Punctal plug occlusion therapy for tear-deficient dry eye is conclusively very effective.

[Canaliculitis caused by Actinomyces in a case of dry eye with punctal plug occlusion].

BACKGROUND: We report a case of canaliculitis caused by Actinomyces odontolyticus in a case of dry eye with punctal plugs. CASE: A 64-year-old female with Sjögren's syndrome type of dry eye developed lacrimation, congestion in the lower palpebral conjunctiva and corneal epithelial damage in her right eye 30 months after punctal plug occlusion. After removal of the plug from lower punctum in her right eye, white material exuded from the punctum. However, even after the removal of a plug, corneal epithelial keratopathy did not get worse, implying that the granulation tissue formed by the plug completely occluded the canaliculus. Actinomices odontolyticus was cultured from the white material. One week after topical antibiotic treatment, conjunctival congestion and irritation were resolved. CONCLUSION: This report indicates the possibility of canaliculitis as a complication of punctal plug occlusion. Careful observation is necessary after punctal occlusion with punctal plugs.

[Comparison of extrusion rate for two different design of punctal plugs].

PURPOSE: Punctal occlusion using a silicone plug is an effective treatment for severe tear-deficient dry eye. At present, plugs from two companies are available in Japan [Eagle plug(EP); Eagle Vision, Punctal plug(PP); FCI]. We compared the extrusion rate between EP and PP in our dry eye clinic. SUBJECTS AND METHODS: Subjects were 20 eyes of 18 patients for EP [5 eyes from 5 males, 15 eyes from 13 females, age: 58.1 +/- 17.5(mean +/- standard deviation)] and 76 eyes of 51 patients for PP (6 eyes from 5 males, 70 eyes from 46 females, age: 58.6 +/- 13.4), 62 eyes from 44 patients with Sjögren syndrome, 34 eyes from 25 patients with non-Sjögren syndrome with severe tear-deficient dry eye treated for the period of November 1996 to February 2002 in our dry eye clinic. We compared the extrusion rate for each plug and necessity of reinsertion of the plug. RESULTS: In the examination for EP, 72.2% plugs were extruded during the follow-up periods, and the average period(59 days) until the extrusion was significantly shorter than for PP(p < 0.0001). In the examination for PP, 55.9% were extruded, and the average period until the extrusion was 287 days. Significant improvement of corneal epithelial damage was seen with PP after insertion of the plug. For the PP, reinsertion of plugs was sometimes impossible, probably because of the granulation formed inside the canaliculus, while for EP, reinsertion of the plugs was possible for all cases. DISCUSSION: EP becomes extruded more easily than PP, and PP is seems for to form granulation more easily.