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ABSTRACT: PURPOSE:: To report a case of spontaneous bleb formation in a presumed pellucid marginal corneal degeneration with acute hydrops. METHODS:: A 51-year-old man reported sudden ocular pain with a lower conjunctival mass in his left eye. A clinical examination was performed to investigate this lesion. RESULTS:: The intraocular pressure in the left eye was markedly lower compared with that in the opposite eye. Slit-lamp examination of the left eye showed a conjunctival mass inferior to the corneoscleral limbus adjacent to corneal epithelial and stromal edema without perforation. Corneal topography showed the typical bow tie appearance of corneal steepening rotated 120 degrees clockwise. The right eye was totally normal. Fourier-domain optical coherence tomography with a corneal anterior module adaptor clearly showed a break in Descemet membrane and a ruptured corneal stromal cleft under the conjunctiva near the corneal limbus that resulted in spontaneous bleb formation. The cornea gradually healed after bandage treatment; the spontaneous bleb became smaller and the corneal stromal cleft and edema regressed at 3 months with corneal scarring. The intraocular pressure in the left eye recovered to the same level as that in the opposite eye in association with the decreased bleb size. CONCLUSIONS:: This case indicated that spontaneous bleb formation in a pellucid marginal corneal degeneration should be included in the differential diagnosis of a conjunctival mass of unknown origin.
Cornea 02/2013; · 1.73 Impact Factor
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ABSTRACT: To investigate the characteristics of the corneal topography with three-dimensional (3-D) anterior segment optical coherence tomography (AS-OCT) following Descemet's stripping automated endothelial keratoplasty (DSAEK).
Thirty-four eyes of 33 patients following DSAEK were studied. In addition to conventional topographic maps, the elevation map of the intrastromal interface and pachymetric maps of the host and graft were obtained by corneal topographic analysis using 3-D AS-OCT. The coefficient of variation of the corneal power (CV-Pa, CV-Pp) and root mean squares of the corneal elevation (RMS-Ea, RMS-Ep) of the anterior and posterior corneal surfaces were determined. Based on the combination of the regularity and irregularity of the anterior and posterior surfaces, subjects were classified into four types: type 1, regular/regular; type 2, irregular/regular; type 3, regular/irregular; and type 4, irregular/irregular.
The average graft decentration was 0.59 ± 0.23 mm. The proportion of types 1, 2, 3, and 4 were 59%, 9%, 24%, and 9 %, respectively. The CV-Pa (25.8 ± 8.9) and CV-Pp (-73.9 ± 18.0) of the type 1 corneas were significantly better than that of type 2 and type 3 corneas, respectively. The RMS-Ea (5.1 ± 1.3) and RMS-Ep (26.0 ± 7.3) of the type 1 corneas were significantly better than that of type 2 and type 3 corneas.
An OCT-based corneal topographer might be useful in determining the factors associated with optical quality of the cornea following DSAEK by analyzing the topographic characteristics of host and donor separately.
Investigative ophthalmology & visual science 05/2012; 53(7):3286-95. · 3.43 Impact Factor
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Journal of cataract and refractive surgery 03/2012; 38(3):560-1. · 2.75 Impact Factor
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Archives of ophthalmology 12/2011; 129(12):1629-30. · 3.86 Impact Factor
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ABSTRACT: To assess a new corneal topographer based on 3-dimensional anterior segment optical coherence tomography (OCT-based corneal topographer) for analyzing corneal topography in patients with keratoconus.
Osaka University Graduate School of Medicine, Osaka, Japan.
Evaluation of diagnostic test or technology.
Keratoconic eyes and normal control eyes were assessed using a rotating Scheimpflug-based corneal topographer and an AS OCT-based corneal topographer. The OCT-based corneal topographer, a 1310 nm swept-source device, captures 8192 points during 0.34 second for 16 radial scans of the corneal topography. The success rate of precisely digitizing the corneal surfaces, patterns of the color-coded maps, central corneal thickness (CCT), and central axial power were compared between the 2 devices.
Forty keratoconic eyes and 30 control eyes were assessed. The OCT-based corneal topographer measured corneal configurations despite corneal opacities. The success rate of precisely digitizing the corneal surfaces in keratoconic eyes was 95% using OCT and 80% using the Scheimpflug-based corneal topographer. The color-coded maps of the anterior and posterior corneal elevations, CCT, and corneal axial power maps generated by the 2 devices agreed well. The correlations between the CCT values and between the central corneal axial power values measured by the 2 devices were well correlated in both groups.
The OCT-based corneal topographer, with its faster acquisition time, provided more consistent measurements than the Scheimpflug-based corneal topographer. The OCT-based corneal topographer seems promising for evaluating highly irregular corneas, as in cases of advanced keratoconus.
No author has a financial or proprietary interest in any material or method mentioned.
Journal of cataract and refractive surgery 10/2011; 37(10):1871-8. · 2.75 Impact Factor
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ABSTRACT: We demonstrate a technique that uses chandelier illumination during Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of severe bullous keratopathy. A chandelier illumination fiber inserted through the corneal side port provides sclerotic scattering-like illumination from the sclerocorneal margin and endoillumination from the anterior chamber, resulting in excellent visibility for Descemet stripping and intraocular manipulation without obstruction from a hazy cornea. In cases complicated by dense cataract, the chandelier fiber can be inserted transconjunctivally into the pars plana, providing sufficient retroillumination to perform phacoemulsification with intraocular lens implantation combined with Descemet stripping for a DSAEK triple procedure. Because of the powerful illumination and hands-free nature of the chandelier fiber, the Descemet membrane can be visualized clearly and stripped as 1 sheet without inadvertent complications. We have developed a new 25-gauge illuminated anterior chamber maintainer comprising a 25-gauge infusion cannula through which a 29-gauge chandelier fiber probe passes. Because of the resulting bright illumination and adequate irrigation flow, excellent visibility with stable anterior chamber maintenance can be concurrently obtained for Descemet stripping, endothelial graft insertion, and subsequent intraocular manipulations without the need for biological staining or ophthalmic viscosurgical products, even in patients with severe corneal haze. This technique and new device facilitates safe and simple intraocular manipulation during DSAEK and encourages surgeons to perform DSAEK in challenging cases.
Cornea 10/2011; 30 Suppl 1:S50-3. · 1.73 Impact Factor
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Japanese Journal of Ophthalmology 07/2011; 55(5):576-8. · 0.92 Impact Factor
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ABSTRACT: To compare the shape of the anterior segment of eyes with keratoconus and normal controls using anterior segment optical coherence tomography (AS-OCT).
Included in the study were eyes with keratoconus (60 eyes of 40 patients), eyes with suspected keratoconus (10 eyes of 10 patients), and normal controls (21 eyes of 13 persons). Anterior segment imaging was performed in these eyes with AS-OCT, and the distance for angle to angle, anterior chamber depth and distribution of corneal thickness including the increasing ratio from center to periphery were compared.
There was no significant difference in the distance of angle to angle among the three groups. The ratio of eyes with anterior chamber depth of more than 3.6 mm in the eyes with keratoconus was significantly higher than in the normal group. Although the corneal thickness from the center to the 3 mm periphery in the keratoconus group and in the keratoconus suspect group was significantly thinner than those in the normal group, there were no significant differences in the corneal thickness at the 4 mm superior or temporal areas among the three groups. Increasing ratio of the corneal thickness from the center to the periphery showed the higher value in the keratoconus group than in the others.
AS-OCT enabled us to understand the configuration of the anterior segment of the eye and the distribution of the corneal thickness quantitatively even for the advanced keratoconus cases with corneal scar. AS-OCT may be useful as an aid to contact lens prescription and surgical planning.
Nippon Ganka Gakkai zasshi 04/2011; 115(4):368-73.
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ABSTRACT: To report 4 cases of Acanthamoeba keratitis treated with excimer laser phototherapeutic keratectomy (PTK) and to discuss the clinical efficacy of this procedure.
Four cases with early stage Acanthamoeba keratitis resistant to medical amoebic therapy for at least 1 week and with an enlarged abscess underwent PTK.
After PTK, the infected corneal lesions were removed and the clinical symptoms rapidly resolved in all cases. Another 40-μm ablation was required as a result of the 1-week delay in performing PTK. There was no recurrence during the postoperative period.
When lesions are limited to about one third of the superficial corneal stromal layer, PTK could be the most beneficial option for treating Acanthamoeba keratitis, resistant to medical amoebic therapy using chlorhexidine or polyhexamethylene biguanide, because of direct removal of resistant amoebic cysts and better visual recovery without irregular astigmatism.
Cornea 10/2010; 29(10):1199-202. · 1.73 Impact Factor
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ABSTRACT: To present the phenotypic variability both among and within families in Japanese gelatinous drop-like corneal dystrophy (GDLD), and to study the genetic background of the variability.
Four Japanese families who suffer from bilateral corneal amyloidoses were studied by a molecular genetic method. All families included a patient whose clinical features alone could not be used to diagnose GDLD. In one family, obvious clinical differences were observed between the two members who were patients. Three families had members who suffered from atypical amyloidoses that had not been initially diagnosed as GDLD. For their final diagnoses and for the investigation of the genetic background of these phenotypes, the sequences of the entire TACSTD2 gene and the genotypes of some polymorphic markers close to the TACSTD2 gene were studied.
Genetic analysis revealed that all the patients possessed a homozygous Q118X mutation in TACSTD2, a major founder mutation in Japanese GDLD. There were no differences in the entire sequence of TACSTD2 in these patients compared with other GDLD patients. Moreover, the genotyping of polymorphic markers near the TACSTD2 gene revealed that these patients shared the same founder chromosome as well as the TACSTD2 gene.
In Japanese GDLD patients, phenotypic variability is observed both among and within families in spite of the allelic homogeneity of Q118X. Even in these atypical cases, the patients shared the same chromosomal region, received from a founder.
Japanese Journal of Ophthalmology 09/2010; 54(5):494-8. · 0.92 Impact Factor
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ABSTRACT: Cultured cell sheets for transplantation generally have been co-cultured with animal feeder cells, which carry risks because of different species and results in non-contact culture between the feeder and target cells. We developed a new technique to produce human eliminable feeder-assisted target cell sheets by novel human-derived genetically modified feeder cells. Three genes (human-derived telomerase reverse transcriptase gene, enhanced green fluorescent protein gene, and herpes simplex virus thymidine kinase gene) were transducted into human stromal cells, which enabled genetically modified feeder cells to be immortalized, labeled, and eliminated as needed. A target cell sheet was produced as one sheet by assisting the genetically modified feeder cells and successfully transplanted in vivo without their contamination. Genetically modified human eliminable feeder cells could be a promising tool for cultivated cell sheet transplantation.
Biochemical and Biophysical Research Communications 08/2010; 399(3):373-8. · 2.48 Impact Factor
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ABSTRACT: A new 25-gauge illuminated anterior chamber maintainer composed of a 25-gauge infusion cannula through which a 29-gauge chandelier fiber probe passes was developed for use during Descemet stripping automated endothelial keratoplasty to treat patients with advanced bullous keratopathy. This device, which is compatible with a xenon or mercury vapor illuminator to generate powerful wide-angle illumination from the cone-shaped chandelier fiber tip, is self-retained at the corneal limbus after insertion of the infusion cannula through a corneal side port. Because of its bifunctionality, that is, bright illumination and adequate irrigation flow, excellent visibility with stable anterior chamber maintenance can be concurrently obtained for Descemet stripping, endothelial graft insertion, and subsequent intraocular manipulations without the need for use of a biologic staining technique or ophthalmic viscosurgical products even in patients with severe corneal haze. This new device facilitates safe and simple intraocular manipulation during Descemet stripping automated endothelial keratoplasty.
Cornea 08/2010; 29(8):917-20. · 1.73 Impact Factor
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Archives of ophthalmology 04/2010; 128(4):502-3. · 3.86 Impact Factor
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ABSTRACT: To assess corneal scrapings and aqueous humor samples analyzed by polymerase chain reaction (PCR) that were positive for cytomegalovirus (CMV) in patients with keratitis of unknown origin and to investigate their clinical manifestations.
Retrospective, interventional case series.
Seventy-eight patients with epithelial (n=37), stromal (n=12), or endothelial keratitis (n=29) of unknown origin examined at the Osaka University Medical Hospital.
Clinical examination and tears, corneal scrapings, and aqueous humor specimens were evaluated by real-time PCR for CMV.
Quantification of CMV DNA at the diagnosis of each type of keratitis with unknown origin and monitoring during the therapeutic course for CMV-positive cases.
No cases of epithelial or stromal keratitis had CMV DNA. Seven of 29 corneal endotheliitis cases (24.1%) were positive for CMV. Cytomegalovirus-positive cases of corneal endotheliitis characterized by localized corneal edema and keratic precipitates included 4 patients who had undergone penetrating keratoplasty and were refractory to the treatment for graft rejection and 3 patients with idiopathic endotheliitis. Cytomegalovirus DNA copy numbers were estimated and ranged from 6.3x10(4) to 3.6x10(6)/ml. In all positive cases, the numbers of CMV DNA copies decreased within weeks during treatment with systemic and topical ganciclovir (GCV) combined with a topical steroid. Five eyes (62.5%) had clinical improvement. In cases of endothelial keratitis, diabetes mellitus was significantly higher in patients positive for CMV (71.4%) than in patients negative for CMV (18.2%, P=0.016, chi-square test).
A total of 24.1% of cases with corneal edema of unknown origin were CMV positive and should be included in the differential diagnosis of idiopathic corneal endotheliitis or graft edema after penetrating keratoplasty, especially for bullous keratopathy. Real-time PCR for CMV, based on the diagnosis and monitoring of the clinical course, may be useful. Cytomegalovirus corneal endotheliitis requires early appropriate treatment using GCV. Because clinical remission after GCV may depend on the area of normal endothelium, early diagnosis and therapy are important for CMV corneal endotheliitis.
Ophthalmology 12/2009; 117(2):216-22. · 5.45 Impact Factor
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Tomoyuki Inoue,
Brenda L K Coles,
Kim Dorval,
Rod Bremner,
Yasumasa Bessho,
Ryoichiro Kageyama,
Shinjiro Hino,
Masao Matsuoka,
Cheryl M Craft,
Roderick R McInnes,
Francois Tremblay,
Glen T Prusky,
Derek van der Kooy
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ABSTRACT: Retinal stem cells (RSCs) are present in the ciliary margin of the adult human eye and can give rise to all retinal cell types. Here we show that modulation of retinal transcription factor gene expression in human RSCs greatly enriches photoreceptor progeny, and that strong enrichment was obtained with the combined transduction of OTX2 and CRX together with the modulation of CHX10. When these genetically modified human RSC progeny are transplanted into mouse eyes, their retinal integration and differentiation is superior to unmodified RSC progeny. Moreover, electrophysiologic and behavioral tests show that these transplanted cells promote functional recovery in transducin mutant mice. This study suggests that gene modulation in human RSCs may provide a source of photoreceptor cells for the treatment of photoreceptor disease.
Stem Cells 12/2009; 28(3):489-500. · 7.78 Impact Factor
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ABSTRACT: To report 2 cases of Acanthamoeba keratitis whose causative pathogen was detected only by real-time polymerase chain reaction (PCR).
Histological examinations of corneal scrapings were stained with Fungiflora Y. Corneal scrapings were also cultured on nonnutrient agar. Real-time PCR analyses of corneal scrapings were also performed.
Both cases had clinical signs and risk factors of Acanthamoeba infection. Histological examinations of corneal scrapings with Fungiflora Y staining were negative, and the cultures did not grow any pathogens. Real-time PCR analysis was positive for Acanthamoeba DNA from 2 corneal scrapings. Antiamoebic treatments led to excellent clinical improvements.
These results indicate that PCR analyses can detect the DNA of Acanthamoeba in corneal scrapings and may be a valuable supplemental examination. This method is especially helpful when clinical signs and risk factors of Acanthamoeba infection are present but histological examinations with Fungiflora Y staining and cultures are negative.
Cornea 09/2009; 29(2):228-31. · 1.73 Impact Factor
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Japanese Journal of Ophthalmology 09/2009; 53(5):548-9. · 0.92 Impact Factor
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ABSTRACT: E-Cadherin, a cell adhesion protein, has been shown to take part in the compartmentalization, proliferation, survival, and differentiation of cells. E-Cadherin is expressed in the adult and embryonic forebrain germinal zones in vivo, and in clonal colonies of cells derived from these regions and grown in vitro. Mice carrying E-Cadherin floxed genes crossed to mice expressing Cre under the Nestin promoter demonstrate defects in the self-renewal of neural stem cells both in vivo and in vitro. The functional role of E-Cadherin is further demonstrated using adhesion-blocking antibodies in vitro, which specifically target cadherin extracellular adhesive domains. Adult neural stem cell colonies decrease in the presence of E-Cadherin antibodies in a dosage-dependent manner, in contrast to P-Cadherin antibody. On overexpression of normal E-Cadherin and a mutated E-Cadherin, containing no intracellular binding domain, an increased number of clonal adult neural stem cell colonies are observed. These data suggest it is specifically E-Cadherin adhesion that is responsible for these self-renewal effects. These data show the importance of E-Cadherin in the neural stem cell niche and suggest E-Cadherin regulates the number of these cells.
Journal of Neuroscience 04/2009; 29(12):3885-96. · 7.11 Impact Factor
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ABSTRACT: To compare the susceptibility and efficacy of 3 fluoroquinolones, (levofloxacin, gatifloxacin, and moxifloxacin) in treating conjunctival bacteria in patients having ocular surgery.
Osaka University Hospital, Osaka, and Tohoku University Hospital, Miyagi, Japan.
Eyes of patients were examined preoperatively. Aerobic and anaerobic cultures were obtained from conjunctival swabs. The minimum inhibitory concentrations (MICs) of levofloxacin, gatifloxacin, and moxifloxacin for isolated strains were determined. Using the MIC values, descriptive statistics (median, MIC(50), MIC(90), mode, and range), susceptibility, and efficacy of each fluoroquinolone were calculated for the bacteria isolated, and the data were analyzed statistically.
Of the 200 eyes sampled, 163 (81.5%) had positive bacterial growth. From the 163 eyes, 235 bacterial strains were isolated: 116 (49.4%) Propionibacterium acnes; 58 (24.7%) coagulase-negative Staphylococcus (CNS), including 36 methicillin-sensitive CNS (MS-CNS) and 22 methicillin-resistant CNS (MR-CNS); 10 (4.3%) Staphylococcus aureus, including 6 methicillin-sensitive S aureus and 4 methicillin-resistant S aureus (MRSA); and 29 (12.3%) Corynebacterium. Approximately 40% of Staphylococci (22/58 CNS, 37.9%; 4/10 S aureus, 40.0%) were methicillin-resistant. Furthermore, 18 (81.8%) of MR-CNS and all 4 MRSA were fluoroquinolone resistant. The MICs of moxifloxacin and gatifloxacin were statistically significantly lower than those of levofloxacin for CNS and P acnes (P<.05, Kruskal-Wallis test). However, there was no statistically significant difference in the susceptibility patterns of the fluoroquinolones for these strains (P>.05, McNemar test).
Because many methicillin-resistant and fluoroquinolone-resistant strains were isolated from the conjunctiva preoperatively, clinicians should be mindful of endophthalmitis or ocular infections associated with these strains.
Journal of cataract and refractive surgery 03/2009; 35(3):475-9. · 2.75 Impact Factor
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ABSTRACT: This study was designed to investigate higher-order aberrations (HOAs) due to the posterior corneal surface in keratoconic eyes compared with normal eyes.
We studied 24 normal and 28 keratoconic eyes. The anterior/posterior corneal heights and pachymetric data were obtained with a rotating Scheimpflug camera. HOAs for 6 mm pupils were calculated from the differences between the height data and the best-fit sphere, using an original program for each corneal surface. The reference axes of the measurements were aligned with the primary line of sight. The HOAs were expanded with normalized Zernike polynomials. For each pair of standard Zernike terms for trefoil, coma, tetrafoil, and secondary astigmatism, one value for the magnitude and axis was calculated by Zernike vector analysis.
The mean total corneal HOAs (root mean square [microm]) from the anterior/posterior surfaces were significantly (P < 0.001) higher in keratoconic (4.34/1.09, respectively) than in control eyes (0.46/0.15). The mean magnitude of each Zernike vector terms for trefoil, coma, and spherical aberration from the anterior/posterior surfaces was significantly (P < 0.001) higher in keratoconic (0.77/0.19, 3.57/0.87, -0.44/0.17) than control eyes (0.09/0.04, 0.33/0.07, 0.25/-0.07), respectively. The mean axes by vector calculation for coma due to the anterior (63.6 degrees ) and posterior surfaces (241.9 degrees ) were in opposite directions.
Corneal HOAs on both corneal surfaces in keratoconic eyes were higher than in control eyes. Coma from the posterior surface compensated partly for that from the anterior surface. Residual irregular astigmatism in patients with keratoconus wearing rigid gas permeable contact lenses can be estimated by measuring the HOA from the posterior corneal surface.
Investigative ophthalmology & visual science 12/2008; 50(6):2660-5. · 3.43 Impact Factor
