Effect of Intracameral Epinephrine and Indocyanine Green Use on Corneal Endothelium during Cataract Surgery

Purpose@#To investigate the safety of single and combined use of epinephrine and indocyanine green during cataract surgery by evaluating the effects on corneal endothelial cells. @*Methods@#From January 2017 to October 2021, 121 patients (132 eyes) who underwent cataract surgery were enrolled. Patients were divided into 4 groups: epinephrine (n = 20), indocyanine green (n = 49), epinephrine and indocyanine green combination (n = 12), and control (n = 51). Retrospective medical chart findings and endothelial cell count change data were compared among study groups before and after operation. @*Results@#Endothelial cell count change (△ECC) decreased for all groups; however, a significant difference among groups was not observed (p = 0.822). Univariate linear regression showed that △ECC was associated with postoperative hexagonality, nuclear sclerosis grade, ultrasound time, and cumulative dissipated energy (beta = -0.216, 0.254, 0.368, 0.351 and p = 0.013, p = 0.003, p < 0.001, p < 0.001). Multivariate linear regression showed that △ECC was associated with postoperative hexagonality and ultrasound time (beta = -0.215, 0.367, p = 0.010, p < 0.001). @*Conclusions@#Factors closely associated with postoperative endothelial cell loss were postoperative hexagonality and ultrasound time. No significant damage to the corneal endothelium was observed when epinephrine and indocyanine green were used alone or in combination. Thus, these agents appear safe for use in this context.

Clinical Study of Changes in Eye Dominance after Pseudophakic Conventional Monovision

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.

Non-invasive Myocardial Strain Imaging to Evaluate Graft Failure in Cardiac Xenotransplantation / 대한이식학회지

BACKGROUND: The shortage of human hearts for allotransplantation makes xenotransplantation a possible option for controllable organ providers. To detect acute xenograft rejection, invasive biopsy seems inevitable; however, this occasionally results in poor incision wound healing or infection. To date, no method of noninvasive imaging for early detection of xenograft rejection has been established. We hypothesized that ultrasound speckle tracking would better detect xenograft failure than routine left ventricular ejection fractions (EF). METHODS: From August 2013 to July 2015, a total of six cardiac heterotopic xenotransplants (α 1, 3-galactosyltransferase gene-knockout porcine heart) into cynomolgus monkeys were monitored with echocardiography every 3 to 7 days. M-mode and two-dimensional (2D)-EF measurements and myocardial strain analyses were performed. Cardiac xenograft pathology was reviewed from the immediate postoperative biopsy, as well as the necropsy. RESULTS: Myocardial speckle tracking analysis was feasible in all six cases. The longest survival was 43 days. Only one pathology-proven immunologic rejection occurred. Cardiac xenograft failure appeared as two types: a dilated pattern with decreased EF or a myocardial-thickening pattern with preserved EF. Both antibody-mediated rejection (n=1) and sepsis-induced myocardial dysfunction (n=2) revealed decreased radial or circumferential strains, but normal-range EF. Xenograft functional decline was significant with respect to radial or circumferential strain (P=0.028), but not to conventional M-mode or 2D-EFs (P=0.600, P=0.340, respectively). CONCLUSIONS: Radial and circumferential strains were significantly decreased in both types of xenograft failure, regardless of EF. Further studies are warranted to correlate the strain analysis and immunopathological details.

Clinical Results of Pseudophakic Monovision 1 Year after Cataract Surgery

PURPOSE: In this study, the visual performance and patient satisfaction one year after monovision cataract surgery and the results after 2 months. METHODS: Thirty patients who had bilateral cataract surgery between February 2010 and January 2014 treated with monovision therapy and received postoperative examinations for at least one year after surgery were enrolled in the present study. The eye with the more severe cataract had the surgery first and was corrected for distance vision targeted at emmetropia. The fellow eye was operated for near vision targeted to -1.50~-2.50 diopter (D) range considering the patient's need for near task and preoperative refractive errors 2-4 weeks after the first operation. Binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), spherical equivalent, anisometropia, stereopsis, patient satisfaction for far and near distance, and spectacle dependence were evaluated preoperatively and two months and one year postoperatively. RESULTS: The mean age of patients was 71.9 years. Two months and one year after the surgery, the binocular UCDVA (log MAR) were 0.03 ± 0.10 and 0.08 ± 0.14, UCNVA were 0.21 ± 0.15 and 0.25 ± 0.14, anisometropia were 1.28 ± 0.68 and 1.29 ± 0.76 D, and stereopsis were 301.67 ± 251.28 and 251.67 ± 269.28 arcsec, respectively. One year after the surgery, the number of patients answering ‘Better’ or ‘Much better’ for distant vision was 27 (90%) and for near vision 22 (73.3%); 11 patients (36.7%) answered ‘Not dependent on spectacles at all’. CONCLUSIONS: Monovision is an effective method to correct presbyopia after bilateral cataract surgery. Visual performances and patient satisfaction at one year after cataract surgery were not different compared with those at two months.

Changes in Central Corneal Thickness and Corneal Endothelial Morphology in Contact Lens-Wearing Diabetic Patients

PURPOSE: To evaluate the changes in central corneal thickness and corneal endothelium in contact lens-wearing diabetic patients. METHODS: This study included 113 patients who visited the Department of Ophthalmology, Konkuk University Medical Center from August 2006 to August 2007. Ultrasound pachymetry and noncontact specular microscopy were performed on the right eyes of 26 diabetic patients who regularly wore soft contact lenses (group 1), 27 diabetic patients who did not wear soft contact lenses (group 2), 30 soft contact lens-wearers without diabetes mellitus (DM) (group 3), and 30 normal subjects who did not wear soft contact lenses (group 4). Central corneal thickness, corneal endothelial cell density, endothelial cell coefficient of variation, and percentage of hexagonal endothelial cells were compared between the groups. RESULTS: Average duration of diabetes in groups 1 and 2 was 4.38 and 4.41 years, respectively, and average duration of soft contact lens wear in groups 1 and 3 was 5.27 and 3.65 years, respectively. The central cornea was significantly thicker and the endothelial cell density was significantly lower in group 1 than in groups 3 and 4. The cell size coefficient of variation was higher in group 1 than in groups 2 and 4 and higher in group 3 than in group 4. The percentage of hexagonal cells was significantly lower in group 3 than in group 4. CONCLUSIONS: Central corneal thickness and endothelial cell density are more affected by DM than contact lens use, and corneal endothelial cell morphology is influenced more by contact lens use than DM. Contact lens use in diabetic patients significantly influences all characteristics of the corneal endothelium compared with those in normal subjects. Patients with DM should be advised not to wear contact lenses.

Central Corneal Thickness and Corneal Endothelial Cell Changes Caused by Contact Lens Use in Diabetic Patients

PURPOSE: To analyze the effects of soft contact lenses on central corneal thickness and morphologic characteristics of the corneal endothelium in diabetic patients. MATERIALS AND METHODS: Ultrasound pachymetry and noncontact specular microscopy were performed on 26 diabetic patients who regularly use soft contact lenses (group 1), 27 diabetic patients who do not use soft contact lenses (group 2) and 30 normal subjects (group 3). We compared the values in each group using the Mann-Whitney test. RESULTS: The central cornea was found to be thicker in diabetic patients, both those who use and do not use contact lenses, than in the normal control group. The central corneal thickness was significantly higher in group 1 (564.73 +/- 35.41 microm) and group 2 (555.76 +/- 45.96 microm) than in the control group (534.05 +/- 27.02 microm), but there was no statistically significant difference between groups 1 and 2. Endothelial cell density was significantly different between the groups, and was smallest in the group of diabetic patients using contact lenses. The coefficient of variation of cell size was significantly higher and the percentage of hexagonal cells was significantly lower in contact lens using diabetic patients than in non-contact lens using diabetic patients and in the control group. CONCLUSION: Central corneal thickness and endothelial cell density is more affected by diabetes mellitus, and corneal endothelial cell morphology is more affected by contact lens use, when compared with normal subjects.

Preliminary Effects of Oral Uridine on the Ocular Surface in Dry Eye Patients

We designed a randomized, double blinded, 3-months controlled prospective clinical study to investigate effects of oral uridine on the ocular surface in dry eye patients. Twenty-seven patients who diagnosed as dry eye with lower than 5 mm of wetting in the Schirmer strip, with corneal epithelial erosion and who completely followed-up till 3 months were enrolled. Corneal-conjunctival fluorescein staining, non-anesthetic Schirmer test, impression cytology, and Ocular Surface Disease Index (OSDI) were evaluated in the experimental and placebo groups at the baseline, 1 and 3 months after start of medication in a double blinded manner. Fluorescein stain score of the cornea was markedly decreased in oral uridine group compared to the placebo group at 3 months after medication (P=0.032, Mann-Whitney U test). The Schirmer wetting score for the oral uridine group was significantly increased (P=0.001, Wilcoxon signed rank test) at 3 months and its difference between two groups was statistically significant (P=0.030, Mann-Whitney U test). OSDI scores were significantly decreased at 1 and 3 months in treatment group. Oral uridine is effective in treatment of dry eyes.

The Feasibility of Short-term Dry Eye Animal Model Using Concanavalin A

PURPOSE: To evaluate the possibility of short-term dry eye model in rabbits by injection of concanavalin A (conA) to the lacrimal and haderian gland of rabbits. METHODS: We injected conA (10 mg/ml, 0.05 ml) to the lacrimal and haderian gland of rabbits twice to induce inflammation of lacrimal gland and compared with saline-injected control by lacrimal gland biopsy with H&E staining for identification of inflammation. The ratio of lacrimal secretion was evaluated by Schirmer test (preinjection vs. postinjection of conA) for 10 days and the number of goblet cells was counted in 10 consecutive high power field using impression cytology with PAS staining. The corneal & conjunctival apoptotic cell deaths were investigated with TUNEL staining 10 days after injection. RESULTS: Infiltration of inflammatory cells and destructed normal architecture of lacrimal gland was found only in conA injected group till 10 days. The Schirmer test showed marked reduction (0.56+/-0.26) by 5days after injection compared with control group (1.07+/-0.35) (p=0.02) and its significant difference was maintained till 10days. The number of goblet cell was 9.70+/-5.03/x200HPF, which was statistically significant decreased compared to control (47.50+/-17.13/x200HPF) at 10 days (p=0.00). Apoptotic cells were increased in injected eye (26.20+/-4.27) compared with those in control (16.60+/-2.70). CONCLUSIONS: Injection of conA to lacrimal glands in rabbit shows decrease of lacrimal secretion and similar cytological changes of the cornea and conjunctiva in human dry eye patients. It suggests its possible feasibility of short-term dry eye animal model for the 10 days.

Isolation of Putative Limbal Epithelial Stem Cells by Fluorescein Activated Cell Sorting

PURPOSE: To analyze the isolating pattern of slow cycling cells as putative limbal epithelial stem cells (PLESCs) using Hoechst exclusive cell sorting. METHODS: Rabbits were injected with 5-bromo-2-deoxyuridine (Brd U) 1 month prior to be sacrificed. After obtaining limbal tissues, fluorescence-activated cells were sorted on a Coulter EPICS 753 after they had been incubated with Hoechst 33342 and propidium iodide. Two different methods were applied to sort PLESCs. Side-population(Sp) cells were obtained using gates with dichroic mirror to detect low Hoechst blue and red after verapamil was treated. Hoechst negative cells were obtained using gates exhibiting low Hoechst blue with a 424/44 BP filter. Brd U-retaining cells were counted and their sizes were evaluated in each gated sample to compare isolating pattern of PLESCs in each method. RESULTS: The percentages of Sp cells and of the Hoechst negative fraction were 0.96 +/- 0.79% and 16.01 +/- 13.60%, respectively(p=0.021). Homogeneity and density of the small cells were higher in Hoechst negative fraction than in Sp cells. The percentage of Brd U-retaining cells was 47.36 +/- 10.34% and 47.14 +/- 14.94% in Sp cells and Hoechst negative fraction, respectively(p>0.05), and they were 10 times higher than in non-Sp and Hoechst positive fraction(p=0.000). CONCLUSIONS: Hoechst negative exclusion without verapamil more efficiently isolated PLESCs than Sp did.