A Case of Sterile Peripheral Corneal Infiltrative Event after LASIK

Purpose@#To report a rare, sterile, peripheral, corneal infiltrative event after laser in situ keratomileusis (LASIK).Case summary: A 29-year-old male presented with left-eye conjunctival injection and peripheral corneal infiltration 3 days after LASIK. A whitish, oval, peripheral infiltration around the corneal flap was apparent from 6-to-10 o’clock in the limbus. Slit lamp examination revealed conjunctival injection and mild corneal edema but neither a corneal epithelial defect nor an inflammatory reaction of the anterior chamber. Intensive cycloplegic, steroid ointment, steroid drops, antibiotic drops, and artificial tear therapies were prescribed under the impression of a sterile, peripheral, corneal infiltrative event. After 1 month, the symptoms and corneal opacity resolved without any complications. @*Conclusions@#A sterile, peripheral, corneal infiltrative event, namely, an oval infiltration of the periphery of the cornea without pain or epithelial damage can develop after LASIK but responds well to steroid eye drops.

A Case of Allergic Reaction to 0.5% Moxifloxacin Eye Drops

Purpose@#We report a rare case of allergic contact dermatitis after the use of a non-preservative 0.5% moxifloxacin ophthalmic solution.Case summary: A 60-year-old male presented with bacterial corneal ulceration of the right eye. He was treated with 50 mg/mL of fortified cefazolin and 14 mg/mL of tobramycin that were tapered as the corneal lesion improved after 1 month, and 0.5% moxifloxacin application was started. After 2 weeks of moxifloxacin treatment, the patient developed conjunctival injection, lid swelling, redness, and itching in the right eye. An allergic reaction was suspected and moxifloxacin administration was immediately stopped. The symptoms improved after the administration of oral antihistamines, 0.5% loteprednol eye drops, and steroid combination ointment. @*Conclusions@#Patients treated with 0.5% topical moxifloxacin should be monitored for allergic contact dermatitis, even if preservative-free eye drops are used.

A Case of Contact Lens Induced Acute Red Eye

Purpose@#To report a rare case of acute red eye in a contact lens user.Case summary: An 18-year-old female presented with decreased visual acuity and ocular pain in the right eye for 4 days. The patient had used contact lenses for > 8 hours a day, even while sleeping at night, for the past 3 months. Corneal epithelial edema and punctate stromal infiltration along with diffuse conjunctival hyperemia and corneal limbal injection in the right eye were observed in slit lamp examination. The uncorrected and corrected visual acuities of the right eye were 0.02 (20/1000) and 0.16 (20/125), respectively. The right eye had an intraocular pressure of 10 mmHg, and the left eye was within normal range. The patient stopped wearing contact lenses and was prescribed steroid and antibiotic eye drops and artificial tears. The corrected visual acuity increased to 0.5 (20/40) on the first day of treatment and to 1.0 (20/20) after 2 months. The cornea and conjunctiva also returned to the normal appearance. @*Conclusions@#It is important to differentiate contact lens-induced acute red eye from microbial keratitis. Discontinuation of contact lens use and education are required to prevent acute red eye caused by contact lens use.

The Influence of Face Shields on the Quality of Colonoscopy in the Era of the COVID-19 Pandemic

Background/Aims@#The worldwide coronavirus disease 2019 pandemic has led endoscopists to use personal protective equipment (PPE) for infection prevention. This study aimed to investigate whether wearing a face shield as PPE affects the quality of colonoscopy. @*Methods@#We reviewed the medical records and colonoscopy findings of patients who underwent colonoscopies at Asan Medical Center, Korea from March 10 to May 31, 2020. The colonoscopies in this study were performed by five gastroenterology fellows and four expert endoscopists. We compared colonoscopy quality indicators, such as withdrawal time, adenoma detection rate (ADR), mean number of adenomas per colonoscopy (APC), polypectomy time, and polypectomy adverse events, both before and after face shields were added as PPE on April 13, 2020. @*Results@#Of the 1,344 colonoscopies analyzed, 715 and 629 were performed before and after the introduction of face shields, respectively. The median withdrawal time was similar between the face shield and no-face shield groups (8.72 minutes vs 8.68 minutes, p=0.816), as was the ADR (41.5% vs 39.8%, p=0.605) and APC (0.72 vs 0.77, p=0.510). Polypectomy-associated quality indicators, such as polypectomy time and polypectomy adverse events were also not different between the groups. Quality indicators were not different between the face shield and no-face shield groups of gastroenterology fellows, or of expert endoscopists. @*Conclusions@#Colonoscopy performance was not unfavorably affected by the use of a face shield. PPE, including face shields, can be recommended without a concern about colonoscopy quality deterioration.

Clinical Efficacy of Iris Cystostomy Using a Yttrium Aluminum Garnet Laser

Purpose@#To report the clinical efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser iris cystotomy in iris cysts. @*Methods@#We examined three eyes with primary iris cysts diagnosed by ultrasound biomicroscopy that had fewer cornea endothelial cells or reduced visual acuity due to an occluded visual axis. Nd:YAG laser cystotomy was done. The logarithm of the minimum angle of resolution (logMAR) visual acuity, intraocular pressure (IOP), and specular microscopy test at baseline and last follow-up were reviewed. @*Results@#The average patient age was 54.0 ± 5.3 years; the mean follow-up was 11.7 ± 2.1 months. The baseline and final logMAR visual acuity were 0.23 ± 0.25 and 0.16 ± 0.15, respectively. Visual acuity improved, although not significantly (p = 0.317). The baseline and final IOP were 14.7 ± 2.3 and 13.7 ± 0.6 mmHg, respectively (p = 0.276). The corneal endothelial cell density (p = 0.109), hexagonality (p > 0.999), and coefficient of variation (p = 0.285) were not significantly different after treatment. There were no serious complications or recurrence. @*Conclusions@#After Nd:YAG laser cystotomy, the cell density and morphology of corneal endothelial cells changed little. It can be considered an effective treatment when there is a decrease in corneal endothelial cells or occlusion of the visual axis.

Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity Correction

Background@#Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS). @*Methods@#Two groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. @*Results@#The mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group (p < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively (p < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group (p < 0.001). The mean IMA decreased from 14.5° (range, 11.8°–17.2°) to 6.4° (range, 2.7°–10.1°) in the KW group and from 18.0° (range, 14.8°–21.2°) to 5.3° (range, 2.5°–8.1°) in the KWS group (p < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group (p < 0.001) and no difference was found in the KWS group (p = 0.280). @*Conclusions@#We found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.

Case Series of Descemet Membrane Detachment Associated with Cataract Surgery

Purpose@#We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. @*Conclusions@#Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.

The Therapeutic Effects of a 0.03% Tacrolimus Ointment on Childhood Phlyctenular Keratitis

Purpose@#We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. @*Methods@#We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. @*Results@#The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. @*Conclusions@#Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.

Case Series of Descemet Membrane Detachment Associated with Cataract Surgery

Purpose@#We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. @*Conclusions@#Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.

The Therapeutic Effects of a 0.03% Tacrolimus Ointment on Childhood Phlyctenular Keratitis

Purpose@#We explored the therapeutic effects of a 0.03% tacrolimus ointment (Protopic) on steroid-resistant phlyctenular keratitis in children. @*Methods@#We enrolled seven eyes of five children with recurrent phlyctenular keratitis despite 3 months of steroid treatment. The topical steroids were tapered and the patients treated with a combination of 0.03% tacrolimus and 0.3% ofloxacin ointment. The logarithm of minimal angle of resolution (logMAR) visual acuity, corneal neovascularization status, and changes in corneal opacity between the baseline and final visit were checked on anterior photographs using Image J software. @*Results@#The average patient age was 6.8 ± 3.0 years (range, 3-9 years) and the treatment duration 8.0 ± 2.0 days (range, 5-10 days). The baseline logMAR visual acuity was 0.42 ± 0.32 and the final value 0.19 ± 0.22. Visual acuity thus improved significantly after treatment (p = 0.026). Corneal neovascularization and phylctenulosis improved in all seven eyes; the fibrotic corneal opacity decreased in two eyes. @*Conclusions@#Topical 0.03% tacrolimus ointment may usefully treat steroid-resistant phlyctenular keratitis of childhood.

Improved immune responses and safety of foot-and-mouth disease vaccine containing immunostimulating components in pigs

Background@#The quality of a vaccine depends strongly on the effects of the adjuvants applied simultaneously with the antigen in the vaccine. The adjuvants enhance the protective effect of the vaccine against a viral challenge. Conversely, oil-type adjuvants leave oil residue inside the bodies of the injected animals that can produce a local reaction in the muscle. The longterm immunogenicity of mice after vaccination was examined. ISA206 or ISA15 oil adjuvants maintained the best immunity, protective capability, and safety among the oil adjuvants in the experimental group. @*Objectives@#This study screened the adjuvant composites aimed at enhancing foot-andmouth disease (FMD) immunity. The C-type lectin or toll-like receptor (TLR) agonist showed the most improved protection rate. @*Methods@#Experimental vaccines were fabricated by mixing various known oil adjuvants and composites that can act as immunogenic adjuvants (gel, saponin, and other components) and examined the enhancement effect on the vaccine. @*Results@#The water in oil (W/O) and water in oil in water (W/O/W) adjuvants showed better immune effects than the oil in water (O/W) adjuvants, which have a small volume of oil component. The W/O type left the largest amount of oil residue, followed by W/O/W and O/W types. In the mouse model, intramuscular inoculation showed a better protection rate than subcutaneous inoculation. Moreover, the protective effect was particularly weak in the case of inoculation in fatty tissue. The initial immune reaction and persistence of long-term immunity were also confirmed in an immune reaction on pigs. @*Conclusions@#The new experimental vaccine with immunostimulants produces improved immune responses and safety in pigs than general oil-adjuvanted vaccines.

Bilateral Infectious Keratitis Caused by Pseudomonas aeruginosa in a Colon Cancer Patient

Purpose@#To report a case of successful treatment of bilateral infectious keratitis combined with endophthalmitis caused by Pseudomonas aeruginosa in an immunocompromised patient.Case summary: A 66-year-old male with colon cancer and lung metastasis was referred to our clinic with ocular pain and reduced visual acuity in both eyes for 3 days. Visual acuity was “light perception” in both eyes at the first visit. On slit lamp examination, he presented with corneal central necrosis with mucopurulent discharge and anterior chamber hypopyon in both eyes. The left eye especially had vitreous haziness using a B-scan. Pseudomonas aeruginosa was detected in the corneal scrape culture and percutaneous transhepatic biliary drainage culture. After administration of topical eye drops, intravitreal injection, and systemic antibiotics, visual acuity improved from “light perception” to 20/63 in the right eye and to 20/125 in the left eye. @*Conclusions@#Although bilateral corneal ulcers combined with endophthalmitis induced by Pseudomonas aeruginosa are rare it can occur in immunocompromised patients. In the case of corneal ulcers combined with endophthalmitis, thorough ocular examinations and active treatments with intravitreal injections and systemic administration of antibiotics can help to recover vision.

Two Cases of Mydriasis following Barrier Photocoagulation at the Peripheral Lattice Degeneration or Retinal Hole

Purpose@#To report two cases of pupil dilatation that occurred after laser treatment at the peripheral lattice degeneration or retinal hole.Case summary: A 28-year-old male was treated with a Pascal laser for barrier photocoagulation at 10-12 and 6 o'clock retinal holes and a lattice degeneration. He complained of decreased visual activity at near distance. The right pupil size was 5 mm and the left pupil size was 3 mm. The right eye was more dilatated. The relative afferent pupillary defect test of the right eye was normal and the direct light reflex was slightly decreased in the same eye. A 35-year-old female patient was treated with a barrier grid photocoagulation with an argon laser for peripheral retinal degeneration, which occurred 1 month prior. The right eye dilatation was 4 mm pupil size. Both the pupillary light reflex and the relative afferent pupillary defect test showed normal results. @*Conclusions@#Because mydriasis can occur as an uncommon complication following barrier photocoagulation at the peripheral retinal degeneration and hole, mydriasis before the peripheral retinal treatmen should be fully explained to the patient. In addition, every effort should be made to minimize damage to the distribution of the short ciliary nerve, especially superior and inferior to the peripheral retinal lesion.

A Conjunctival Myxoid Stromal Tumor

Purpose@#We report a conjunctival myxoid stromal tumor (CMST), which is a rare benign conjunctival mass.Case summary: A 70-year-old man with a history of hypertension and cerebral infarction visited our hospital with a clear mass ofthe conjunctiva in the left eye. His visual acuity was normal, and no other abnormal findings were noted. A transparent, yellowish,jelly-like, 4 × 3 mm mass with a clear border between it and the surrounding tissue was found at the lower temporal part of theconjunctiva. The mass was mobile and there was no pain or tenderness. Excisional biopsy was performed on the mass.Histopathological examination showed reticular fibers located in an abundant mucus-like matrix with fusiform, astrocytic andscattered inflammatory cells. Immunologic examination revealed CD34 positive and SMA negative findings and we diagnosedthe mass as a CMST. @*Conclusions@#When there is a clear pale yellow to light pink mass with a clear border and a distinct vascular distribution or pigmentationin the conjunctiva, the possibility of a CMST must be considered. Histopathologic and immunologic examinationshould be performed through biopsy and evaluation for systemic disease should be performed as necessary.

Multilayer Collagen Sheet Graft for Corneal Perforation with a Corneal Ulcer

Purpose@#To report a rare case of corneal perforation treated with a multilayer collagen sheet graft transplantation after amniotic membrane graft failure to prevent corneal perforation in a fungal corneal ulcer.Case summary: A 64-year-old woman with a past history of rheumatoid arthritis 1 year prior was transferred to our hospital due to unresponsive treatment of a corneal ulcer. Although the corneal ulcer of the right eye was treated with antibiotics for 10 days, loss of the corneal epithelial layer and corneal stromal infiltration were observed on examination. A culture test was conducted on the corneal ulcer that identified the pathogen as the Paecilomyces strain. Corneal perforation occurred 1 month after undergoing an amniotic membrane graft to prevent this outcome. A multilayer collagen sheet graft (Aongen®; Pharos Tech Medical, Seoul, Korea) was applied at the perforated corneal ulcer site without a donor cornea. One year after this operation, visual acuity has not been restored; however, corneal perforation of the ulcer site has not progressed. @*Conclusions@#If there is no donor cornea, partial corneal transplantation using a multilayer collagen sheet graft is thought to be a therapeutic method to treat corneal perforation in cases involving impacted corneal perforation or corneal perforation that occurs in corneal disease.

Multilayer Collagen Sheet Graft for Corneal Perforation with a Corneal Ulcer

Purpose@#To report a rare case of corneal perforation treated with a multilayer collagen sheet graft transplantation after amniotic membrane graft failure to prevent corneal perforation in a fungal corneal ulcer.Case summary: A 64-year-old woman with a past history of rheumatoid arthritis 1 year prior was transferred to our hospital due to unresponsive treatment of a corneal ulcer. Although the corneal ulcer of the right eye was treated with antibiotics for 10 days, loss of the corneal epithelial layer and corneal stromal infiltration were observed on examination. A culture test was conducted on the corneal ulcer that identified the pathogen as the Paecilomyces strain. Corneal perforation occurred 1 month after undergoing an amniotic membrane graft to prevent this outcome. A multilayer collagen sheet graft (Aongen®; Pharos Tech Medical, Seoul, Korea) was applied at the perforated corneal ulcer site without a donor cornea. One year after this operation, visual acuity has not been restored; however, corneal perforation of the ulcer site has not progressed. @*Conclusions@#If there is no donor cornea, partial corneal transplantation using a multilayer collagen sheet graft is thought to be a therapeutic method to treat corneal perforation in cases involving impacted corneal perforation or corneal perforation that occurs in corneal disease.

Effectiveness of Cyclosporine-steroid Treatment after Cataract Surgery according to Dry Eye Severity

PURPOSE: To evaluate the effectiveness of topically administered 0.05% cyclosporine combined with a topical steroid in the early postoperative period after cataract surgery, and to compare the therapeutic efficacy according to the severity of dry eye. METHODS: One hundred and fifty-six patients who underwent unilateral cataract surgery and received topical cyclosporine 0.05% for 8 weeks combined with a fluorometholone 0.1% steroid for 4-weeks were classified into three groups according to preoperative dry eye level: the control group, non-dry eye (n = 78); group 1, level I dry eye (n = 38); and group 2, level II dry eye (n = 40). The best-corrected distance visual acuity, intraocular pressure, dry eye symptom questionnaire (ocular surface disease index), tear film break-up time (TBUT), and Schirmer test-I (STI) were evaluated. RESULTS: The preoperative score of dry eye symptoms improved significantly at one week postoperatively and continued to improve until postoperative 8-weeks in all groups, especially in group 2 compared with the control. Groups 1 and 2 showed significant improvement in the TBUT at one week, four weeks, and eight weeks postoperatively, compared to eight weeks postoperatively in the control; Group 2, especially, showed significant improvement in TBUT. There was no difference in STI value after cyclosporine-steroid treatment in the control group; however, a significant difference was observed at four weeks postoperatively in dry eyes. No significant differences in STI results were observed among the three groups. CONCLUSIONS: Use of topical cyclosporine 0.05% combined with a topical fluorometholone 0.1% steroid after cataract surgery is more effective in dry eyes level II than in non-dry eyes, especially those with TBUT and dry eye symptoms at eight weeks postoperatively.

Needleless intradermal vaccination for foot-and-mouth disease induced granuloma-free effective protection in pigs

Vaccination is one of the most effective ways of controlling and preventing foot-and-mouth disease (FMD) outbreaks. The effective prevention of this disease requires the use of high-quality vaccines to meet the criteria that enable customers to use them simply. The administration of FMD vaccines containing oil-based adjuvants in pigs can induce the formation of granuloma in the muscle of the vaccinated, which makes these vaccines a less preferable option. Therefore, it is important to establish an FMD vaccine and vaccine delivery tool that offers better immunity and safer application. This study compared the immune responses of intramuscular and needleless intradermal vaccination in pigs. When the same amount of an FMD virus (FMDV) antigen was administered to pigs, both the intradermally and intramuscularly vaccinated groups were protected completely against a challenge of the homologous FMDV, but the intramuscularly vaccinated group showed an overall higher level of neutralizing antibodies. Importantly, the formation of granuloma in muscle could be excluded in the intradermally vaccinated group. Of the oil-based adjuvants selected in this study, ISA 207 was effective in eliciting immunogenicity in intradermal vaccination. In conclusion, a new vaccine formula can be chosen for the delivery of intradermal route to exclude the possibility of local reactions in the muscle and generate protective immunity against an FMDV challenge.

Comparison of the Toxicity of Olopatadine Anti-allergic Ophthalmic Agents on Rabbit Conjunctival Cells

PURPOSE@#To compare the in vitro toxicity of commercial olopatadine anti-allergic ophthalmic agents on cultured rabbit's conjunctival cells according to concentrations and exposure times.@*METHODS@#Rabbit conjunctival cells were exposed to anti-allergic olopatadine ophthalmic agents, (Patanol® [0.1% olopatadine hydrochloride; Alcon, Fort Worth, TX, USA], Pataday® [0.2% olopatadine hydrochloride; Alcon], and Pazeo® [0.7% olopatadine hydrochloride; Alcon]) at concentrations of 5%, 10%, and 15% for periods of 30 minutes, 1, 2, 3, and 6 hours, respectively. Cell proliferation and injury assays were performed using the methylthiazoltetrazolium and lactate dehydrogenase (LDH) leakage assays. We checked the composition of the three anti-allergic agents, and performed light and transmission electron microscopy to compare the morphological changes in cells.@*RESULTS@#The conjunctival cell proliferation was inhibited after 1 hour exposure to each olopatadine ophthalmic agent, with significant cell proliferation inhibited using 15% of each drug. The proliferation of conjunctival cells was inhibited during 6 hours of drug exposure at all concentrations of Pataday® and Pazeo®. The titer of LDH increased from 3 hours after drug exposure, but 15% Pazeo® significantly increased the LDH titer at 2 hours after drug exposure. As the concentration of the drug increased, the LDH titer also significantly increased. The cellular morphological changes of conjunctival cells were in the increasing order of Pazeo®, Pataday®, and Patanol® with a high concentration of olopatadine hydrochloride.@*CONCLUSIONS@#Among the anti-allergic olopatidine ophthalmic agents, higher olopatadine concentrations in the increasing order of Pazeo®, Pataday®, and Patanol® resulted in cytoplasmic damage of conjunctival cells, but there was no severe damage to the cytoplasmic or the nuclear membranes.

Anti-influenza properties of herbal extract of Althaea rosea in mice

Althaea rosea has been used in traditional Chinese medicine to treat numerous diseases, but no studies have investigated its anti-influenza properties to date. In this study, we investigated the anti-influenza effects of Althaea rosea. BALB/c mice orally pretreated with Althaea rosea (200 µL, 0.1 mg/mL concentration in phosphate-buffered saline) and followed by infection of influenza A virus nasally showed higher survivability and lower lung virus titer against divergent subtypes of influenza A virus infection. We also found that oral administration of Althaea rosea elicited antiviral innate immune responses in serum, bronchoalveolar lavage fluid, small intestinal fluid, and the lungs. Taken together, these findings suggest that aqueous extracts of Althaea rosea are a potential candidate for use as an anti-influenza drug.