Changes in Tear Osmolarity after Cataract Surgery.

BACKGROUND: The purpose of this study was to examine changes in the ocular surface before and after phacoemulsification with small incisions and to examine the changes in tear osmolarity. METHODS: This was a prospective, observational study involving 55 eyes of 39 patients (19 male, 20 female patients; average age 72.0±7.3 years) who had cataract surgery at a Nippon Medical School Hospital between December 2013 and June 2018. Compromised tear dynamics were determined by the Schirmer test or the tear break-up time (BUT). An abnormal ocular surface was identified by positive vital staining with fluorescein or lissamine green. Moreover, tear osmolarity (Tosm) and corneal sensitivity were measured. All assessments were done preoperatively and 1 and 4 weeks (P1W and P4W) after the surgery. RESULTS: None of the operations had any complications. Operating time was 17.8±9.3 minutes. BUT was significantly decreased at P1W, and it recovered at P4W. The Schirmer test did not change significantly. The fluorescein staining score (FSS) increased significantly at P1W and recovered at P4W. The Lissamine green score (LSS) did not change significantly. Tear osmolarity increased significantly at P1W and did not recover at P4W. Corneal sensitivity decreased significantly at P1W and recovered at P4W. CONCLUSION: In the present study, there were temporary changes in dry eye-related examinations including tear osmolarity after cataract surgery. In particular, tear osmolarity increased significantly 4 weeks after surgery compared to before surgery, and it showed long-term changes, unlike other factors. After cataract surgery, tear osmolarity, BUT, and FSS increase, resulting in dry eye symptoms. Therefore, it is necessary to pay attention to discomfortable eye symptoms of patients after cataract surgery.

The correlation between plasma osmolarity and tear osmolarity.

PURPOSE: To the correlation between plasma osmolarity (Posm) and tear osmolarity (Tosm) in patients (54 patients, 88 eyes) who underwent cataract surgery was evaluated. METHODS: Before cataract surgery, routine pre-operative biochemical tests were performed, and Posm was determined from blood samples. Also, Tosm was measured using the TearLab system, and objective signs including tear break-up time (BUT), fluorescein staining, lissamine green staining, and Schirmer's test were evaluated. Dry eye (DE) was diagnosed according to the Japanese criteria for DE. RESULTS: Of the 88 eyes, 4 were diagnosed as definite DE, 70 as probable DE, and 14 as normal. Since the number of definite DE was small, the eyes were divided into two groups: normal group (n = 14) and DE group (n = 74), which included definite DE (n = 4) and probable DE (n = 70). There was no correlation between Posm and Tosm, though Posm (293.32 mOsm/L) was significantly higher than Tosm (288.48 mOsm/L; p < 0.001). There was no significant difference in Tosm between the normal group (288.29 mOsm/L) and the DE group (288.51 mOsm/L). No patients had a Tosm higher than 310 mOsm/L even in the DE group. Correlations between Posm/Tosm and each DE sign value were not found. Of 54 patients, 18 were diabetic. Posm was significantly higher in diabetic (295.78 mOsm/L) than in non-diabetic (292.36 mOsm/L; p = 0.014) patients, while there was no significant difference in Tosm between diabetic and non-diabetic patients. CONCLUSIONS: The results suggest that Tosm is independent of Posm, and Tosm elevation in DE occurs by some local mechanisms.

Tyrosine triple mutated AAV2-BDNF gene therapy in a rat model of transient IOP elevation.

PURPOSE: We examined the neuroprotective effects of exogenous brain-derived neurotrophic factor (BDNF), which provides protection to retinal ganglion cells (RGCs) in rodents, in a model of transient intraocular pressure (IOP) elevation using a mutant (triple Y-F) self-complementary adeno-associated virus type 2 vector encoding BDNF (tm-scAAV2-BDNF). METHODS: The tm-scAAV2-BDNF or control vector encoding green fluorescent protein (GFP; tm-scAAV2-GFP) was intravitreally administered to rats, which were then divided into four groups: control, ischemia/reperfusion (I/R) injury only, I/R injury with tm-scAAV2-GFP, and tm-scAAV2-BDNF. I/R injury was then induced by transiently increasing IOP, after which the rats were euthanized to measure the inner retinal thickness and cell counts in the RGC layer. RESULTS: Intravitreous injection of tm-scAAV2-BDNF resulted in high levels of BDNF expression in the neural retina. Histological analysis showed that the inner retinal thickness and cell numbers in the RGC layer were preserved after transient IOP elevation in eyes treated with tm-scAAV2-BDNF but not in the other I/R groups. Significantly reduced glial fibrillary acidic protein (GFAP) immunostaining after I/R injury in the rats that received tm-scAAV2-BDNF indicated reduced retinal stress, and electroretinogram (ERG) analysis confirmed preservation of retinal function in the tm-scAAV2-BDNF group. CONCLUSIONS: These results demonstrate the feasibility and effectiveness of neuroprotective gene therapy using tm-scAAV2-BDNF to protect the inner retina from transiently high intraocular pressure. An in vivo gene therapeutic approach to the clinical management of retinal diseases in conditions such as glaucoma, retinal artery occlusion, hypertensive retinopathy, and diabetic retinopathy thus appears feasible.

Improvements in Signs and Symptoms of Dry Eye after Instillation of 2% Rebamipide.

PURPOSE: Because dry eye greatly reduces quality of life, this study aimed to examine rebamipide instillation in patients with dry eye and assess the improvement of signs and symptoms as evaluated with the Ocular Surface Disease Index, which is the most popular index and is highly reliable. METHODS: From June 2013 through January 2014, we examined 50 eyes of 25 patients with dry eye (6 men and 19 woman) at our institution. Dry eye was diagnosed on the basis of the presence of symptoms, tear dynamics, and ocular surface abnormalities according to the Japanese criteria for dry eye. Before being enrolled, all patients underwent ocular surface health assessment, including history interviews, and completed the Ocular Surface Disease Index questionnaire. Patients received 2% rebamipide ophthalmic solution 4 times daily for 4 weeks. Signs and symptoms were analyzed before and 4 weeks after rebamipide administration. Tear dynamics, tear break-up time, and ocular surface abnormalities were measured and compared between before and 4 weeks after rebamipide administration. RESULTS: Of the 25 patients, 9 had definite dry eye and 16 had probable dry eye. Tear break-up time and the fluorescein staining score significantly improved after 4 weeks. However, no significant change was observed for the Schirmer test I and the lissamine green staining score. CONCLUSIONS: The administration of 2% rebamipide 4 times daily for 4 weeks improves the signs and symptoms of dry eye and improves patients' quality of life.

Short-time exposure of hyperosmolarity triggers interleukin-6 expression in corneal epithelial cells.

PURPOSE: Although tear hyperosmolarity is assumed to play a major role in dry eye disease, correlation between the level of hyperosmolarity and inflammation remains unclear. The purpose of this study was to examine the effect of short-time hyperosmolarity exposure in the production of inflammatory cytokines in corneal epithelial cells in vitro. METHODS: Human corneal epithelial (HCE) cells were cultured under different osmotic conditions [310 (control), and 400-1000 mOsm]. Lactate dehydrogenase (LDH) release after short-term (10 minutes) or long-term (24 hours) hyperosmotic stress exposure was evaluated to determine HCE cell cytotoxicity. Production of inflammatory cytokines, including IL-6, IL-1ß, IL-8, IL-23, and TGF-ß1, due to hyperosmotic stress was also measured by enzyme-linked immunosorbent assay and semiquantitative real-time polymerase chain reaction. RESULTS: After a 24-hour culture, exposures above 700 mOsm caused all HCE cells to die, 500 and 600 mOsm damaged the cells, whereas 400 mOsm caused no morphological changes. However, there was a significant increase in the release of LDH after 24-hour cultures, even in 400 mOsm. In contrast, LDH examination showed that there was no cytotoxicity for the 10-minute exposures, even at above 800 mOsm. The significant increases in IL-6 production and mRNA expression at 700 mOsm during the short-time exposures were both dependent on the osmolarity. Other cytokines such as IL-1ß, IL-8, IL-23, and TGF-ß1 were not detected. CONCLUSIONS: Short-time hyperosmolarity exposure may activate IL-6 expression and production in HCE cells without cytotoxicity. These observations suggest that hyperosmolarity could cause inflammation on the ocular surface in dry eye disease.

A new mutation in the RP1L1 gene in a patient with occult macular dystrophy associated with a depolarizing pattern of focal macular electroretinograms.

PURPOSE: To determine whether a mutation in the RP1-like protein 1 (RP1L1) gene is present in a Japanese patient with sporadic occult macular dystrophy (OMD) and to examine the characteristics of focal macular electroretinograms (ERGs) of the patient with genetically identified OMD. METHODS: An individual with OMD underwent detailed ophthalmic clinical evaluations including focal macular ERGs. Mutation screening of all coding regions and flanking intron sequences of the RP1L1 gene were performed with DNA sequencing analysis in this case with OMD. RESULTS: A new RP1L1 mutation (c.3596 C>G in exon 4) was identified. The variant c.3596 C>G in exon 4 resulted in the substitution of cysteine for serine at amino acid position 1199. The serine at position 1199 is well conserved among the RP1L1 family in other species. Four out of five computational assessment tools predicted that this mutation is damaging to the protein function. This mutation was not present in 294 control alleles. The waveform of focal macular ERGs recorded from the patient with OMD had a depolarizing pattern, simulating the ERG waveforms observed after the hyperpolarizing bipolar cell activity is blocked. CONCLUSIONS: We have demonstrated in a Japanese patient the possibility that sporadic OMD may also be caused by an RP1L1 mutation. The waveform of focal macular ERGs elicited from the OMD patient with the RP1L1 mutation showed a depolarizing pattern. This characteristic is the same as reported for the focal macular ERGs of OMD.

Reactive gliosis of astrocytes and Müller glial cells in retina of POMGnT1-deficient mice.

Protein O-linked mannose beta1, 2-N-acetylglucosaminyltransferase 1 (POMGnT1) is an enzyme that catalyzes the transfer of N-acetylglucosamine to O-mannose of glycoproteins. Alpha-dystroglycan, a substrate of POMGnT1, is concentrated around the blood vessels, in the outer plexiform layer (OPL), and in the inner limiting membrane (ILM) of the retina. Mutations of the POMGnT1 gene in humans cause muscle-eye-brain (MEB) disease. Several ocular abnormalities including retinal dysplasia, ERG abnormalities, and retinal detachments have been reported in patients with MEB. We have analyzed the eyes of POMGnT1-deficient mice, generated by standard gene targeting technique, to study the retinal abnormalities. Clinical examination of adult mutant mice revealed a high incidence (81% by 12-months-of-age) of retinal detachments. Sheathing of the retinal vessels and the presence of ectopic fibrous tissues around the optic nerve head were also found. Histological examinations showed focal retinal detachment associated with GFAP immunopositivity. The ILM of the mutant mice was disrupted with ectopic cells near the disruptions. The expression of Dp71, a shorter isoform of dystrophin, was severely reduced in the ILM and around retinal blood vessels of POMGnT1-deficient mice. The expression of Dp427, Dp260, Dp140 were also reduced in the OPL of the mutant mice. Electroretinographic (ERG) analyses showed reduced a- and b-wave amplitudes. Examinations of flat mounts revealed abnormal vascular network associated with highly irregular astrocytic processes. In addition, ER-TR7-positive fibrous tissue was found closely associated with reactive astrocytes especially around the optic nerve head. Our results suggest that altered glycosylation of alpha-DG may be responsible for the reactive gliosis and reticular fibrosis in the retina, and the subsequent developments of retinal dysplasia, abnormal ERGs, and retinal detachment in the mutant mice.