Blepharokeratoconjunctivitis Presumably Caused by Paederus fuscipes, a Beetle: A Case Report.

Toxicity of Paederus species to eyes has scarcely been reported. This report presents a case of chemical blepharokeratoconjunctivitis with delayed re-epithelialization caused by Paederus fuscipes in a patient with dry eye after laser-assisted in situ keratomileusis (LASIK). A 47-year-old woman who had undergone LASIK for myopia 10 years prior experienced visual disturbance and pain in her left eye after being hit by a P. fuscipes insect in her eye 1 day prior to evaluation. At the initial presentation, dermatitis around the patient's left eye, eyelid oedema, conjunctival chemosis, corneal epithelial defects, and a best corrected visual acuity (BCVA) of 20/200 were noted. No gram-positive/negative bacteria or indication of cellulitis/elevated inflammation was detected. Administration of topical steroids (betamethasone) and antibiotics (topical: cefmenoxime and levofloxacin; intravenous: ceftriaxone) improved the non-infectious chemical blepharokeratoconjunctivitis; however, the large corneal epithelial defect remained for 10 days. Switching from betamethasone to a preservative-free form facilitated re-epithelialization, and the patient's BCVA improved to 20/16 after 2 months. Ophthalmologists should consider the toxicity of the Paederus species on the ocular surface and eyelid.

Corneal Edema with Anterior Uveitis after Exposure to the Sap of Euphorbia trigona: A Case Report.

Although a few cases of dermatitis or keratitis caused by exposure to the sap of Euphorbia trigona have been reported, we present a rare case of transient corneal endothelial dysfunction following exposure to the sap, resulting in corneal edema. A woman in her 70s complained of reduced vision, redness, and teariness in her left eye 2 days after exposure to the sap of E. trigona at home. Upon examination, hyperemia, serious corneal edema, and anterior uveitis with hypopyon were observed in her left eye, without corneal epithelial defects or keratic precipitates. The best-corrected visual acuity (BCVA) was 2.0 (logarithm of the minimum angle of resolution), and the measured central corneal thickness (CCT) was 812 µm. The patient was treated with topical instillation of 1.5% levofloxacin and 0.1% dexamethasone to reduce intraocular inflammation and corneal edema. Three weeks later, the BCVA reached 0, the CCT was 519 µm, and the corneal endothelial cell density was 3,233 cells/mm2. Six months after the injury, the patient had good visual acuity, and the cornea was completely transparent. No recurrence of corneal edema or anterior uveitis was observed. Exposure to the sap of E. trigona can lead to severe corneal edema with anterior uveitis, impairing visual acuity. Taking precautions to prevent the exposure of the eye to the sap of this plant is crucial.

Benzalkonium Chloride Resistance in Staphylococcus epidermidis on the Ocular Surface of Glaucoma Patients Under Long-Term Administration of Eye Drops.

Purpose: We previously reported the presence of multidrug-resistant staphylococci on the ocular surface of glaucoma patients using prostaglandin analog drops for more than 1 year. Here, we investigated the effect of benzalkonium chloride (BAC) on these multidrug-resistant staphylococci. Methods: Staphylococcus epidermidis was isolated from the conjunctival sacs of 32 eyes of 32 patients comprised of 13 eyes treated with 0.005% latanoprost (Xalatan; Xa group) and 19 eyes treated with 0.004% travoprost (Travatan Z; Tz group). The minimum inhibitory concentrations (MICs) of prostaglandin analogs and BAC were measured. The presence of efflux pump genes was analyzed using polymerase chain reaction. Results: No difference was found in the MIC values of prostaglandin analogs. In contrast, the MIC values of BAC were significantly higher for the isolates from the Xa group than for those from the Tz group (2.02 vs. 1.02 µg/mL; P = 0.001). One proton-motive efflux gene, qacC/smr, was detected more frequently in the Xa isolates than in the Tz isolates (P < 0.001). The prevalence of methicillin resistance was correlated with the presence of qacC/smr (P = 0.010), and the MIC of BAC was significantly correlated with the detection of qacA/B and qacC/smr sequences (P = 0.03 and P < 0.001, respectively). Conclusions: The long-term use of eye drops containing BAC might select BAC-resistant S. epidermidis harboring qacC/smr. Translational Relevance: These findings suggest that the long-term use of eye drops containing BAC might be inappropriate in terms of avoiding antimicrobial resistance.

Twelve-month efficacy and safety of glaucoma filtration device for surgery in patients with normal-tension glaucoma.

PURPOSE: To assess the efficacy and safety of filtration surgery using the EX-PRESS glaucoma filtration device in patients with normal-tension glaucoma (NTG). STUDY DESIGN: Prospective, single-arm, multicenter interventional case series. METHODS: Eyes with NTG underwent EX-PRESS implantation with or without cataract surgery. The efficacy and safety were assessed at 1 day; 1 and 2 weeks; and 1, 3, 6, and 12 months after surgery. The main outcome measure was reduction in intraocular pressure (IOP) from baseline at 3, 6, and 12 months after surgery. Safety assessments included adverse event incidence, postoperative inflammation, and corneal endothelial cell density. RESULTS: Thirty-two Japanese patients (37 eyes) with NTG were enrolled. The mean IOP decreased from 14.8 ± 2.3 mmHg at baseline to 10.0 ± 3.1 mmHg at 12 months after surgery (mean reduction 4.9 ± 4.2 mmHg [31.1%]; P < .0001). IOP-lowering medication use decreased from a mean of 3.3 medications per eye before surgery to 0.1 medications per eye at 12 months after surgery. IOP reductions > 20% were achieved by 61.5% of the eyes at 12 months. Adverse events were typical for filtration procedures, and none was deemed device-related. Postoperative inflammation was mild and self-limiting. The mean corneal endothelial cell density had decreased by 3.3% at 12 months after surgery. CONCLUSION: The EX-PRESS glaucoma filtration device is safe and effective for filtration surgery in patients with NTG, providing mean IOP reduction consistent with recommendations based on the Collaborative NTG Study.

Conjunctival Bacteria Flora of Glaucoma Patients During Long-Term Administration of Prostaglandin Analog Drops.

Purpose: To investigate the effects of the long-term use of prostaglandin analogs for glaucoma treatment on the indigenous flora of the conjunctiva. Methods: Bacterial isolates were collected from the conjunctival sacs of 68 patients at Miyata Eye Hospital from February to September 2014, who had been receiving continuous monotherapy with prostaglandin analogs for glaucoma for at least 1 year. Minimum inhibitory concentrations of levofloxacin, gatifloxacin, moxifloxacin, cefmenoxime, tobramycin, chloramphenicol, and erythromycin against the isolates were measured to determine susceptibility. Results: The positive culture rate in all cases was 90.5% (57/63 eyes), and a total of 79 bacterial strains were isolated. The isolated bacteria included aerobic gram-positive cocci (8% Staphylococcus aureus and 41% Staphylococcus epidermidis), coagulase-negative staphylococci (5%), Streptococcus spp. (1%), Corynebacterium spp. (4%), gram-negative bacteria (4%), and the facultative anaerobe Propionibacterium acnes (33%). The positive culture rates for patients using 0.005% latanoprost (Xa group) and 0.004% travoprost (Tz group) were 88.9% and 92.6%, respectively, with no statistically significant difference in the composition of isolated bacteria between groups. Methicillin-resistant S. epidermidis (MRSE) was significantly more frequently isolated in the Xa group. The antimicrobial susceptibility rates of S. epidermidis were significantly lower in the Xa group for levofloxacin, gatifloxacin, moxifloxacin, and tobramycin. Conclusions: The indigenous flora may be affected by the long-term use of prostaglandin analogs. The higher incidence of MRSE in the Xa group should be considered during the long-term, continuous administration of eye drops, such as in glaucoma treatment.

[Comparison between subtraction skin electrodes and corneal-contact electrodes in flash electroretinograms].

PURPOSE: To compare electroretinogram (ERG) responses measured with a skin electrode with those from a corneal-contact electrode in healthy adults. METHOD: Sixty two eyes of 31 healthy adults (8 men and 23 women) were enrolled (mean age 34.0 +/- 8.1 years). ERG responses for full-field and single flash stimuli was recorded with skin electrodes and corneal-contact electrodes. Morphology of the ERG waveform, a-wave and b-wave amplitudes, b/a ratios, and a-wave and b-wave implicit times were compared between the two electrode measurements. Correlations between the two measurements were also examined. RESULTS: All features of the ERG waveform were identifiable using the skin electrodes. In the skin electrode ERGs, a-wave and b-wave amplitudes, and the b/a ratios were smaller (p<0.001) and the a-wave and b-wave implicit times were shorter (p<0.001) than those in the corneal-contact electrode ERGs. The B-wave amplitudes, b/a ratios and the a-wave and b-wave implicit times showed significant correlations between the two electrodes (p<0.01). In 16 eyes the OP4 was detected as the b-wave. CONCLUSION: The skin electrode ERG had shorter amplitudes and shorter implicit times than the corneal electrode ERGs, but corresponded well in its morphology to the corneal-contact electrode ERGs. Skin electrodes ERG would be useful for the examination of child patients and patients with corneal diseases. Further study is required for clinical application.

Ray-tracing intraocular lens power calculation using anterior segment optical coherence tomography measurements.

PURPOSE: To assess the efficiency of ray-tracing intraocular lens (IOL) power calculation with anterior segment optical coherence tomography (AS-OCT) in normal eyes with cataract. SETTING: Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. DESIGN: Case series. METHODS: The study comprised consecutive patients who had cataract surgery and obtained a corrected visual acuity of 0.15 logMAR or better postoperatively. Preoperatively, Placido topography and AS-OCT measurements were taken during a routine examination. The predicted postoperative refractions were obtained using 3 methods: the SRK/T formula with autokeratometry, ray-tracing calculation with Placido topography data, and ray-tracing calculations with AS-OCT measurement of both corneal surfaces. The refractive errors from the manifest refraction spherical equivalent were compared 1 month postoperatively, and the effects of corneal eccentricity and posterior corneal curvature were evaluated. RESULTS: Seventy patients (102 eyes) were enrolled. There was no significant difference in refractive errors (P=.89). The refractive error with the SRK/T formula was correlated significantly with corneal eccentricity (P=.0017); the ray-tracing calculations were unaffected. There was a weak correlation with the posterior corneal curvature in the ray-tracing calculations performed with Placido topography (P<.0002). CONCLUSION: The accuracy of the ray-tracing IOL power calculations using AS-OCT data was comparable to that of the conventional formula and minimized the effect of corneal eccentricity and posterior corneal curvature.

[Effects of laser in situ keratomileusis on intraocular pressure measurements in Japanese myopic eyes].

PURPOSE: To prospectively compare preoperative and postoperative measurements of intraocular pressure (IOP) using Goldmann applanation tonometry (GAT), noncontact tonometer (NCT), and Dynamic contour tonometer (DCT) in eyes undergoing myopic laser in situ keratomileusis (LASIK) and to examine the effects of preoperative corneal curvature and IOP, and the change in central corneal thickness (CCT). METHODS: One hundred six eyes of 53 patients underwent myopic LASIK with -5.3 +/- 2.3 (mean +/- SD) diopters. Within 4 weeks before and at 1 month after LASIK, IOP using GAT, NCT and DCT and CCT were measured. RESULTS: Postoperatively, although IOP was reduced in the three measurements, IOP changes in DCT (-0.9 +/- 1.7 mmHg) were significantly lower than in the GAT (-3.6 +/- 2.1 mmHg) and in the NCT (-4.7 +/- 1.9 mmHg) measurements (p < 0.001, Tukey test). In all the measurements, the decrease in the IOP increased with the higher preoperative IOP (p < 0.001). Changes in the CCT were significantly correlated in the GAT and NCT measurements (p < 0.015). CONCLUSIONS: IOP measurements using DCT minimized the changes in IOP readings after myopic LASIK in Japanese eye. This demonstrated that the DCT was effective for IOP monitoring after LASIK.

Intraindividual comparison of aspherical and spherical intraocular lenses of same material and platform.

PURPOSE: There have been few studies which compared aspherical and spherical intraocular lenses (IOLs) of same material and platform in bilateral cataract cases. We performed an intraindividual comparison of ocular aberration and scotopic, mesopic, and photopic contrast sensitivity with aspherical and spherical IOLs, using the same IOL material and platform manufactured by the same company. DESIGN: Prospective, randomized, controlled study. PARTICIPANTS: Eighty-two eyes of 41 patients undergoing bilateral cataract surgery. METHODS: One eye of a patient was assigned to acrylic foldable aspherical IOL (Tecnis ZA9003, Advanced Medical Optics), and the contralateral eye was allocated to acrylic foldable spherical IOL (AR40e, Advanced Medical Optics). All patients were examined at 2 days, 1 week, and 1 month postoperatively. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA), contrast sensitivity under scotopic (15 lux), mesopic (70 lux), and photopic (180 lux) conditions, corneal and ocular wavefront aberrations, anterior chamber depth, amount of IOL decentration and tilt, pupil diameter under scotopic (3 lux) and photopic (250 lux) conditions, area of anterior capsule opening, degree of posterior capsule opacification, and all-distance visual acuity. RESULTS: There was no significant difference between IOLs in BCVA, anterior chamber depth, amount of IOL decentration and tilt, pupil diameter, area of anterior capsule opening, and degree of posterior capsule opacification. In corneal wavefront aberrations, there was no difference in 3rd-, 4th-, and total higher-order root-mean-square (RMS). In ocular wavefront aberration, aspherical IOL showed significantly lower 4th-order (P<0.001) and total higher-order RMS (P<0.001) than spherical IOL, but not in 3rd-order RMS (P = 0.103). Contrast sensitivity under scotopic conditions was significantly better with aspherical IOL than with spherical IOL at 3 (P = 0.0015), 6 (P = 0.0192), and 12 cycles per degree (P = 0.0315). Contrast sensitivity under mesopic and photopic conditions was not significantly different between IOLs. There was no between-group difference in visual acuity at 0.3, 0.5, 0.7, 1.0, or 5.0 meters measured with full distance correction. CONCLUSIONS: Acrylic foldable aspherical IOL (Tecnis ZA9003) yielded significantly lower ocular wavefront aberration and better contrast sensitivity under scotopic condition without compromising depth of focus. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

One-year prospective intrapatient comparison of aspherical and spherical intraocular lenses in patients with bilateral cataract.

PURPOSE: To conduct longitudinal, intrapatient comparisons of aspherical and spherical silicone intraocular lenses (IOL) of the same material and platform in patients undergoing bilateral cataract surgery. DESIGN: Prospective, randomized study. METHODS: Sixty-two eyes of 31 patients were randomized to receive a silicone aspherical IOL (Tecnis Z9000; AMO Inc, Santa Ana, California, USA) in 1 eye and a silicone spherical IOL (CeeOn 911A; AMO Inc) in the other eye. Best spectacle-corrected visual acuity (BSCVA); corneal and ocular wavefront aberrations; contrast sensitivity under photopic (180 lux), intermediate (75 lux), and scotopic (15 lux) illumination; amount of IOL decentration and tilt; and degree of posterior capsular opacification were measured at 1, 3, 6, and 12 months after surgery. All-distance visual acuity (VA) was measured 3 months after surgery. RESULTS: There were no significant differences between IOLs with regard to BSCVA, amount of IOL decentration and tilt, degree of posterior capsule opacification, and all-distance VA at any point after surgery. Regarding corneal wavefront aberrations, there was no difference in third- and fourth-order root mean square (RMS). In ocular wavefront aberrations, aspherical IOLs showed significantly lower fourth-order RMS (P < .001) than spherical IOLs throughout the study, but not in third-order RMS. Contrast sensitivity under photopic and mesopic conditions was not different between IOLs, but contrast sensitivity under scotopic conditions was significantly better with aspherical IOLs than with spherical IOLs (P < .01) at all measurement points. CONCLUSIONS: The silicone aspherical IOL (Tecnis Z9000; AMO Inc) significantly reduced ocular spherical aberration and improved scotopic contrast sensitivity, and these results were consistent through the 1-year follow-up.

Influences of optic edge design on posterior capsule opacification and anterior capsule contraction.

PURPOSE: To investigate the influence of optic edge design on posterior capsule opacification (PCO) and anterior capsule contraction (ACC). METHODS: A total of 43 eyes of 43 patients scheduled to undergo cataract surgery were included in this study. Patients received either a Sensor AR40 intraocular lens (IOL) or a Sensor AR40e IOL. The area of the anterior capsule opening (ACO) was determined by diaphanoscopy using the anterior eye segment analysis system EAS-1000 at 1 day, 1 week and 1, 3, 6 and 12 months postoperatively. Posterior capsule opacification was evaluated objectively in two ways, using either the EAS-1000 or POCOman. RESULTS: There was no significant difference between the two groups in either ACO area or percentage reduction of ACO area at any time-point after surgery. The difference in the degree of PCO 1 year after surgery was not significant when measured by either the EAS-1000 or POCOman. CONCLUSIONS: A sharp IOL edge is required to prevent PCO. Sharp-edged IOLs do not appear to be a risk factor for ACC.

Residual bed thickness and corneal forward shift after laser in situ keratomileusis.

PURPOSE: To prospectively assess the forward shift of the cornea after laser in situ keratomileusis (LASIK) in relation to the residual corneal bed thickness. SETTING: Miyata Eye Hospital, Miyazaki, Japan. METHODS: Laser in situ keratomileusis was performed in 164 eyes of 85 patients with a mean myopic refractive error of -5.6 diopters (D) +/- 2.8 (SD) (range -1.25 to -14.5 D). Corneal topography of the posterior corneal surface was obtained using a scanning-slit topography system before and 1 month after surgery. Similar measurements were performed in 20 eyes of 10 normal subjects at an interval of 1 month. The amount of anteroposterior movement of the posterior corneal surface was determined. Multiple regression analysis was used to assess the factors that affected the forward shift of the corneal back surface. RESULTS: The mean residual corneal bed thickness after laser ablation was 388.0 +/- 35.9 microm (range 308 to 489 microm). After surgery, the posterior corneal surface showed a mean forward shift of 46.4 +/- 27.9 microm, which was significantly larger than the absolute difference of 2 measurements obtained in normal subjects, 2.6 +/- 5.7 microm (P<.0001, Student t test). Variables relevant to the forward shift of the corneal posterior surface were, in order of magnitude of influence, the amount of laser ablation (partial regression coefficient B = 0.736, P<.0001) and the preoperative corneal thickness (B = -0.198, P<.0001). The residual corneal bed thickness was not relevant to the forward shift of the cornea. CONCLUSIONS: Even if a residual corneal bed of 300 microm or thicker is preserved, anterior bulging of the cornea after LASIK can occur. Eyes with thin corneas and high myopia requiring greater laser ablation are more predisposed to an anterior shift of the cornea.

A clinical evaluation of uveitis-associated secondary glaucoma.

PURPOSE: To investigate the clinical features of secondary glaucoma associated with uveitis. METHODS: The subjects of the study were 1,099 patients with uveitis (1,604 eyes) treated at the Miyata Eye Hospital, Miyakonojo, Miyazaki, between October 1974 and January 2000. The intraocular pressure (IOP) and clinical data were analyzed retrospectively. Secondary glaucoma was diagnosed in the patients when IOP was higher than 21 mm Hg at two consecutive visits and they needed treatment with medication to control the high IOP. RESULTS: Secondary glaucoma was found in 293 eyes (18.3%) of 217 patients (19.7%) among the uveitis patients. The clinical entity with the highest incidence of secondary glaucoma was Posner-Schlossman syndrome in 100%, followed by sarcoidosis in 34.1%, herpetic anterior uveitis in 30.4%, Behçet's disease in 20.8%, human leukocyte antigen-B27-related acute anterior uveitis in 20.0%, Vogt-Koyanagi-Harada's disease in 16.4%, and human T-lymphotropic virus type 1 uveitis in 16.2%. Among these 293 eyes with secondary glaucoma, the majority (72%) had active anterior uveitis at the time of high IOP. Only 7.5% of the secondary glaucoma eyes had peripheral anterior synechia wider than 180 degrees of the trabecular meshwork. Steroid-induced glaucoma was found in only 8.9% of the secondary glaucoma eyes. Surgical therapy, mainly trabeculectomy with anti-metabolites, was performed in 38 eyes and the post-surgical IOP was controlled under 20 mm Hg in 34 eyes. Despite the medical and surgical therapy for secondary glaucoma, visual field defect was found in 39% of the secondary glaucoma eyes. CONCLUSIONS: The incidence of secondary glaucoma in the 1,604 eyes with uveitis was 18.3%, but it differed depending upon the clinical entity of the uveitis. The evaluation and the management of IOP are very important in the treatment of patients with uveitis, in addition to the management of intraocular inflammation.

[A clinical evaluation of uveitis-associated secondary glaucoma].

PURPOSE: To investigate the clinical features of secondary glaucoma associated with uveitis. SUBJECTS AND METHODS: The subjects of the study were 1,604 eyes of 1,099 patients with uveitis at Miyata Eye Hospital, Miyakonojo, Miyazaki, between October 1974 and January 2000. The intraocular pressure (IOP) and clinical data were analyzed retrospectively. Secondary glaucoma was defined as being an IOP higher than 21 mmHg and needing treatment with medication to control the high IOP. RESULTS: Secondary glaucoma was found in 293 eyes (18.3%) of 217 patients (19.7%) among the uveitis patients. The clinical entity with the highest frequency of secondary glaucoma was Posner-Schlossman syndrome in 100%, followed by sarcoidosis in 34.1%, herpetic anterior uveitis in 30.4%, Behçet's disease in 20.8%, HLA-B 27 related acute anterior uveitis in 20.0%, Vogt-Koyanagi-Harada' disease in 16.4%, and HTLV-1 uveitis in 16.2%. Among the 293 eyes with secondary glaucoma, the majority (72%) had active anterior uveitis at the time of high IOP. Only 7.5% of secondary glaucoma eyes had peripheral anterior synechia wider than 180 degrees of trabecular meshwork. Steroid glaucoma was found only in 8.9% of the secondary glaucoma eyes. Surgical therapy mainly with trabeculectomy with anti-metabolites was performed in 38 eyes and the postsurgical IOP was controlled to 20 mmHg or lower in 36 eyes. Despite the medical and surgical therapy for secondary glaucoma, defect of the visual field was found in 38% of the secondary glaucoma eyes. CONCLUSIONS: The frequency of secondary glaucoma in 1,604 eyes with uveitis was 18.3%, and the frequency of secondary glaucoma differed depending upon the clinical entity of uveitis. The evaluation and the management of IOP are very important in treatment patients with uveitis, in addition to the management of intraocular inflammation.