Interactions of Corneal Endothelial Cells with Stromal Cells during Corneal Endothelial Injury

Purpose@#To investigate the interaction of corneal endothelial cells (CECs) with corneal stromal cells (CSCs) on the healing of chemically induced corneal endothelial injury. @*Methods@#Twenty-five rabbits were divided into two groups: rabbits exposed to NaOH and controls. Rabbits were clinically evaluated and sacrificed at 1 day, 1 week, 2 weeks, and 4 weeks after endothelial injury. Corneal endothelial cells and corneal stromal cells were cultured and the wound healing rate of the corneal endothelium and cytokines in the culture medium were analyzed with and without co-culture in the Transwell system. @*Results@#Corneal edema and opacity scores were higher in all rabbits exposed to NaOH than in controls. Corneal endothelial apoptosis with little effect on CSCs was observed in rabbits exposed to NaOH at day 1. Two weeks after injury, CECs migrated from the periphery. CSCs were aligned in parallel to Descemet's membrane, which exhibited the presence of CECs. Transforming factor-β1 and interleukin-6 secretion was lower in the co-culture system than in individual cultures of CECs or CSCs. @*Conclusions@#These results revealed intracameral NaOH injection is a model of corneal endothelial injury with minimal impact on the stroma. Communication between CECs and CSCs during wound healing may lead to the modulation of cytokine production, which is necessary for an enhanced healing process of corneal endothelial injury.

Accuracy of Intraocular Lens Power Prediction Using 9 Formula

Purpose@#To compare the accuracy of nine intraocular lens (IOL) power calculation formulas. @*Methods@#This study is retrospective consecutive case series. A total of 228 eyes of 228 patients who underwent uncomplicated cataract surgery between October 2015 and March 2021 were included. The accuracy of nine IOL calculation formulas (Kane, Emmetropia verifying optical version, Hill-radial basis function, Olsen, Barrett Universal II [Barrett II], Haigis, Holladay, Hoffer, and SRK/T) was compared and analyzed using differences between the predicted refractive power and actual refractive power at 2 months after cataract surgery. Mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE), and the percentage of eyes that were within ± 0.50 diopters (D), ± 0.75 D, and ± 1.00 D of the target refraction were calculated for each formula. @*Results@#For all eyes, Haigis formula was the most accurate in MAE, followed by Barrett II formula. Comparing the probability of MAE within 0.50 D, Haigis formula showed the highest accuracy. A total of 20 eyes of 20 patients had more than 25 mm axial length. Regarding MAE, Hoffer Q was the most accurate, followed by the Olsen formula. Comparing the probability of MAE within 0.50 D, the Hoffer Q formula was the most accurate. A total of 24 eyes of 24 patients had more than 46 D keratometry. Regarding MAE and MedAE, Haigis was the most accurate, followed by the Barrett II formula. Comparing the probability of MAE within 0.5 D, Holladay formula was the most accurate. @*Conclusions@#Barrett II and Haigis formulas showed greater accuracy for all patients when we determined IOL power before cataract surgery. Hoffer Q, Olsen, and Barrett II formulas showed higher accuracy for long axial length. And Haigis and Barrett II were the most accurate for steep keratometry.

Effect of Cyclosporine A-induced Senescence on Cultured Human Corneal Endothelial Cells

Purpose@#To investigate the in vitro effect of cyclosporine A (CsA)-induced senescence on human corneal endothelial cells (HCECs). @*Methods@#HCECs were cultured and incubated with 0-100 µM CsA. Senescence-associated β–galactosidase (SA-β-gal) staining was performed. Mitochondrial dehydrogenase activity was assessed using a WST-8 assay kit and mitochondrial membrane potential (∆Ψ m ) was measured using JC-1 dye. Intracellular and mitochondrial formation of reactive oxygen species (ROS) was measured with 2’,7’-dichlorodihydrofluorescein diacetate and MitoSOX probes. Intracellular and mitochondrial calcium levels were measured using Fluo-4 and Rhod-2, respectively. Protein expression was evaluated by Western blotting. @*Results@#CsA increased the percentage of SA-β-gal-positive cells (p = 0.003) and decreased mitochondrial dehydrogenase activity and ∆Ψ m in a dose-dependent manner (p = 0.029, pp = 0.004). Intracellular and mitochondrial ROS levels increased during incubation with CsA (p = 0.005). CsA at 100 µM increased mitochondrial calcium levels (p = 0.001), whereas intracellular calcium levels decreased at 100 µM CsA (p = 0.029). CsA activated GSK3β and ERK1/2 and reduced ZO-1 expression. @*Conclusions@#CsA induces senescence in HCECs through oxidative stress and via mitochondria-, GSK3β-, and ERK1/2-dependent pathways. Thus, concentrations of CsA should be monitored.

Recent treatment of dry eye

Dry eye disease is a disease characterized by ocular irritation symptoms, tear film instability and ocular surface inflammation. Dry eye is due to aqueous tear deficiency or excessive tear evaporation, which causes damage to the ocular surface and is associated with ocular discomforts. A lot of therapy has been developed for treatment and management of dry eye disease. In this article, we review the current therapy for dry eye disease. We present the characteristics and efficacy of therapy for dry eye disease. We believe that our review will aid clinicians in the treatment of patients with dry eye disease.

Recent treatment of dry eye

Dry eye disease is a disease characterized by ocular irritation symptoms, tear film instability and ocular surface inflammation. Dry eye is due to aqueous tear deficiency or excessive tear evaporation, which causes damage to the ocular surface and is associated with ocular discomforts. A lot of therapy has been developed for treatment and management of dry eye disease. In this article, we review the current therapy for dry eye disease. We present the characteristics and efficacy of therapy for dry eye disease. We believe that our review will aid clinicians in the treatment of patients with dry eye disease.

Robotic Total Knee Arthroplasty with a Cruciate-Retaining Implant: A 10-Year Follow-up Study

BACKGROUND: This study compared clinical and radiological results between robotic total knee arthroplasty (TKA) and conventional TKA with a cruciate-retaining implant at 10-year follow-up. The hypothesis was that robotic TKA would allow for more accurate leg alignment and component placement, and thus enhance clinical and radiological results and long-term survival rates. METHODS: A total of 113 primary TKAs performed using a cruciate-retaining implant in 102 patients from 2004 to 2007 were reviewed retrospectively. Of the 113 TKAs, 71 were robotic TKAs and 42 were conventional TKAs. Clinical outcomes (visual analogue scale pain score, Hospital for Special Surgery score, Western Ontario and McMaster University score, range of motion, and complications), radiological outcomes, and long-term survival rates were evaluated at a mean follow-up of 10 years. RESULTS: Clinical outcomes and long-term survival rates were similar between the two groups. Regarding the radiological outcomes, the robotic TKA group had significantly fewer postoperative leg alignment outliers (femoral coronal inclination, tibial coronal inclination, femoral sagittal inclination, tibial sagittal inclination, and mechanical axis) and fewer radiolucent lines than the conventional TKA group. CONCLUSIONS: Both robotic and conventional TKAs resulted in good clinical outcomes and postoperative leg alignments. Robotic TKA appeared to reduce the incidence of leg alignment outliers and radiolucent lines compared to conventional TKA.

Causes of Aseptic Persistent Pain after Total Knee Arthroplasty

BACKGROUND: Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA. METHODS: Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees). RESULTS: In the intra-articular group, the main reasons for pain were aseptic loosening (n = 40), polyethylene wear (n = 16), instability (n = 10), recurrent hemarthrosis (n = 5), patellar maltracking (n = 4), tendon ruptures (n = 4), and stiffness (n = 2). In the extraarticular group, 10 knees (25.6%) were found to have nerve entrapment in the spine, 6 knees (15.4%) were found to have hip osteoarthritis or femoral head avascular necrosis. The reasons for persistent knee pain in the remaining 23 knees (59.0%) still remain elusive. CONCLUSIONS: Persistent pain after TKA originated from pathology of extra-articular origin in a considerable number of cases in this study. Therefore, it is important to perform thorough preoperative evaluations to reduce pain resulting from extra-articular causes. Furthermore, meticulous surgical procedures and optimal alignment are required to reduce pain of intra-articular origin related to implant wear, instability, and patellar maltracking.

Intraocular Lens Power Calculations Using Dual Scheimpflug Analyzer

PURPOSE: To investigate the accuracy of intraocular lens power calculations using simulated keratometry (simK) of dual Scheimpflug analyzer and 5 types of formulas in cataract patients. METHODS: The keratometry (K), axial length (AXL) and anterior chamber depth (ACD) were measured using ultrasound biometry (USB) combined with auto-keratometry (Auto-K), parital coherence interferometry (PCI; IOL master®) and dual Scheimpflug analyzer (DSA; Galilei®) in 39 eyes of 39 patients. Predicted refraction was calculated using Auto-K, mean K of PCI, and simK and total corneal power (TCP) of DSA in the Sanders-Retzlaff-Kraff (SRK-T) formula. The SRK-II, SRK-T, Holladay II, Haigis, and Hoffer-Q formula were used to calculate predicted refraction with the simK of DSA and AXL of USB. Manifest refraction, mean numerical error (MNE) and mean absolute error were evaluated 1, 3 and 6 months after cataract surgery. RESULTS: TCP of DSA was lower compared with other keratometric values (p < 0.05). The MNE was not different among Auto-K, mean K and simK. The MNE using TCP was larger compared with Auto-K, mean K and simK at 1 month after surgery (p < 0.05). There was a difference in MNE between simK and TCP of DSA at 6 months after surgery (p < 0.05). The MNE of SRK-T formula was the smallest in the intraocular lens (IOL) power calculation using the simK of DSA. CONCLUSIONS: We suggest using IOL power calculations with simK of DSA and SRK-T formula rather than TCP of DSA in cataract patients with normal corneas.

Oxidative Stress Levels in Aqueous Humor from High Myopic Patients

PURPOSE: To compare oxidative stress status in the aqueous humor of highly myopic eyes and control eyes. METHODS: Aqueous humor samples were collected from 15 highly myopic eyes (high myopia group) and 23 cataractous eyes (control group) during cataract surgery. Central corneal thickness, corneal endothelial cell density, hexagonality of corneal endothelial cells, and cell area of corneal endothelial cells were measured using specular microscopy. Axial length was measured using ultrasound biometry. 8-Hydroxydeoxyguanosine (8-OHdG) and malondialdehyde levels were measured using enzyme-linked immunosorbent assay. RESULTS: 8-OHdG level was lower in the aqueous humor of myopic patients than in that of control group (p = 0.014) and was positively correlated with central corneal thickness and negatively correlated with axial length (r = 0.511, p = 0.02; r = -0.382, p < 0.001). There was no correlation between 8-OHdG level and corneal endothelial cell density, hexagonality, or cell area. Malondialdehyde level did not show any correlation with any parameters evaluated. CONCLUSIONS: 8-OHdG might be a sensitive biomarker for evaluating oxidative stress status in the eye. Oxidative stress level was lower in the aqueous humor of highly myopic eyes compared to that in control eyes, which indicates lower metabolic activity in these eyes.

Predictors of Recurrent Ductal Carcinoma In Situ after Breast-Conserving Surgery / 한국유방암학회지

PURPOSE: Local recurrence is a major concern in patients who have undergone surgery for ductal carcinoma in situ (DCIS). The present study assessed whether the expression levels of hormone receptors, human epidermal growth factor receptor 2 (HER2), and Ki-67, as well as resection margin status, tumor grade, age at diagnosis, and adjuvant hormonal therapy and radiotherapy (RT) are associated with recurrence in women with DCIS. METHODS: In total, 111 patients with DCIS were included in the present study. The invasive and noninvasive recurrence events were recorded. The clinicopathological features; resection margins; administration of hormonal therapy and RT; expression statuses of estrogen receptor (ER), progesterone receptor (PR), and HER2; Ki-67 expression; and molecular subtypes were evaluated. Logistic regression analysis was performed to examine the risk factors for recurrence. RESULTS: Recurrence was noted in 27 of 111 cases (24.3%). Involvement of resection margins, low tumor grade, high Ki-67 expression, and RT were independently associated with an increase in the recurrence rate (p<0.05, Pearson chi-square test). The recurrence rate was not significantly associated with patient age; ER, PR, and HER2 statuses; molecular subtype; and hormonal therapy. CONCLUSION: The results of the present study suggested that the involvement of resection margins, low tumor grade, high Ki-67 index, and the absence of adjuvant RT were independently associated with increased recurrence in patients with DCIS. Future studies should be conducted in a larger cohort of patients to further improve the identification of patients at high-risk for DCIS recurrence.

Effect of Cysteamine on Human Peripheral Blood Mononuclear Cells-Chemically Injured Keratocytes Reaction

PURPOSE: To investigate the effect of cysteamine on mixed peripheral blood mononuclear cells (PBMCs)-chemically injured keratocytes reaction (mixed lymphocyte-keratocyte reaction; MLKR). METHODS: PBMC stimulation assay was performed after keratocytes were chemically injured with 0.05 N NaOH for 60 seconds. MLKR was treated with various concentrations of cysteamine (0-10 mM). Intracellular reactive oxygen species (ROS) formation was measured using the oxidation-sensitive fluorescent probe, 2'7'-dichlorofluorescein diacetate (DCF-DA). Proliferation rate of PBMCs stimulated by NaOH-treated keratocytes and secretion profiles of matrix metalloprotease-9 (MMP-9), transforming growth factor-beta1 (TGF-beta1), interleukin-6 (IL-6), and macrophage migration inhibitory factor (MIF) were determined using the bromodeoxyuridine proliferation assay and enzyme-linked immunosorbent assay, respectively. RESULTS: Proliferation rate of PMBCs was suppressed by cysteamine in a dose-dependent manner (p = 0.019). Fluorescence of DCF-DA decreased depending on cysteamine concentration (p < 0.001). MMP-9, IL-6 and TGF-beta1 levels were suppressed by cysteamine in a dose-dependent manner (p < 0.05), whereas MIF levels increased with cysteamine concentration of 0.5-10 mM (p = 0.008). CONCLUSIONS: These study results indicate that cysteamine induced the ROS-mediated inhibition of inflammatory cytokine release and proliferation of PBMCs stimulated by chemically injured keratocytes. Thus, cysteamine can be used in the treatment of chemical corneal burns.

Changes of the Meibomian Gland According to Age in the Normal Korean Population

PURPOSE: To examine the changes in meibomian glands associated with aging in a normal Korean population and to estimate the differences between the upper and lower eyelid in each age group. METHODS: We performed meibography on adult subjects using an infrared charge-coupled device (CCD) camera. Each eyelid was scored based on the loss of meibomian glands, and the meiboscores of the upper and lower eyelids were summed to obtain a score for each eye. Meiboscores were evaluated according to age, sex, and upper and lower eyelid meiboscores in each age group. RESULTS: One hundred seventeen eyes of 117 people were enrolled in this study. The study subjects had an average age of 50.4 +/- 19.1 years (range, 20-92; male, 56; female, 61). There was a significant positive correlation between age and total meiboscore, upper and lower eyelid meiboscore (r = 0.578, p < 0.001; r = 0.550, p < 0.001; r = 0.524, p < 0.001). There were no significant differences in the meiboscores of the upper and lower eyelids in any age group, though meiboscores were significantly higher since 40 year-old group than 20 year-old group (p < 0.001, p < 0.001, p < 0.001, p < 0.001). CONCLUSIONS: Based on noncontact meibography in normal adult eyes, the authors concluded that prevalence of changes in the meibomian glands was about 60% and changes in meibomian glands increase with age.

Internal Lens Signal Measured by Dual Scheimpflug Anterior Segment Analyzer

PURPOSE: To investigate the clinical significance of the internal lens signal measured using dual Scheimpflug anterior segment analyzer (Galilei(TM), Ziemer, Switzerland) in patients receiving cataract surgery. METHODS: The present study included 151 eyes of 148 patients who received surgery for senile cataracts from February 2012 to January 2013. Preoperative internal lens signals were measured preoperatively. The depth of anterior chamber and anterior angles were measured using dual Scheimpflug anterior segment analyzer preoperatively and 1 month postoperatively. Preoperative and postoperative best-corrected visual acuities (BCVAs) were measured. The relationships between preoperative internal lens signal and the changes in BCVA or anterior angles were evaluated. RESULTS: Internal lens signal and preoperative BCVA (log MAR) or preoperative anterior chamber depth were highly correlated (r = 0.287, p = 0.001 and r = -0.271, p = 0.004, respectively). Anterior angles increased 1 month after surgery compared with the preoperative values (p < 0.001). The amount of change between preoperative and postoperative anterior angles correlated with preoperative anterior angles (p < 0.001). However, no statistically significant correlation was observed between internal lens signal and preoperative anterior angles or postoperative BCVA. Internal lens signal correlated with changes in postoperative anterior angles (p < 0.001). CONCLUSIONS: Internal lens signal correlated with preoperative visual acuity and may help evaluate the cataract severity quantitatively and objectively. Internal lens signal may aid in understanding the structure of anterior segments by predicting the lens volume. Knowing the effect of visual impairment due to cataracts and predicting visual improvement after cataract surgery is necessary.

Comparison of Intraocular Pressure after Cataract Surgery According to Incisional Techniques

PURPOSE: In the present study we compared the intraocular pressure (IOP) after cataract surgery according to incisional techniques. METHODS: Patients who underwent phacoemulsification with intraocular lens implantation were divided into 2 groups: clear corneal incision group (CC group), and scleral tunnel incision group (ST group). All complicated cases were excluded. IOP was measured preoperatively and at 1 week, 1, 3, 6, 12, 18 and 24 months after surgery. RESULTS: Seventy-seven patients (100 eyes) were enrolled in the present study; CC group (28 patients, 33 eyes), ST group (49 patients 67 eyes). Preoperative IOPs in both groups were not significantly different (p = 0.908, student's t-test). IOP in the CC group at 1 week after surgery significantly decreased 2.22 +/- 2.57 mm Hg compared to preoperative IOP (p < 0.001, repeated-measures ANOVA with post hoc analysis), and the IOP of the ST group decreased 2.11 +/- 2.50 mm Hg (p < 0.001, repeated-measures ANOVA with post hoc analysis). The lowered IOP was maintained for 24 months postoperatively. There was no significant difference in IOP change after surgery depending on incisional techniques (p = 0.848, repeated measures ANOVA). CONCLUSIONS: There may be no difference in IOP lowering effect after surgery depending on incisional techniques.

A Novel Computerized Visual Acuity Test for Children

PURPOSE: To investigate the efficacy of a computerized visual acuity test, the SNU visual acuity test for children. METHODS: Fifty-six children, ranging from 1 to 5 years of age, were included. In a dark room, children gazed at and followed a circular dot with 50% contrast moving at a fixed velocity of 10 pixels/sec on a computer monitor. Eye movement was captured using a charge coupled device camera and was expressed as coordinates on a graph. Movements of the eye and dot were superimposed on a graph and analyzed. Minimum visualized dot diameters were compared to the Teller visual acuity. RESULTS: Ten eyes (8.9%) of six children failed to perform the Teller visual acuity test, and two eyes (1.8%) of one patient failed to perform the SNU visual acuity test. The observed Teller visual acuity and SNU visual acuity were significantly correlated (p < 0.001). Visual angle degrees converted from the Teller visual acuity and SNU visual acuity were also significantly correlated (p < 0.001). CONCLUSION: The SNU visual acuity using moving targets correlated well with Teller visual acuity and was more applicable than the Teller acuity test. Therefore, the SNU visual acuity test has potential clinical applications for children.

A Case of CMV Endotheliitis Treated with Intravitreal Ganciclovir Injection

We report a case of CMV corneal endotheliitis that was treated with intravitreal ganciclovir injection. A 56-year-old man who has suffered from uveitis was referred to our clinic due to corneal endothelial abnormality. Slit lamp examination showed a localized sectoral corneal edema and linear keratic precipitates along the boundary of edema. In spite of treatment with oral steroid and acyclovir, the disease progressed and two new coin-like lesions were developed. After topical ganciclovir and intavitreal injection of ganciclovir, the corneal lesions disappeared.

A Case of CMV Endotheliitis Treated with Intravitreal Ganciclovir Injection

We report a case of CMV corneal endotheliitis that was treated with intravitreal ganciclovir injection. A 56-year-old man who has suffered from uveitis was referred to our clinic due to corneal endothelial abnormality. Slit lamp examination showed a localized sectoral corneal edema and linear keratic precipitates along the boundary of edema. In spite of treatment with oral steroid and acyclovir, the disease progressed and two new coin-like lesions were developed. After topical ganciclovir and intavitreal injection of ganciclovir, the corneal lesions disappeared.

A Case of Retained Descemet's Membrane after Penetrating Keratoplasty

PURPOSE: To report a case of retained Descemet's membrane after penetrating keratoplasty (PKP). CASE SUMMARY: A 64-year-old man visited our clinic, complaining of visual disturbance and corneal opacity in his right eye 40 years in duration. On the first visit, his best corrected visual acuity was hand movement on the right eye, and he underwent an uneventful PKP. On the postoperative first day, the patient's visual acuity was 20/200 and slit lamp examination showed a retained Descemet's membrane and pseudo-chamber behind the corneal graft. The corneal graft was edematous, but no intraocular inflammation was observed. The retained Descemet's membrane was surgically removed a quarter at a time. Sutures in one quadrant were removed; the retained Descemet's membrane was lifted with forceps, removed with scissors and knife, and then sutured again. Two months after PKP, the corneal graft remained clear and no intraocular inflammation was observed. An extracapsular cataract extraction (ECCE) was then successfully performed with posterior chamber lens implantation for the senile cataract in his right eye. After the 1-year follow-up, the status of the corneal graft remained clear with a single anterior chamber and best corrected visual acuity improved to 20/100. CONCLUSIONS: Careful post-operative slit-lamp examination is considered important for diagnosis of retained Descemet's membrane after undergoing PKP, and surgical removal can be helpful for maintaining the corneal graft clear.

Corneal Thickness Measured by Dual Scheimpflug, Anterior Segment Optical Coherence Tomography, and Ultrasound Pachymetry

PURPOSE: To compare central corneal thickness (CCT) as measured by dual rotating Scheimpflug camera (Galilei), anterior segment optical coherence tomography (AS-OCT), and ultrasound pachymetry (USP). METHODS: The measurements of CCT using a dual rotating Scheimpflug camera, AS-OCT, and USP in 40 eyes of 20 healthy subjects were compared. RESULTS: The average measurements of CCT by dual rotating Scheimpflug camera, AS-OCT, and USP were 538.10 +/- 31.36 microm, 536.20 +/- 31.21 microm, and 541.93 +/- 34.93 microm, respectively. The CCT measurement by USP was statistically significantly thicker than by the dual rotating Scheimpflug camera and AS-OCT (p = 0.017, p = 0.001, respectively). There was no significant difference between the dual rotating Scheimpflug camera and AS-OCT (p = 0.054). A significant linear correlation was observed between the dual rotating Scheimpflug camera, the AS-OCT, and the USP (r > 0.900, p < 0.001). CONCLUSIONS: The results of the 3 methods have significant correlation with each other, but the measurement by USP was significantly thicker than the dual rotating Scheimpflug camera and AS-OCT. Therefore, CCT should be interpreted in the context of the instrument used.

Total Hip Arthroplasty in Patient with Osteonecrosis of the Femoral Head Following Liver Transplantation: Case Report

Liver transplantation has improved the survival of patients with end stage liver disease. As the rates of success of liver transplantation continue to increase, more patients who have a liver transplant will become candidates for joint replacement due to osteonecrosis. The incidence of osteonecrosis has been variously reported as from 2% to 8.2% after liver transplantation. However, there are only three reports in the English medical literature about total hip arthroplasty for osteonecrosis of the femoral head following liver transplantation, and especially there has not been such a report from Asian countries. We report here on two patients with transplanted livers and who then underwent total hip arthroplasty.