Intraoperative Measurement of Crystalline Lens Diameter in Living Humans

Background: There are no reports on accurate measurement of lens equatorial diameter of the living human eye. This study aimed to measure lens equatorial diameter with a special measurement device during cataract surgery and examine the relationships with preoperative parameters. Methods: From April 7 to December 1, 2019, the equatorial diameters of 24 eyes from 24 patients who underwent cataract surgery at Kushimoto Arita Hospital were measured with a loop shaped measurement device during cataract surgery. Correlations between the value of the diameters and various preoperative parameters measured by CASIA2® were evaluated. Results: The average value of the measured equatorial diameter using the device was 10.5 ± 0.4 mm and the value estimated by circular approximation using the CASIA2® was 10.1 ± 0.7 mm. A significant difference was observed between these two groups (P = 0.016), and only a weak correlation was observed (γ = 0.31). A positive correlation was observed between equatorial diameter and anterior chamber depth (ACD) or anterior chamber width (ACW) (γ = 0.57 and 0.47, respectively). No significant correlation was found between other parameters and the value measured by the device. Conclusion: Our method is a completely new approach to measuring the living human lens equatorial region of the eye. No complications were observed in any of the cases. One new finding was the values of the lens equatorial diameters are actually longer than those reported previously. The results suggest that the values of the equatorial diameter measured by the loop device and those estimated by CASIA2® measurement were closer than those reported previously by other methods, although both were slightly different. We conclude that it is still difficult to estimate the equatorial diameter of the living human lens using preoperative examination parameters. This research will greatly contribute to the development of accommodative intraocular lenses in the future

Candida albicans keratitis modified by steroid application

The paper reports on Candida albicans ocular infection modified by steroid eye drops. A 74-year-old male complained of conjunctival injection and pain in his right eye three months after pterygium and cataract surgery. After treatment with antibiotics and steroid eye drops for three days, he was referred to our hospital. Clear localized corneal endothelial plaque with injection of ciliary body was observed. No erosion of the corneal epithelium, or infiltration of stromal edema was observed, suggesting that the pathological organism derived from the intracameral region. Because ocular infection was suspected, steroid eye drops were stopped, which led immediately to typical infectious keratitis in the pathological region, with epithelial erosion, fluffy abscess, stromal infiltration, and edema. For diagnostic purposes, the plaque was surgically removed with forceps and the anterior chamber was irrigated with antibiotics. The smear and culture examination from the plaque revealed C. albicans surrounded by neutrophils. However, aqueous fluid and fibrous tissue after gonio procedure contained no mycotic organisms. Topical fluconazole, micafungin, and pimaricin with oral itraconazole (150 mg/day) were effective. Special attention is needed when prescribing steroid eye drops to treat corneal disease especially postoperatively. Diagnosing infectious keratitis is sometimes difficult because of modification by some factors, such as postoperative conditions, scarring, and drug-induced masking. Here, we report on mycotic keratitis modified by postoperative steroid administration

First multicenter survey on infectious keratitis following excimer laser surgery in Japan

AbstractPurposeTo report the first multicenter survey in Japan on infectious keratitis after excimer laser surgery.MethodsThe laser in situ keratomileusis (LASIK) Safety Network (LSN) Committee sent questionnaires to 28 LSN member hospitals to assess the total number of laser corneal surgeries, the number of infection cases (including suspicious cases), and the postoperative follow-up rate during a 3-year period.ResultsResponses were obtained from 27 (96.4%) of 28 institutions. One phototherapeutic keratectomy infection case was reported among 22,415 excimer laser surgery cases, which equates to an incidence rate of 0.004%. The follow-up rate was 94.14% (67.2–100%), 80.11% (41.0–96.1%), 57.95% (11.5–93.0%), and 46.64% (4.7–93.0%) at 1 month, 3 months, 6 months, and 12 months of follow-up, respectively.ConclusionInfectious keratitis is a potentially devastating complication of excimer laser surgery. We did not see any infectious keratitis for refractive cases. This first multicenter survey in Japan on infectious keratitis provides important information on the safety of this therapy

CMV infection of trabecular meshwork cells

Purpose: Human cytomegalovirus (HCMV) infections can cause endotheliitis which is associated with an elevation of the intraocular pressure (IOP). However, the mechanism of the IOP elevation has not been determined. The purpose of this study was to determine whether HCMV strains which are capable of infecting corneal endothelial cells can also replicate, induce anti-viral responses, and can reorganize the actin cytoskeleton in trabecular meshwork cells. Study design: Experimental study design Methods: Cultured primary human trabecular meshwork cells (HTMCs) were infected with the Towne or TB40/E strains of HCMV. TB40/E is trophic for vascular endothelial and corneal endothelial cells. Real-time PCR, western blot, and fluorescent immunostaining have been used to determine whether HCMV-infected HTMCs will support the expression of viral mRNA and protein, allow viral replication, and elicit anti-viral host responses. We also determined whether lytic replication was present after an HCMV infection. Results: HCMV infection led to the expression of viral mRNA and proteins of IE1, glycoprotein B(gB), and pp65. TB40/E infection induced interferon-β, a sign of host anti-viral immune response and MCP-1. Together with the induction of the regulators of actin cytoskeleton, myosin phosphatase Rho interacting protein (MPRIP) and monocyte chemotactic protein-1 (MCP-1), TB40/E induced a high level of expression of viral proteins, including IE1, gB, and pp65 as well as actin stress fiber formation, and achieved pathogenically high viral titers. Conclusions: Human trabecular meshwork cells support the replication of endotheliotropic TB40/E strain of HCMV which indicates that this strain may have high virulence for trabecular meshwork

A Kerato-Epithelin (βig-h3) Mutation in Lattice Corneal Dystrophy Type IIIA

This report covers phase 2 of the IWMI-Tata Water Policy Research Program (ITP) for the period 2006-2010. The major areas of action: Research focusing on water sector issues concerning underprivileged communities and backward regions in the country; Idea-incubation for livelihoods enhancement efforts using water as a central input, supporting the Trust in their water sector partnerships; Dissemination and raising public awareness; Widening the network of research partners; Policy influencing

Real-time PCR for VZV keratitis

Pupose: To determine the efficacy of real-time PCR for the diagnosis and prognosis of varicella-zoster virus (VZV) keratitis. Study design: Retrospective case series. Methods: Patients: 545 consecutive patients with keratitis were examined to quantify copy numbers of VZV DNA by real-time PCR. Association of copy numbers of DNA of VZV to clinical signs and disease course was assessed using logistic regression analysis and Cox proportional hazard model. Results: Of the 545 eyes, 38 eyes (6.9%) were diagnosed as VZV keratitis. The copy numbers of the DNA of VZV (median: 104.19 copy) was significantly associated with diagnosis of VZV keratitis with the highest odds ratio (OR) of 3390 (for median copy) compared to clinical signs. Diagnostic accuracy of the VZV DNA copy indicated good diagnostic value of area under the curve (0.92) by receiver operating characteristic analysis, and detection of unrelated VZV DNA from the cornea was very rare (0.2%). When the VZV DNA copy and clinical signs were assessed for association with the disease course after herpes zoster ophthalmicus, the disease duration was significantly prolonged in VZV keratitis cases with higher numbers of VZV DNA copies, iritis, and history of recurrences. The amount of VZV DNA led to a continuous risk to prolong disease duration until the ocular inflammation subsides (hazard ratio (HR) 0.17, 95%CI: 0.07 - 0.42, for median copies). Conclusions: Higher VZV DNA copy numbers are associated with the refractoriness of VZV keratitis, and its evaluation may be a clinically useful way to diagnose and manage VZV keratitis