Time Course of Lens Epithelial Cell Behavior in Rabbit Eyes following Lens Extraction and Implantation of Intraocular Lens.

BACKGROUND: After cataract surgery, some lens epithelial cells (LECs) transdifferentiate into myofibroblast-like cells, which causes fibric posterior capsule opacification (PCO). Residual LECs differentiate into lens fiber cells, forming Elschnig pearls with PCO. This study was carried out to identify the time course of both types of LEC behavior in rabbit eyes following lens extraction and implantation of an intraocular lens (IOL). METHODS: Phacoemulsification and implantation of posterior chamber IOLs were performed in rabbit eyes. Following enucleation, immunohistochemical methods were used to detect α-smooth muscle actin (α-SMA), a marker for myofibroblast-like cells, in the pseudophakic rabbit eyes. A mouse monoclonal antibody against α-SMA was used. RESULTS: Soon after the operation, the LECs migrated and covered the lens capsule. Thereafter, the LECs around the anterior capsular margin were always positive for α-SMA. However, the distributions of these cells were not consistent. In some specimens, α-SMA-positive LECs were present around the IOL optic early after surgery, but most of them had disappeared several weeks after the surgery. The residual cells induced fibrotic PCO. In the other specimens, most LECs around the IOL optic except the anterior capsular margin were negative for α-SMA. In the peripheral region covered by the peripheral anterior and posterior capsules, LECs on the posterior capsule always differentiated into lens fiber cells and formed a Soemmering ring. Thereafter, migration of lens fiber cells from the Soemmering ring and differentiation of LECs in situ on the central posterior capsule consisted of Elschnig pearls type of PCO. CONCLUSIONS: Although postoperative LEC behavior is not consistent, residual α-SMA-positive LECs induced fibrotic PCO. The lens fiber cells that migrated from the peripheral capsular bag or that were differentiated in situ covered the central posterior capsule, forming Elschnig pearls with PCO.

Blue light-filtering and violet light-filtering hydrophobic acrylic foldable intraocular lenses: Intraindividual comparison.

PURPOSE: To compare the clinical outcomes after cataract surgery and implantation of a blue light-filtering IOL (AcrySof IQ SN60WF) or a violet light-filtering intraocular lens (IOL) (OptiBlue ZCB00V). SETTING: Four surgical sites in Japan. DESIGN: Prospective case series. METHODS: One eye of patients with bilateral cataract was randomly allocated to the blue light-filtering IOL and the fellow eye to the violet light-filtering IOL. Visual acuity and contrast sensitivity were assessed over 3 months. The incidence of cyanopsia was evaluated using the neutralization method. RESULTS: The study enrolled 110 eyes of 55 patients. There was no significant difference in visual acuity between the two IOLs. Based on the neutralization results 1 week postoperatively, 15 cases (27.8%) with the light-filtering IOL and 8 cases (14.8%) with the violent light-filtering IOL had cyanopsia; the difference reached statistical significance (P = .049). After 2 weeks, the difference in the incidence of cyanopsia was not significant. Postoperative contrast sensitivity under photopic condition at 1 week and 3 months and contrast sensitivity under mesopic conditions at 3 months were significantly better with the violet light-filtering IOL than with the blue light-filtering IOL (P < .05). CONCLUSIONS: The violet light-filtering IOL yielded highly satisfactory clinical outcomes, including reduction of cyanopsia and a potential improvement in contrast sensitivity. The different chromophores of the IOL and its different material and design might have contributed.

SOX2 nonsense mutation in a patient clinically diagnosed with non-syndromic hypogonadotropic hypogonadism.

Hypogonadotropic hypogonadism (HH) is a genetically heterogeneous condition that occurs either as an isolated disorder or as a component of congenital malformation syndromes. SOX2 is a causative gene of syndromic HH characterized by anophthalmia, microphthalmia, or coloboma and other neurological defects such as epilepsy. To date, the causal relationship between SOX2 abnormalities and non-syndromic HH remains speculative. Here, we identified a nonsense mutation of SOX2 in a male patient clinically diagnosed with non-syndromic HH. The patient had epilepsy but no additional clinical features. Ophthalmological examination revealed no abnormalities except for decreased thickness of the retinal nerve fiber layer. Audiometry showed mild sensorineural hearing impairment of both ears. Hormonal evaluation suggested isolated gonadotropin deficiency. Next-generation sequencing-based mutation screening of 13 major causative genes for HH identified a p.Lys35∗ mutation in SOX2 and excluded pathogenic mutations in other tested genes. The p.Lys35∗ mutation appeared to encode a non-functioning SOX2 protein that lacks 283 of 317 amino acids. The SOX2 mutation was absent in the maternal DNA sample, while a paternal sample was unavailable for sequence analysis. These results expand the clinical consequences of SOX2 haploinsufficiency to include non-syndromic HH. Systematic mutation screening using a next-generation sequencer and detailed evaluation of nonspecific ocular/neurological features may help identify SOX2 mutation-positive individuals among HH patients.

Unilateral cone dysfunction as a manifestation of acute zonal occult outer retinopathy.

PURPOSE: To report a patient with unilateral cone dysfunction (UCD) who later developed acute zonal occult outer retinopathy (AZOOR) in the contralateral eye. METHODS: A 19-year-old Japanese woman was referred complaining of decreased vision and photopsia of the left eye. Static perimetry, full-field electroretinography (ERG), and multifocal ERGs (mfERGs) were performed to evaluate her visual functions. She returned 9 months later with visual field defect and photopsia in the right eye. RESULTS: The static visual field of the left eye demonstrated a scotoma that extended from the physiologic blind spot to the center of the visual field. The cone full-field ERGs were extinguished with preservation of rod function. The mfERGs were reduced throughout the posterior pole of the left eye. The patient was diagnosed with UCD. She revisited us 9 months later complaining of visual symptoms in the right eye and was found to have an arcuate scotoma in the upper visual field corresponding to decreased mfERGs. These findings were consistent with clinical signs of AZOOR. CONCLUSION: These findings indicate that UCD is one of the clinical manifestations of AZOOR.

Changes of oscillatory potentials and photopic negative response in patients with early diabetic retinopathy.

PURPOSE: To investigate the clinical significance of the oscillatory potentials (OPs) and photopic negative response (PhNR) of the electroretinogram (ERG) in patients with early diabetic retinopathy. METHODS: One hundred two diabetic patients with diabetic retinopathy at different stages were examined. Thirty-two age-matched normal controls were also studied. Full-field maximal and photopic cone ERGs were recorded. The amplitudes and implicit times of the OPs, cone b wave, and PhNR were compared at the different stages of diabetic retinopathy. RESULTS: The a and b wave amplitudes of the maximal scotopic ERGs remained unchanged despite advancing stages of retinopathy, but the OP amplitudes were significantly attenuated even at an early stage of diabetic retinopathy. The amplitudes of both the PhNR and cone b wave were reduced at an early stage of diabetic retinopathy. Analysis of the receiver operating characteristic curves demonstrated that the amplitudes and implicit times of the OPs were more sensitive and specific than those of the PhNR in detecting changes of retinal function in the early stages of diabetic retinopathy. CONCLUSIONS: The amplitudes of the OPs and PhNR progressively decrease with the progression of diabetic retinopathy. The PhNR amplitudes were reduced along with the cone b wave, indicating that earlier change of the PhNR in diabetic patients reflects reduced input to the retinal ganglion cell from the distal retina. The amplitudes and implicit times of the OPs are better indicators than those of the PhNR in detecting functional decreases in patients with early diabetic retinopathy.

Decrease of blue cone sensitivity in acute idiopathic blind spot enlargement syndrome.

PURPOSE: To determine the sensitivity of the blue cone system by static perimetry in patients with unilateral acute idiopathic blind spot enlargement (AIBSE) syndrome. DESIGN: Observational case series. METHODS: Four patients with AIBSE syndrome, aged 16 to 30 years, were studied. Diagnosis of the AIBSE syndrome was based on clinical findings including an enlarged blind spot without corresponding ophthalmoscopic changes of the ocular fundus and with depressed multifocal electoretinograms. The visual sensitivity and mean deviations (MD) were measured by white-on-white (W/W) and blue-on-yellow (B/Y) automated perimetry. RESULTS: The average difference in the MD between the affected and unaffected eyes was 4.87 +/- 1.51 dB and 13.65 +/- 4.19 dB for W/W and B/Y perimetries, respectively. The difference between the two groups of eyes was significantly greater for B/Y perimetry than that for W/W perimetry (P =.01). CONCLUSIONS: Our results suggest that the decrease of blue cone sensitivity is diffusely present over the retina in eyes with AIBSE syndrome. We recommend B/Y perimetry as a sensitive measure to detect retinal dysfunction that is not detected by W/W perimetry.