[Comparison between binocular and monocular reading ability and its relation with central visual field sensitivity in glaucoma patients].

PURPOSE: To evaluate binocular and monocular reading ability in glaucoma patients with good visual acuity and to examine its relationship with central visual field sensitivity. METHODS: Glaucoma patients(35 individuals, mean +/- SD : 51.8 +/- 12.9 years) with a decimal visual acuity in each eye of >or=1.0, reading ability was tested both binocular and monocular using Japanese version of Minnesota Reading Acuity Chart (MNREAD-J). Reading ability parameters were calculated for maximum reading speed (MRS), critical print size (CPS), and reading acuity (RA). The results were compared with those of people with normal vision; differences in reading ability under varied testing conditions and correlations between visual field sensitivity and each parameter were examined. RESULTS: Under binocular reading conditions, MRS, CPS, and RA were decreased significantly in glaucoma patients compared with normal controls (p = 0.00044, p = 0.00004, p = 0.00028, respectively). Under monocular reading conditions, glaucoma patient MRS and RA were decreased significantly in comparison with normal controls (p=0.00155, p= 0.00142). In glaucoma patients undergoing binocular reading tests, MRS was greatest in the paracentral bottom right quadrant of the worse eye (r = 0.41709, p= 0.04447). The CPS decreased in proportion to the extent of the difference between both eyes in the mean deviation value and the visual field sensitivity of the paracentral bottom left (r = 0.40693, p = 0.02699 and r=0.41478, p=0.02384). RA improved in proportion to the extent of the difference between both eyes in the visual field sensitivity of the upper left (r = 0.33557, p=0.04799). CONCLUSION: In glaucoma patients, binocular reading is not necessarily useful in cases of visual field sensitivity differences.

Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report.

BACKGROUND: Fibrin pupillary-block glaucoma is a rare complication after cataract surgery. The treatment for this condition is still controversial, since Nd:YAG laser fibrin membranotomy tends to reocclude and laser peripheral iridotomy entails the risk of damaging the corneal endothelium in the presence of corneal edema associated with elevated intraocular pressure. CASE PRESENTATION: A 62-year-old man with diabetes mellitus developed acute elevation of intraocular pressure with a shallow anterior chamber five days after uneventful cataract surgery. Initially, slit lamp examination provided only limited information due to severe corneal edema. After resolution of corneal edema with systemic glaucoma therapy, a complete fibrin membrane was observed across the pupil by slit lamp examination. Anterior segment optic coherence tomography clearly revealed a thin fibrin membrane covering the entire pupillary space, a shallow anterior chamber, and a deep posterior chamber. The intraocular lens was not observed by anterior segment optic coherence tomography. In contrast, ultrasound biomicroscopy, which has superior penetration depth, was able to visualize the intraocular lens deep in the posterior chamber. Injection of tissue plasminogen activator into the anterior chamber resulted in complete fibrinolysis and released the pupillary block. CONCLUSION: This case suggests that ocular anterior segment imaging modalities, especially ultrasound biomicroscopy, serve as powerful diagnostic tools to identify mechanisms of acute angle closure glaucoma, which is often accompanied by poor intraocular visibility. This is the first reported case of fibrin pupillary-block glaucoma after cataract surgery successfully treated with intracameral tissue plasminogen activator.

A case of bilateral diffuse uveal melanocytic proliferation with secondary angle closure caused by ciliary body thickening.

Purpose: To describe a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) with secondary angle closure caused by ciliary body thickening accompanied by intraocular pressure (IOP) elevation after mydriasis. Observations: A 55-year-old woman with a history of ovarian cancer had blurred vision in both eyes. Fundus examination revealed multiple patchy lesions in both eyes and a nevus-like elevated lesion in the right eye. Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) demonstrated angle closure resulting from ciliary body thickening. After mydriasis, the IOP was elevated in both eyes. Instillation of a miotic drug successfully reversed the IOP to normal levels. Conclusions and Importance: BDUMP caused secondary angle closure in both eyes, presumably due to thickening of the entire ciliary body. AS-OCT and UBM were advantageous for analyzing the morphology of the anterior eye segment in BDUMP. Clinicians should be aware of the possibility of angle closure during the management of patients with BDUMP.

Dual neuroprotective pathways of a pro-electrophilic compound via HSF-1-activated heat-shock proteins and Nrf2-activated phase 2 antioxidant response enzymes.

Activation of the Keap1/nuclear factor erythroid 2-related factor 2 (Nrf2) pathway and consequent induction of phase 2 antioxidant enzymes is known to afford neuroprotection. Here, we present a series of novel electrophilic compounds that protect neurons via this pathway. Natural products, such as carnosic acid (CA), are present in high amounts in the herbs rosemary and sage as ortho-dihydroquinones, and have attracted particular attention because they are converted by oxidative stress to their active form (ortho-quinone species) that stimulate the Keap1/Nrf2 transcriptional pathway. Once activated, this pathway leads to the production of a series of antioxidant phase 2 enzymes. Thus, such dihydroquinones function as redox-activated 'pro-electrophiles'. Here, we explored the concept that related para-dihydroquinones represent even more effective bioactive pro-electrophiles for the induction of phase 2 enzymes without producing toxic side effects. We synthesized several novel para-hydroquinone-type pro-electrophilic compounds (designated D1 and D2) to analyze their protective mechanism. DNA microarray, PCR, and western blot analyses showed that compound D1 induced expression of heat-shock proteins (HSPs), including HSP70, HSP27, and DnaJ, in addition to phase 2 enzymes such as hemeoxygenase-1 (HO-1), NADP(H) quinine-oxidoreductase1, and the Na(+)-independent cystine/glutamate exchanger (xCT). Treatment with D1 resulted in activation of Nrf2 and heat-shock transcription factor-1 (HSF-1) transcriptional elements, thus inducing phase 2 enzymes and HSPs, respectively. In this manner, D1 protected neuronal cells from both oxidative and endoplasmic reticulum (ER)-related stress. Additionally, D1 suppressed induction of 78 kDa glucose-regulated protein (GRP78), an ER chaperone protein, and inhibited hyperoxidation of peroxiredoxin 2 (PRX2), a molecule that is in its reduced state can protect from oxidative stress. These results suggest that D1 is a novel pro-electrophilic compound that activates both the Nrf2 and HSF-1 pathways, and may thus offer protection from oxidative and ER stress.

Estimation of the central 10-degree visual field using en-face images obtained by optical coherence tomography.

PURPOSE: To estimate the central 10-degree visual field of glaucoma patients using en-face images obtained by optical coherence tomography (OCT), and to examine its usefulness. PATIENTS AND METHODS: Thirty-eight eyes of 38 patients with primary open angle glaucoma were examined. En-face images were obtained by swept-source OCT (SS-OCT). Nerve fiber bundles (NFBs) on en-face images at points corresponding to Humphrey Field Analyzer (HFA) 10-2 locations were identified with retinal ganglion cell displacement. Estimated visual fields were created based on the presence/absence of NFBs and compared to actual HFA10-2 data. κ coefficients were calculated between probability plots of visual fields and NFBs in en-face images. RESULTS: Actual HFA10-2 data and estimated visual fields based on en-face images were well matched: when the test points of <5%, <2%, and <1% of the probability plot in total deviation (TD) and pattern deviation (PD) of HFA were defined as points with visual field defects, the κ coefficients were 0.58, 0.64, and 0.66 in TD, respectively, and 0.68, 0.69, and 0.67 in PD. In eyes with spherical equivalent ≥ -6 diopters, κ coefficients for <5%, <2%, and <1% were 0.58, 0.62, and 0.63 in TD and 0.66, 0.67, and 0.65 in PD, whereas for the myopic group with spherical equivalent < -6 diopters, the values were 0.58, 0.69, and 0.71 in TD and 0.72, 0.71, and 0.71 in PD, respectively. There was no statistically significant difference in κ coefficients between highly myopic eyes and eyes that were not highly myopic. CONCLUSIONS: NFB defects in en-face images were correlated with HFA10-2 data. Using en-face images obtained by OCT, the central 10-degree visual field was estimated, and a high degree of concordance with actual HFA10-2 data was obtained. This method may be useful for detecting functional abnormalities based on structural abnormalities.

[A case of disseminated BCG infection found during treatment of an infant with Crohn's disease].

Bloody stools, diarrhea and perianal abscesses were observed from the age of two months infant. The boy received a BCG vaccination at the age of four months. The patient was diagnosed as having Crohn's disease at the age of six months by intestinal endoscopy. Based on the diagnosis, he was treated with nutrition therapy, salazosulfapyridine, and prednisolone. Fever of unknown origin occurred two months after he had taken azathioprine at the age of two years and two months. Mycobacterium tuberculosis was detected from a gastric aspirate, and he was diagnosed as having disseminated BCG infection by means of the multiplex PCR method. Chest CT showed miliary pulmonary nodules in both lungs on admission. Physical examination revealed enlarged lymphnodes, which were palpable around the neck and groin, and hepatomegaly. Laboratory data were within normal ranges except a slightly increased peripheral white blood cell and serum CRP level. He was treated with rifampicin (15 mg/kg/day), isoniazid (15 mg/kg/day) for 12 months, and streptomycin (25 mg/kg/day) for two months. He became afebrile a week after starting the treatment, and the miliary pulmonary nodules in both lungs had disappeared by 5 months after starting the treatment. An abnormality of the NEMO gene, which is the gene responsible for ectodermal dysplasia and immunodeficiency, was identified at the age of three years. It is assumed that an abnormality of the NEMO gene caused a latent BCG infection over a period of one year and ten months, and immunosuppressive medicine (azathioprine) induced a disseminated BCG infection. This case report supports that anti-tuberculosis medicine should be given to prevent disseminated BCG infection if an infant who receive immunosuppressive therapy is found to have an immune deficiency characterized by a mycobacterium infection after BCG vaccination.

[Surgical site infection by bacillus Calmette-Guerin (BCG) after radical cystectomy, occurring after intravesical bcg therapy: a case report].

A 51-year-old man received 2 courses of intravesical bacillus Calmette-Guerin (BCG) therapy for carcinoma in situ of the bladder. Two years after the therapy, he underwent left radical nephroureterectomy, cystectomy, urethrectomy and construction of an ileal conduit because of left renal pelvic cancer and severe atrophic bladder. The histopathological diagnosis was carcinoma in situ of the left pelvis and ureter, and epithelioid cell granuloma of left kidney, prostate and bladder. After the operation, he developed extensive surgical site infection (SSI) by BCG, the diagnosis of which was delayed. He recovered from the SSI soon after anti-tuberculosis chemotherapy was begun. We discuss the requirements for more prompt diagnosis of SSI by BCG by analysis of this case.

Comparison of fornix- and limbus-based conjunctival flaps in mitomycin C trabeculectomy with laser suture lysis in Japanese glaucoma patients.

PURPOSE: To analyze the results of mitomycin C (MMC) trabeculectomy and laser suture lysis using either fornix-based (FB) or limbus-based (LB) conjunctival flaps. METHODS: Eighty-two Japanese glaucoma patients were treated by MMC trabeculectomy, with 38 eyes receiving an FB conjunctival flap and 44 eyes receiving an LB conjunctival flap. Postoperative intraocular pressure (IOP), the probability of success, and complications were compared between the FB and LB groups. RESULTS: The IOP of the FB group decreased from 21.6+/-7.90 mmHg to 9.75+/-3.23 mmHg at 12 months postoperation, and the IOP of the LB group decreased from 21.3+/-6.77 mmHg to 9.30+/-3.16 mmHg. The postoperative IOPs were similar in the two groups at all postoperative time points. A life-table analysis (Kaplan-Meier method) showed that the survival rate was similar in the two groups but tended to be lower in the early postoperative period in the FB group. Complications were similar also, with the exception of increased leakage in the FB group. CONCLUSIONS: MMC trabeculectomy results were similar between FB and LB conjunctival flaps, in agreement with previous reports. However, increased care may be warranted when an FB flap is used in MMC trabeculectomy.

The outcome of mitomycin C trabeculectomy and laser suture lysis depends on postoperative management.

PURPOSE: To verify that postoperative management affects the outcome of mitomycin C (MMC) trabeculectomy and suture lysis. METHODS: A total of 108 eyes in 108 Japanese patients were treated with MMC trabeculectomy. They were divided into two groups based on when the operation was performed: group A, 57 eyes in 1998, and group B, 51 eyes in 2001. The results, including postoperative intraocular pressure (IOP), complications, and postoperative management, were compared between groups. In addition, they were evaluated by a Kaplan-Meier life-table analysis. RESULTS: Postoperative IOP was lower and the probability of success by life-table analysis was higher in group B than in group A. Postoperative management, including laser suture lysis and subconjunctival injection of 5-fluorouracil, was started significantly earlier in group B than in group A patients. Although more postoperative complications occurred in group B, none were severe and all were adequately managed. CONCLUSIONS: Starting postoperative management earlier, particularly laser suture lysis, may be necessary to achieve lower and longer IOP control in MMC trabeculectomy.

[Optic nerve atrophy after vitrectomy for diabetic retinopathy: its systemic and local risk factors].

PURPOSE: To evaluate the incidence and risk factors of optic nerve atrophy after vitrectomy for diabetic retinopathy. SUBJECTS AND METHODS: Clinical charts of 48 eyes of 40 patients who underwent vitrectomy for diabetic retinopathy were retrospectively reviewed. The relationship between postoperative optic nerve atrophy and patients' physical condition was statistically analyzed. RESULT: Postoperative optic nerve atrophy, distinct from glaucomatous optic nerve atrophy, occurred in 5 eyes (10.4%). Its incidence was correlated with higher plasma creatinine concentration (p=0.001), proliferative diabetic retinopathy (p= 0.046), and retinal white vessel formation (p= 0.007). Maintenance of the best postoperative visual acuity was difficult in the patients with optic nerve atrophy. CONCLUSION: Patients with proliferative diabetic retinopathy accompanied by renal dysfunction were at high risk of optic nerve atrophy after vitrectomy.

Rate of progression of total, upper, and lower visual field defects in patients with open-angle glaucoma and high myopia.

PURPOSE: We evaluated the rate of progression of total, upper, and lower visual field defects in patients with treated primary open-angle glaucoma (POAG) with high myopia (HM). SUBJECTS AND METHODS: Seventy eyes of 70 POAG patients with HM [≤-8 diopters (D)] were examined. The mean deviation (MD) slope and the upper and lower total deviation (upper TD, lower TD) slopes of the Humphrey Field Analyzer were calculated in patients with high-tension glaucoma (HTG) (>21 mmHg) versus normal-tension glaucoma (NTG) (≤21 mmHg). The mean age of all the patients (29 eyes with HTG and 41 eyes with NTG) was 48.5 ± 9.6 years. The MD slope, and upper and lower TD slopes of the HM group were compared to those of the non-HM group (NHM) (>-8 D) selected from 544 eyes in 325 age-matched POAG patients. In all, 70 eyes with HM and NHM were examined. RESULTS: The mean MD slope was -0.33 ± 0.33 dB/year in the HM, and -0.38 ± 0.49 dB/year in the NHM. There were no statistical differences between the HM and NHM (p = 0.9565). In the comparison of HTG versus NTG patients in both groups, the MD slope, and upper and lower TD slopes were similar. CONCLUSIONS: The rate of progression of total, upper, and lower visual field defects was similar among patients with HM and NHM. Although HM is a risk factor for the onset of glaucoma, HM may not be a risk factor for progression of visual field defects as assessed by the progression rate under treatment.

Involvement of brain-derived neurotrophic factor in early retinal neuropathy of streptozotocin-induced diabetes in rats: therapeutic potential of brain-derived neurotrophic factor for dopaminergic amacrine cells.

Although neurotrophins have been assessed as candidate therapeutic agents for neural complications of diabetes, their involvement in diabetic retinopathy has not been fully characterized. We found that the protein and mRNA levels of brain-derived neurotrophic factor (BDNF) in streptozotocin-induced diabetic rat retinas were reduced to 49% (P < 0.005) and 74% (P < 0.05), respectively, of those of normal control animals. In addition, dopaminergic amacrine cells appeared to be degenerating in the diabetic rat retinas, as revealed by tyrosine hydroxylase (TH) immunoreactivity. Overall TH protein levels in the retina were decreased to one-half that of controls (P < 0.01), reflecting reductions in the density of dopaminergic amacrine cells and the intensity of TH immunoreactivity within them. To confirm the neuropathological implications of BDNF reduction, we administered BDNF protein into the vitreous cavities of diabetic rats. Intraocular administration of BDNF rescued dopaminergic amacrine cells from neurodegeneration and counteracted the downregulation of TH expression, demonstrating its therapeutic potential. These findings suggest that the early retinal neuropathy of diabetes involves the reduced expression of BDNF and can be ameliorated by an exogenous supply of this neurotrophin.

BDNF is upregulated by postnatal development and visual experience: quantitative and immunohistochemical analyses of BDNF in the rat retina.

PURPOSE: This study sought to elucidate changes in the levels and distribution of brain-derived neurotrophic factor (BDNF) in the retina throughout aging and depending on visual experience. METHODS: Protein and mRNA levels of BDNF were quantified by enzyme-linked immunosorbent assay (ELISA) and semiquantitative reverse transcription-polymerase chain reaction (RT-PCR), respectively. Levels were assayed in the retinas of rats on postnatal day (P)2, P7, and P14 (approximate time of eye opening) and at 1 month (M), 3M, 8M, and 18M of age. Changes in BDNF expression and localization in the retina were assessed by immunohistochemistry. The effect of monocular deprivation during infancy on retinal BDNF expression was also examined, by ELISA and immunohistochemistry. RESULTS: Both protein and mRNA levels of BDNF in the rat retina increased after P14. Immunohistochemical analyses revealed that the increase in BDNF protein levels occurred in retinal ganglion cells (RGCs) between P14 and 1M. BDNF immunoreactivity in Müller cell processes was observed in the inner nuclear layer at 1M, but not at P14. The levels of BDNF protein in the retinas of visually deprived eyes were lower than those of control eyes, as quantified by ELISA. Immunohistochemistry showed that BDNF immunoreactivity in RGCs was diminished by visual deprivation, whereas Müller cells were unaffected. CONCLUSIONS: These observations indicate that BDNF expression in RGCs is upregulated in an activity-dependent manner, whereas that in Müller cells is regulated only by development.

Establishment of a novel enzyme-linked immunosorbent assay for Thy-1; quantitative assessment of neuronal degeneration.

In the central nervous system (CNS), Thy-1 is expressed predominantly on neurons and serves as a specific marker for neurons. In the present study, we established a two-site enzyme-linked immunosorbent assay (ELISA) that detects trace amounts of Thy-1 protein. Recombinant Thy-1 protein expressed in Escherichia coli was purified and used as a standard. Of the regions of the nervous system examined, the highest Thy-1 concentration was found in the striatum followed by the hippocampus, neocortex, cerebellum, spinal cord, retina and optic nerve. We found that injection of a neurotoxin, N-methyl-D-aspartate, into the vitreous cavity reduced the Thy-1 level in the retina. Thy-1 ELISA will be useful for quantitative assessment of neurodegeneration in the CNS.

Quantitative analyses of mRNA and protein levels of neurotrophin-3 in the rat retina during postnatal development and aging.

PURPOSE: In this study, we sought to elucidate changes in the levels of neurotrophin-3 (NT-3) in the rat retina throughout postnatal development and aging. METHODS: We demonstrated NT-3 localization in the retina by immunohistochemistry. Protein and mRNA levels of NT-3 were quantified by enzyme-linked immunosorbant assay and semiquantitative reverse transcriptase-polymerase chain reaction, respectively. NT-3 protein levels were assayed in the various regions of the central nervous system. Age-associated changes in protein and mRNA levels of NT-3 in the retinas were assessed. RESULTS: NT-3-immunoreactivity localized in the ganglion cell layer, inner nuclear layer, and outer nuclear layer. NT-3 content in the retina was relatively high in the examined regions of the central nervous system. Retinal NT-3 protein levels decreased after eye opening, whereas mRNA levels were constant. Both mRNA and protein levels of NT-3 in the retinas of aged animals remained constant. CONCLUSIONS: Our observations suggest that NT-3 regulation in the retina is independent of increasing visual stimuli after eye opening. Stable expression of NT-3 in the adult retina suggests a possible role in the maintenance of the retinal environment throughout later life.

Evaluation of the new digital goldmann applanation tonometer for measuring intraocular pressure.

Purpose. To compare a new digital Goldmann applanation tonometer (dGAT) that measures intraocular pressure (IOP) in 0.1 mmHg increments to a standard Goldmann applanation tonometer (sGAT). Methods. This study included 116 eyes of 60 subjects. A single examiner first measured IOP in triplicate using either sGAT or dGAT, which was randomly chosen. After a 5-minute interval, the next set of three consecutive IOP was measured using the other GAT. Results. The mean IOP measured with sGAT was 16.27 ± 6.68 mmHg and 16.35 ± 6.69 mmHg with dGAT. Pearson's correlation coefficient was 0.998 (P < 0.01). The subjects were divided into three groups based on the mean IOP: IOP < 14 mmHg, 14-20 mmHg, or >20 mmHg. The Pearson's correlation coefficient within each group was 0.935, 0.972, and 0.997 (P < 0.01), respectively. The difference within the three consecutive IOP measurements (maximum-minimum) for dGAT (0.72 ± 0.34 mmHg) was significantly smaller than those with sGAT (0.92 ± 0.42 mmHg, P < 0.01). Even in patients with equal IOP (zero left-right difference) with sGAT (n = 30), dGAT detected IOP differences between the left and right eyes (0.47 ± 0.31 mmHg). Conclusion. Compared to sGAT, dGAT measurements are highly reproducible and less variable.

Secondary glaucoma associated with bilateral complete ring cysts of the ciliary body.

PURPOSE: To report a case of acute glaucoma due to complete ring cyst of the ciliary body. PATIENTS AND METHODS: A 33-year-old woman experienced blurred vision in her left eye. Intraocular pressure of the left eye was elevated accompanied with a very shallow anterior chamber. Anterior segment-optical coherence tomography and ultrasound biomicroscopy detected ring-shaped ciliary masses in the both eyes. Myopic change and contact between the ciliary mass and lens in the left eye suggested the presence of aqueous misdirection resulting in forward displacement of the lens-iris diaphragm. Because elevated intraocular pressure was refractory to conservative management, the left eye underwent clear lens aspiration and implantation of intraocular lens. RESULTS: Although the anterior chamber became deep in the left eye initially after lens extraction in conjunction with core vitrectomy, possible aqueous misdirection recurred. Second vitrectomy in the left eye together with posterior and anterior capsulotomies, to establish humoral communication between the anterior and posterior chambers, deepened the anterior chamber and lowered the intraocular pressure. The anterior chamber in the fellow right eye remained deep a year after the episode. CONCLUSIONS: This is the first reported case of bilateral ring cysts of the ciliary body. The manifestation caused secondary glaucoma, which was resolved by lensectomy and vitrectomy.

Reading performance in patients with glaucoma evaluated using the MNREAD charts.

BACKGROUND: Reading performance in glaucoma patients has yet to be studied. We hypothesized that glaucomatous visual field loss affects reading performance even in patients with good acuity and evaluated their reading performance quantitatively. METHODS: A cross-sectional, comparative, non-interventional study. Forty-nine patients with early-moderate glaucomatous visual field loss OU with visual acuity better than 1.0 in the better and 0.7 in the worse eye. Reading performance in glaucoma patients was examined by the Japanese version of the Minnesota Reading Acuity Chart (MNREAD) were compared to that of age-matched normal subjects (n = 30). RESULTS: The study subjects consisted of the 21 men and 28 women. The mean age was 53.3 ± 12.6 years. Diagnosis included primary open-angle glaucoma (n = 22), normal-tension glaucoma (n = 22), developmental glaucoma (n = 4) and exfoliation glaucoma (n = 1). Reading parameters of glaucoma patients examined by MNREAD were: maximum reading speed (MRS), 329.9 ± 55.4 characters per min.; critical print size (CPS), 0.24 ± 0.14 logMAR; reading acuity (RA), 0.02 ± 0.12 log MAR, significantly lower than those of normal subjects (MRS 363.0 ± 42.9, CPS 0.09 ± 0.13 logMAR, RA -0.13 ± 0.10 logMAR, P < 0.01 for three parameters by unpaired t test). CPS in glaucoma subjects was negatively correlated with mean deviation of Humphrey Field Analyzer 10-2 and 30-2 programs in the better eye (r = -0.402, P < 0.005; r = -0.304, P < 0.05; respectively, by linear regression analysis). CONCLUSIONS: The reading performance deteriorated even in glaucoma patients with good acuity.

Modified ab externo method for introducing 2 polypropylene loops for scleral suture fixation of intraocular lenses.

We describe a method that enables the introduction of 2 suture loops for scleral fixation of an intraocular lens (IOL) by a single ab externo procedure. A long needle carrying a polypropylene suture loop is inserted through the scleral fixation site and docked with a hollow needle inserted through the opposite fixation site. The hollow needle pulls the suture needle out, but the suture loop end is left external. Another polypropylene suture loop is placed through the first loop. As the first (leading) suture is pulled, the second (trailing) suture is drawn into the eye. The suture loops are retrieved through the main incision. The IOL haptics are secured with a polypropylene loop by cow hitches. After the IOL is placed in the eye, the sutures are fixated to the sclera. This technique enhances efficiency and control during the introduction of suture loops for scleral fixation of IOLs.

Eyelid and eyelash changes due to prostaglandin analog therapy in unilateral treatment cases.

PURPOSE: To investigate the incidence of adverse effects on eyelids and eyelashes related to treatment with prostaglandin analogs (PGAs) in patients who apply the medication in only one eye. METHODS: A clinical examination of 39 glaucoma patients treated for over 3 months continuously in one eye with one of four PGAs. Face photographs were used to judge adverse effects of PGA treatment on eyelids and eyelashes of the treated eyes by comparing them with the eyelids and eyelashes of the contralateral eyes. Each of three examiners then calculated scores for the eyelids and eyelashes by counting how many adverse effects were present (out of five possible effects for eyelids and two for eyelashes). The findings for the eyelids or eyelashes were considered "positive" if two or more examiners judged that at least one adverse effect was present. RESULTS: Thirty-five (89.7 %) patients were judged to have positive eyelid findings and 37 (94.9 %) patients were judged to have positive eyelash findings. There was a significant correlation between the period of PGA administration and eyelid score (P = 0.0218). CONCLUSION: There was a high incidence of adverse effects caused by PGAs in the eyelids and eyelashes. The frequency of adverse effects of the eyelid seemed to increase as the use of PGAs was prolonged. The cosmetic complications caused by PGA use should be considered, and patients should be informed of them in advance.