Characteristics of glaucoma patients with intraocular pressure elevation early after trabectome surgery.

PURPOSE: To analyze the rate and time of occurrence of intraocular pressure (IOP) elevation early after trabectome surgery (TOM) and the characteristics of glaucoma patients recovering from IOP elevation. METHOD: Four hundred sixty eyes of 460 glaucoma (191 primary and 269 secondary open-angle glaucoma) patients who underwent TOM were evaluated. IOP elevation early after TOM was diagnosed when IOP increased by more than 5 mmHg over baseline within 1 week to 3 months. If the IOP decreased with the administration of anti-glaucoma eye drops alone, patients were classified as recovered. If the IOP did not decrease despite additional anti-glaucoma eye drop use, patients were classified as non-recovered. The rate and time of occurrence of IOP elevation early after TOM were investigated. Demographic and ocular variables related to recovery and non-recovery were identified by multivariate logistic regression analysis. RESULTS: Of the 460 patients, IOP elevation early after TOM occurred in 102 (22.2%). IOP elevation occurred most frequently at postoperative week 1. Of the 102 patients with IOP elevation, 55 (53.9%) recovered and 47 (46.1%) did not. A large hyphema size the day after surgery was associated with increased likelihood of recovery from IOP elevation (odds ratio [OR], 6.6). A history of past selective laser trabeculoplasty (SLT; OR, 0.10) and high baseline IOP (OR, 0.86) were associated with reduced likelihood of recovery from IOP elevation. CONCLUSION: IOP elevation early after TOM occurred most frequently at postoperative week 1. Patients with a large hyphema size, no history of SLT, and a lower baseline IOP recovered from IOP elevation early after TOM. A large hyphema the day after surgery suggested an increased likelihood of recovery from IOP elevation.

Long-term clinical results of trabectome surgery in patients with open-angle glaucoma.

PURPOSE: To evaluate the 72-month clinical results of trabectome surgery (TOM) in patients with primary open-angle glaucoma (POAG), secondary OAG and childhood glaucoma. METHOD: A total of 305 eyes from 249 glaucoma patients were analyzed in the current retrospective single-center study. Kaplan-Meier analysis was performed using three criteria: criterion A (postoperative intraocular pressure [IOP] ≤ 21 mmHg and ≥ 20% reduction from baseline IOP); criterion B (postoperative IOP ≤ 18 mmHg and ≥ 20% reduction from baseline IOP); and criterion C (postoperative IOP ≤ 16 mmHg and ≥ 20% reduction from baseline IOP). The changes in IOP, medication score, success probability, results of the multivariate analysis for success and failure risk factors, and complications were analyzed. RESULTS: The baseline IOP in all glaucoma patients decreased from 29.2 ± 9.8 mmHg with a 5.3 ± 1.7 medication score to 16.4 ± 5.8 mmHg (- 43.8%) with a 4.2 ± 1.5 medication score at 72 months (p < 0.01). The success probabilities in all cases for 72 months based on criterion A, B, and C were 44%, 35%, and 17%, respectively. For criterion A, no significant differences were found in the success probability according to the glaucoma subtype for 72 months. The combined surgical procedure significantly decreased the failure risk (hazard ratio [HR]: 0.59). On the other hand, the presence of POAG (HR: 1.6) and a history of past selective laser trabeculoplasty (HR: 2.2) significantly increased failure risk. One patient (0.3%) demonstrated endophthalmitis after TOM but recovered through appropriate treatment. CONCLUSION: At the 72-month time point, approximately half of the glaucoma patients maintained an IOP ≤ 21 mmHg with ≥ 20% IOP reduction. TOM is a safe surgery but may not yield sufficient IOP reduction in patients who have received SLT or have POAG.

Comparison of corneal biomechanical properties in normal tension glaucoma patients with different visual field progression speed.

AIM: To compare the corneal biomechanical properties difference by ocular response analyzer (ORA) in normal tension glaucoma (NTG) patients with different visual field (VF) progression speed. METHODS: NTG patients with well-controlled Goldmann applanation tonometer (GAT) who routinely consulted Kitasato University Hospital Glaucoma Department between January 2010 and February 2014 were enrolled. GAT and ORA parameters including corneal compensated intraocular pressure (IOPcc), Goldmann estimated intraocular pressure (IOPg), corneal hysteresis (CH), corneal resistance factor (CRF) were recorded. VF was tested by Swedish interactive threshold algorithm (SITA)-standard 30-2 fields. All patients underwent VF measurement regularly and GAT did not exceed 15 mm Hg at any time during the 3y follow up. Patients were divided into four groups according to VF change over 3y, and ORA findings were compared between the upper 25(th) percentile group (slow progression group) and the lower 25(th) percentile group (rapid progression group). RESULTS: Eighty-two eyes of 56 patients were studied. There were 21 eyes (21 patients) each in rapid and slow progression groups respectively. GAT, IOPcc, IOPg, CH, CRF were 12.1±1.4 mm Hg, 15.8±1.8 mm Hg, 12.8±2.0 mm Hg, 8.4±1.1 mm Hg, 7.9±1.3 mm Hg respectively in rapid progression group and 11.5±1.3 mm Hg, 13.5±2.1 mm Hg, 11.2±1.6 mm Hg, 9.3±1.1 mm Hg, 8.2±0.9 mm Hg respectively in slow progression group (P=0.214, <0.001, 0.007, 0.017, 0.413, respectively). In bivariate correlation analysis, IOPcc, IOPcc-GAT and CH were significant correlated with mΔMD (r=-0.292, -0.312, 0.228 respectively, P=0.008, 0.004, 0.039 respectively). CONCLUSION: Relatively rapid VF progression occurred in NTG patients whose IOPcc are rather high, CH are rather low and the difference between IOPcc and GAT are relatively large. Higher IOPcc and lower CH are associated with VF progression in NTG patients. This study suggests that GAT measures might underestimate the IOP in such patients.

Short-term evaluation of Trabectome surgery performed on Japanese patients with open-angle glaucoma.

PURPOSE: To evaluate the short-term results of Trabectome surgery performed on Japanese patients. METHODS: Retrospective observational study. Trabectome surgery was performed on 117 eyes from 101 patients at Kitasato University Hospital from December 2010 to June 2013, involving 48 eyes with primary open-angle glaucoma (POAG), 62 eyes with secondary open-angle glaucoma (SOAG), and 7 eyes with developmental glaucoma. Trabectome surgery alone was performed on 34 phakic eyes (the phakic group) and 35 pseudophakic eyes (the pseudophakic group), and Trabectome surgery combined with phacoemulsification (the combined surgery group) was performed on 48 eyes. The main outcomes assessed were intraocular pressure (IOP), number of IOP-lowering medications, and success probabilities using Kaplan-Meier life-table analyses. Failure risk factors were identified using the Cox proportional hazards ratio. RESULTS: In all cases, after a mean follow-up of 18.5 ± 13.5 months, IOP was reduced from 31.6 ± 9.9 (SD) mmHg using 5.0 ± 1.7 medications to 16.4 ± 5.4 mmHg using 3.8 ± 1.8 medications. One year after surgery, IOP was reduced from 29.4 ± 7.8 to 16.1 ± 3.8 mmHg in POAG, from 33.6 ± 11.1 to 14.7 ± 2.9 mmHg in SOAG, from 33.0 ± 10.2 to 15.7 ± 3.3 mmHg in the phakic group, from 32.6 ± 9.3 to 15.3 ± 3.0 mmHg in the pseudophakic group, and from 29.9 ± 10.0 to 15.2 ± 3.0 mmHg in the combined surgery group. There were no statistically significant differences in IOP at each measurement point, either between POAG and SOAG or among the three procedure subtypes. The POAG and SOAG success rates at 12 months using postoperative IOP ≤ 21 mmHg and ≥20 % reduction in baseline as criteria were 53.9 and 77.2 %, respectively (p = 0.024, log-rank test). Twenty-one eyes (17.9 %) needed additional trabeculectomy. None of the univariate and multivariate risk factors for failure were detected. CONCLUSIONS: Trabectome surgery is safe and effective for Japanese patients whose target IOP is 18 mmHg or above. However, it is necessary to carefully consider Trabectome surgery for advanced POAG cases.

[Challenges Related to Employees with Developmental Disabilities, from the Perspective of an Occupational Physician].

Changing in the work environment in recent years, an occupational physician needs to make a countermeasure to mental health disorders. When the occupational physician works with employees who have, or are suspected of having, high-functioning developmental disorders, it is necessary to consider the following: Whether, in the course of addressing problems faced by employees, occupational health staff members are able to consider the possibility of developmental disorders. An additional issue is whether the occupational physician, when working with the treating psychiatrist, is able to appropriately provide precise information. Furthermore, when an employee is diagnosed with a developmental disorder, there are questions of whether a smooth internal company approach is possible in the context of appropriate workplace support, and whether it is possible to obtain the understanding of colleagues prior to implementing appropriate workplace assignments and accommodations. Additionally, it is necessary to consider the career paths of employees with high-functioning developmental disorders that are discovered subsequent to being hired. In this paper, introducing some cases, It was summarized the challenges of developmental disabilities in the workplace and discussed correspondence in the workplace.

Comparative optical coherence tomography study of differences in scleral shape between the superonasal and superotemporal quadrants.

PURPOSE: To determine the differences in scleral shape between the superonasal and superotemporal quadrants, the sites of scleral flap creation in trabeculectomy, using anterior segment optical coherence tomography (OCT). METHODS: Thirty-four right eyes of 34 enrolled subjects without ocular disease, with the exception of cataract or ametropia, were studied. Mean patient age was 63.2 ± 15.9 (standard deviation) years (range 28-84 years). The same examiner captured all images using anterior segment swept source OCT. The mean measurements were calculated from three images captured for each eye, 60° from the horizontal line passing through the pupillary center in the superonasal and superotemporal sclera. The radius of the scleral surface curvature and the area of the convex part of the sclera between the superonasal and the superotemporal quadrants were determined using image analysis software and the paired t test. RESULTS: The radius of the scleral curvature was significantly different in the superonasal quadrant and superotemporal quadrant (34.3 ± 12.6 vs. 18.3 ± 3.6 mm, respectively; P < 0.001). The area of the convex part of the sclera was also significantly different in the superonasal and superotemporal quadrants (0.36 ± 0.1 vs. 0.57 ± 0.1 mm(2), respectively; P < 0.001). CONCLUSIONS: Anterior segment OCT analysis of the scleral shape revealed a more gradual scleral gradient in the superonasal quadrant compared with the superotemporal quadrant.

A modified glaucoma staging system based on visual field index.

PURPOSE: To describe a modified glaucoma staging system (Modified GSS) based on the visual field index (VFI) and evaluate the performance of the Modified GSS compared with the Bascom Palmer GSS and Enhanced GSS. METHODS: A total of 549 eyes of 549 patients were studied retrospectively. The Modified GSS was used to classify the glaucomatous visual field defects into stage 0 to 5 based on the VFI. The cutoff values for each stage were derived from VFI that were equivalent to mean deviations of -6, -12, -20, and -25 dB by receiver operating characteristic analysis. The staging performances, based on each of three GSSs, were compared with both the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS) scores. RESULTS: The VFI cutoff values calculated for each stage were 81.5, 62.5, 42.5, and 22.5%, respectively. The correlation coefficient of Modified GSS was greater than that of Bascom Palmer GSS (p < 0.001), and correlation coefficients of Modified GSS and Enhanced GSS were equivalent. However, Enhanced GSS tended to classify moderate to severe AGIS and CIGTS scores into higher stages (p < 0.001). CONCLUSIONS: The Modified GSS is easy to use and accurate, and the staging performance is either equal or superior to existing GSSs.

Evaluation of optic nerve head using a newly developed stereo retinal imaging technique by glaucoma specialist and non-expert-certified orthoptist.

PURPOSE: To evaluate the reproducibility and interexaminer consistency in analyzing the optic disc parameters using a newly fundus stereoscopic camera, and their correlation with parameters of the Heidelberg Retina Tomograph II (HRT II) was also examined. METHODS: This study examined 53 eyes of 53 healthy volunteers (mean age, 21.8 y). Fifty-five eyes of 55 glaucoma patients (mean age, 59.3 y) were also involved. A Nonmyd WX retinal camera was used for stereoscopic fundus imaging. The diagnostic parameters for the optic nerve head analyses were examined under the following conditions: (1) the intraexaminer reproducibility was determined by a certified orthoptist (CO) with 1 year's experience, with the appropriate coefficient of variation in 8 healthy eyes; and (2) the interexaminer consistency of the diagnostic parameters by both glaucoma specialist and CO was examined in 45 healthy eyes and 55 glaucomatous eyes. By subgroup analysis, the healthy eyes were classified into 2 groups based on the degree of myopia, the optic disc of glaucomatous eye was classified into 4 types: focal ischemic, generalized enlargement, myopic, and senile sclerotic, and also classified into 3 stages (early, moderate, and severe) by Hodapp-Anderson-Parrish scale. (3) The correlation of parameters common to Nonmyd WX and HRT II was examined in 18 eyes of randomly selected patients. RESULTS: The results were as follows: (1) Mean coefficient of variation of 2.6% to 17.6%, with volume parameters considerably lower than the other parameters. (2) In both groups, a high or moderate degree of consistency was obtained (r=0.40 to 0.99; P=0.032 to <0.0001), except only the upper rim width in healthy subjects (r=0.28; P=0.137). In particular, good consistency was obtained in healthy eye with >-3 D of myopia, in glaucoma patients with the generalized type of optic disc and severe glaucomatous stage. (3) A strong correlation with HRT II was obtained only in the cup area and the disc area by both specialist and CO (r=0.75 to 0.90; P=0.0003 to <0.0001). CONCLUSIONS: Our studies indicated that most of the parameters were highly reproducible and consistent, and less difference was found between the results obtained by an experienced glaucoma specialist and a non-expert CO in patients with deep cupping and severe eye, but the examiner needs a clear understanding of the criteria for the rim and the cup.

[A survey of the dosage of zoledronic acid and investigation of the relationship between renal function and adverse events].

Zoledronic acid(ZA)dosage should be adjusted according to the risk it poses for renal impairment. The recommended dosage for patients with creatinine clearance(Ccr)of less than 60mL/min was established on the basis of an area under the curve analysis, but is doubted because it was calculated without performing a clinical trial. Creatinine secretion from the renal tubule affects Ccr; therefore, using Ccr as the basis for dosage adjustment may be inappropriate since this can cause an overestimation of the glomerular filtration rate(GFR). The Japanese Society of Nephrology recommends using the estimated GFR(eGFR)for evaluating renal function. Therefore, this study investigated the relationship between renal function before and adverse events(AEs)after ZA administration. The dosage of only 3 of the 47 patients with Ccr less than 60mL/min could be adjusted on the basis of Ccr. During ZA therapy(3 courses), the blood urea nitrogen level and occurrence of hypokalemia were higher in the non-adjusted group than in the adjusted group, but the total number of AEs was equivalent for both groups. For all the patients, Ccr and eGFR were used as parameters for investigating AEs; the total number of AEs was equivalent for patients with differing levels of renal function. Therefore, we suggest that AEs observed during ZA therapy did not depend on the renal function level before ZA administration.

Corneal biomechanical properties in normal-tension glaucoma.

PURPOSE: To investigate the intraocular pressure (IOP) and corneal biomechanical properties of normal and normal-tension glaucoma (NTG) eyes. METHODS: This study included 83 normal and 83 NTG eyes. We measured corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal resistance factor (CRF), corneal hysteresis (CH) and central corneal thickness (CCT) three times each for normal and NTG eyes using an Ocular Response Analyzer (ORA). RESULTS: No significant difference in CCT was seen between normal eyes (541.4 ± 26.8 µm) and NTG eyes (535.4 ± 24.9 µm; p = 0.16). IOPcc was significantly higher in NTG eyes (16.1 ± 2.6 mmHg) than in normal eyes (15.1 ± 2.9 mmHg; p = 0.01), while IOPg was significantly lower in NTG eyes (14.1 ± 2.7 mmHg) than in normal eyes (15.1 ± 3.0 mmHg; p = 0.04). CRF and CH were significantly lower in NTG eyes (CRF, 8.9 ± 1.5 mmHg; CH, 9.2 ± 1.3 mmHg) than in normal eyes (CRF, 10.6 ± 1.4 mmHg; CH, 10.8 ± 1.3 mmHg; p < 0.0001 each). CONCLUSION: IOPcc was significantly higher in NTG eyes than in normal eyes. The ORA may be useful for distinguishing between the IOPcc of NTG eyes with normal IOP and that of normal eyes. In addition, the ORA enables CRF and CH to be measured in vivo, and weakness of the lamina cribrosa may be clinically inferred from the fact that CRF and CH were reduced in NTG eyes in our study. Low CRF and CH may be clues to the pathology of NTG.

Intraocular pressure measured by dynamic contour tonometer and ocular response analyzer in normal tension glaucoma.

BACKGROUND: To investigate intraocular pressure (IOP) measurement values in normal tension glaucoma (NTG) eyes using two different types of tonometer that are supposed to be little affected by corneal biochemical properties. METHODS: This study included 30 normal eyes of 16 healthy subjects and 30 eyes of 16 patients with NTG. IOP was measured with a Goldmann applanation tonometer (GAT), a Pascal dynamic contour tonometer (DCT), and a Reichert ocular response analyzer (ORA) three times each for normal and NTG eyes. The main measures were GAT-IOP, DCT-IOP, corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), and central corneal thickness (CCT). RESULTS: In normal eyes, GAT-IOP was 13.2 +/- 1.4 mmHg; DCT-IOP, 13.0 +/- 1.6 mmHg; IOPcc, 13.6 +/- 2.0 mmHg; and IOPg, 12.4 +/- 2.0 mmHg. Multivariate analysis revealed no significant differences between the four measurements (p = 0.08). CCT was 524.6 +/- 27.3 microns. In NTG eyes, GAT-IOP was 13.1 +/- 1.3 mmHg; DCT-IOP, 13.7 +/- 1.3 mmHg; IOPcc, 15.2 +/- 2.0 mmHg; and IOPg, 12.7 +/- 2.0 mmHg. Multivariate analysis showed significant differences between the four measurements (p < 0.01). Sheffé's test showed that IOPcc was significantly higher than GAT-IOP, DCT-IOP, and IOPg (GAT-IOP vs IOPcc: p < 0.0001; DCT-IOP vs IOPcc: p = 0.01; IOPcc vs IOPg: p < 0.0001). CCT was 515.4 +/- 32.9 microns, with no significant difference between normal and NTG eyes (p = 0.15). CONCLUSIONS: We investigated the values of IOP in NTG eyes as measured by the DCT and ORA. IOPcc was significantly greater than GAT-IOP, DCT-IOP and IOPg in NTG eyes, suggesting the possibility that IOP values may be underestimated.

Effect of corneal astigmatism on intraocular pressure measurement using ocular response analyzer and Goldmann applanation tonometer.

PURPOSE: To assess the effect of corneal astigmatism on intraocular pressure (IOP) measurements using an Ocular Response Analyzer (ORA) and a Goldmann applanation tonometer (GAT). METHODS: We prospectively examined 59 normal eyes of 59 healthy volunteers (18 men, 41 women; age, mean +/- standard deviation, 40.5 +/- 14.2 years; age range, 19-68 years). We quantitatively assessed the values of corneal-compensated intraocular pressure (IOPcc) and Goldmann-correlated intraocular pressure (IOP(G)) using an ORA (Reichert Ophthalmic Instruments). We also measured the IOP using a GAT (GAT-IOP). The amount of corneal astigmatism was assessed with an autokeratometer. We carried out these measurements three times, and the mean value obtained was used for statistical analysis. RESULTS: The mean IOPcc, IOP(G), and GAT-IOP were 14.7 +/- 2.6, 14.0 +/- 2.8, and 14.2 +/- 1.7 mmHg respectively. The mean corneal astigmatism was 0.94 +/- 0.55 D. We found no significant correlation between IOPcc and corneal astigmatism (Pearson's correlation coefficient r = -0.04, p = 0.79), or between IOP(G) and corneal astigmatism (r = 0.09, p = 0.52). However, we found a weak, but significant, correlation between GAT-IOP and corneal astigmatism (Pearson's correlation coefficient r = 0.34, p = 0.009). CONCLUSIONS: Both IOPcc and IOP(G) measured with ORA were less affected by the amount of corneal astigmatism, and the GAT-IOP readings were significantly higher in eyes with greater corneal astigmatism, suggesting that IOPcc as well as IOP(G) may be helpful for accurate IOP measurements in eyes with some corneal astigmatism.

[Cancer pain management using opioid together with NSAIDs at Sakai Kinki University Hospital].

The basic cancer pain management at our hospitalis based on WHO Cancer Pain Treatment Method-Opioid together with NSAIDs. We investigated 48 patients who were administered an opioid as management of cancer pain for three (3) months from May to July in 2008. Consequently, we found that 20 out of the 48 patients (41.7%) used an opioid together with NSAIDs. Meanwhile, we also investigated constipation and digestive impediment as side effects caused from opioid and NSAIDs, respectively. Of the 20 patients, 12 patients (60%) used laxative for constipation, and 18 patients (90%) used a digestive ulcer treatment drug for digestive impediment. Ten (20.8%) of the 48 patients used all 4 drugs-opioid, NSAIDs, laxative and digestive ulcer treatment drugs. As a result, we decided to further examine cancer pain management at our hospital.

[Qualitative evaluation of employer requirements associated with occupational health and safety as good practice in small-scale enterprises].

The purpose of this study was to identify what motivates employers to promote good occupational health and safety practices in small-scale enterprises. Previous studies have shown that small-scale enterprises generally pay insufficient attention to issues of occupational health and safety. These findings were mainly derived from questionnaire based surveys. Nevertheless, some small-scale enterprises in which employers exercise good leadership do take a progressive approach to occupational health and safety. Although good practices can be identified in small-scale enterprises, it remains unclear what motivates employers in small-scale enterprises to actively implement occupational health and safety practices. We speculated that identifying employer motivations in promoting occupational health would help to spread good practices among small-scale enterprises. Using a qualitative approach based on the KJ methods, we interviewed ten employers who actively promote occupational health and safety in the workplace. The employers were asked to discuss their views of occupational health and safety in their own words. A semi-structured interview format was used, and transcripts were made of the interviews. Each transcript was independently coded by two or more researchers. These transcripts and codes were integrated and then the research group members discussed the heading titles and structural relationships between them according to the KJ method. Qualitative analysis revealed that all the employers expressed a strong interest in a "good company" and "good management". They emphasized four elements of "good management", namely "securing human resources", "trust of business partners", "social responsibility" and "employer's health condition itself", and considered that addressing occupational health and safety was essential to the achievement of these four elements. Consistent with previous findings, the results showed that implementation of occupational health and safety activities depended on "cost", "human resources", "time to perform", and "advisory organization". These results suggest that employer awareness of the relationship between good management and occupational health is essential to the implementation of occupational health and safety practices in small-scale enterprises.

Inequality in the health status of workers in small-scale enterprises.

BACKGROUND: Small-scale enterprises (SSEs) usually share poorer resources for promoting occupational health. AIM: To investigate inequality of health status among SSEs in Japan. METHOD: A cross-sectional, multiple-centred study was carried out using the periodical health check-up data for the fiscal year 2000 to compare the age-adjusted proportions of workers with hypertension (HT), hyperlipidaemia, impaired glucose tolerance (IGT) and obesity and of current smokers by size of enterprise, i.e. or=1000 employees in Japan. RESULTS: From five leading occupational health organizations, data were collected for 9833 enterprises with a total of 436 729 subjects, 302 383 males and 134 346 females. The proportions of workers in SSEs with or=50 male employees. The prevalence of smokers in SSEs with or=50 male employees. These proportions showed a significantly increasing tendency with decreasing size of male workforce. CONCLUSION: Despite the cross-sectional design and only adjusting age as a potential confounder, higher proportions of HT, IGT, obesity and smoking in male workers were found in SSEs compared to larger organizations.

Cellulose production from glucose using a glucose dehydrogenase gene (gdh)-deficient mutant of Gluconacetobacter xylinus and its use for bioconversion of sweet potato pulp.

A gene fragment encoding a putative pyrroloquinoline quinone glucose dehydrogenase (PQQ GDH) was cloned from a bacterial cellulose (BC)-forming acetic acid bacterium, Gluconacetobacter xylinus (=Acetobacter xylinum) strain BPR 2001, which was isolated as a high BC producer when using fructose as the carbon source. A GDH-deficient mutant of strain BPR 2001, namely GD-I, was then generated via gene disruption using the cloned gene fragment. Strain GD-I produced no gluconic acid but produced 4.1 g.l(-1) of BC aerobically in medium containing glucose as the carbon source. The ability of strain GD-I to convert glucose to BC was approximately 1.7-fold higher than that of the wild type. Strain GD-I was also able to produce 5.0 g.l(-1) of BC from a saccharified solution, which was derived from sweet potato pulp by enzymatic saccharification. Supplementation of ethanol during aerobic cultivation further increased the concentration of BC produced by strain GD-I to 7.0 g.l(-1). The rate of conversion from glucose to BC under these cultivation conditions was equivalent to that of strain BPR 2001 cultivated with fructose as the carbon source.

Intraocular pressure lowering effect of brinzolamide 1.0% as adjunctive therapy to latanoprost 0.005% in patients with open angle glaucoma or ocular hypertension: an uncontrolled, open-label study.

PURPOSE: A prospective study was conducted to evaluate the intraocular pressure (IOP) lowering effect of brinzolamide 1.0% ophthalmic suspension as an adjunctive therapy with latanoprost 0.005% ophthalmic solution in patients with open angle glaucoma or ocular hypertension. PATIENTS AND METHODS: Fourteen patients with open angle glaucoma (OAG) or ocular hypertension (OH) who had been using latanoprost 0.005% for more than 6 months were initiated on adjunctive brinzolamide therapy. The IOP values at 1 month, 2 months, and 3 months were compared with those measured immediately before adding brinzolamide to the regimen (baseline). The incidence of adverse events such as conjunctival hyperemia and corneal epithelial defect were also examined. RESULTS: The baseline IOP was 21.1 +/- 4.8 mmHg (mean +/- standard deviation). After 1 month, 2 months, and 3 months of therapy IOP was 16.9 +/- 4.5 mmHg, 16.6 +/- 4.0 mmHg, and 15.9 +/- 3.1 mmHg, respectively, showing significant reductions in IOP at all the measuring time-points during the study compared with the baseline value (p < 0.01). Conjunctival hyperemia developed in one patient after 1 month and in another after 2 months; however, both were mild, and therapy was continued. Corneal epithelium defect was observed in 3 patients. One of them had mild defect before brinzolamide was added to the regimen. Increase of eye discharge was seen in one patient. No serious side effects were otherwise observed. CONCLUSION: The addition of brinzolamide to a latanoprost 0.005% regimen may further lower intraocular pressure in patients with open angle glaucoma or ocular hypertension.

The effect of continuous low doses of X-ray irradiation on the rat lens.

PURPOSE: To clarify the morphological changes in the rat lens after irradiation with continuous low doses of x-ray at different intervals. METHODS: Male Wistar rats at the age of 8 weeks were irradiated with three doses of 2 Gy at intervals of either 1 week or 1 day. Over the period from the first week to the eighth week after irradiation, the eyeballs of the rats were enucleated progressively and changes in the lenses were examined morphologically. A comparison was made with specimens from control rats at each time of enucleation. RESULTS: (1) Three doses of weekly irradiation: 1 week later, the lens epithelium and fibers at the equator showed mild swelling. Bow configuration was slightly disturbed. Eight weeks later, swelling and uneven height of epithelial cells in the equatorial area, irregular bow configuration, swelling of cortical fibers and epithelial loss and deformed nuclei at the central epithelium were observed. (2) Three doses of daily irradiation: 1 week later, mild changes in the lens such as uneven height of epithelial cells, irregular bow structures, and swelling of cortical fibers were observed. Eight weeks later, irregular bow configuration, posterior dislocation of nuclei, severe epithelial loss and marked swelling of cortical fibers were observed at the equatorial area. Epithelial loss and deformed nuclei of the epithelium were observed in the central area. CONCLUSION: The lens was damaged by continuous irradiation even though the dose was low. The damage to the lens caused by daily irradiation was more severe than that by weekly irradiation. The main symptoms were degeneration and loss of epithelial cells and swelling of cortical fibers.

Repair and reconstruction of the mouse lens after perforating injury.

PURPOSE: To investigate the process of repair in the epithelial cells and the reconstruction in lens fibers of a mouse lens that has developed opacity because of a large-scale perforating injury. METHODS: Lenses of 4-week-old mice were perforated with a needle through the cornea to induce the development of traumatic cataracts. Over the period from the first day to the fifth month after injury, eyeballs were extracted progressively from the mice and changes in the epithelial cells of these lenses were observed morphologically as well as histochemically. RESULTS: Following the injury, the epithelial cells of the lenses extended toward the center of the injury, while undergoing repeated proliferation and stratification. After a month, the epithelial cells completely covered the entire injury. Later, a basal lamina and collagen fibers developed among the epithelial cells that had proliferated, the intracellular space enlarged, but the number of cells decreased. Histochemically, a strong actin-positive finding was observed in the epithelial cells in the growth phase. On the other hand, an investigation by means of the TUNEL method revealed epithelial cell death and a decrease in cell number. Maximal cell death was observed in the second month. During this period, lens fibers regenerated, and the clear areas of the cortex increased. CONCLUSION: Although the lenses exhibited opacity over a large area, the epithelial cells eventually fully covered the injured area. Once the repair was completed, the number of epithelial cells decreased. At the same time, the lenses were found to have developed increased clarity, leading to reconstruction. The epithelial recovery and the residual posterior suture may be the key to the reconstruction of the lenses.

Morphological analysis of iodoacetic acid-induced cataract in the rat.

PURPOSE: To clarify the mechanism underlying the development of cataract in the rat lens after intraperitoneal administration of iodoacetic acid (IAA). METHODS: (1) The 2% IAA dissolved in saline solution was injected at a dose of 40 mg/kg body weight into the rat peritoneal cavity. The retina and lens were intermittently extirpated and were examined by light and electron microscopy. (2) Two kinds of tracer, Evans blue (EB) and horseradish peroxidase (HRP), were injected into the tail veins and anterior chamber, and were observed with dissecting and electron microscopes. RESULTS: (1) Four weeks after administration, a part of the lens epithelium at the lateral side of the lens was degenerated, and the lens nucleus developed faint turbidity after 8 weeks. After 16 weeks, the nuclear turbidity could not be observed because mild cortical opacity was developing. The epithelial degeneration recovered from around 12 weeks, and instead of spherical nuclei, elliptical nuclei appeared. (2) The EB dye injected into the tail vein significantly stained the ciliary body, where the anterior and posterior ciliary arteries anastomosed. EB injected from the lateral side of the lens was seen to move towards the lens nucleus. Electron microscopically, the epithelial degeneration of the ciliary body was observed. The incorporated HRP substance was found in the cytoplasm of the nonpigmented cells of the ciliary epithelium at an early stage after IAA administration. CONCLUSION: IAA injected intravenously first developed epithelial degeneration at the lateral side of the lens. This change induced swelling of the lens fibers in the lens nucleus. Recovered epithelial cells had a transformed nucleus, and in turn the cortical cataract was induced by a differentiation disorder of the lens fibers. These results indicate that the breakdown of the blood-aqueous barrier in the nonpigmented epithelium of the ciliary body is a trigger to cause the cataract. The IAA-induced cataract may be useful as an animal model of human age-related cataract.