Changes in the Visual Field Test after Descemet Stripping Automated Endothelial Keratoplasty in Advanced Glaucoma.

Background: To evaluate changes in the visual field (VF) after Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with advanced glaucoma and previous trabeculectomy. Methods: Changes in VF, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications were analyzed before and after DSAEK in 19 eyes. The VFs were evaluated using the 10-2 program of the Humphrey Field Analyzer (HFA) and/or Goldmann perimetry (GP). Results: In nine eyes, the MD improved from -22.24 ± 6.5 dB to -18.36 ± 5.1 dB in HFA. In five out of nine eyes, postoperative MD improved >1 dB compared to preoperative MD. In GP testing, 10 out of 15 eyes showed an improvement, that is, greater than 20° in VF enlargement by the isopter of I-4e and/or new detection of a smaller or darker isopter. Overall, improvement in VF with the HFA and/or GP test was observed in 12/19 (63.2%) eyes after DSAEK. Postoperative BCVA improved by more than two lines in logMAR VA in 18 of 19 (94.7%) eyes. There were no significant differences between the preoperative and postoperative IOP and the number of glaucoma medications. Conclusions: DSAEK may produce subjective improvement in the visual field as well as improved visual acuity, even in advanced glaucomatous eyes.

Corneal ulcers with non-infectious appearance caused by nasolacrimal duct obstruction or canaliculitis.

Purpose: To describe the clinical features of corneal ulcers with non-infectious appearance due to nasolacrimal disease in a retrospective case series. Observations: Eight eyes of 8 patients (aged 74.4 ± 11.1 years) with corneal disease due to nasolacrimal duct obstruction or canaliculitis, who were treated between October 2013 and December 2020 at 3 hospitals were included. Patient background, anterior ocular findings, organisms in secretion, and time course during treatment were retrospectively analyzed. The corneal findings were peripheral ulcers (5 cases), phlyctenular keratitis (1 case), and paracentral perforation with slight cellular infiltration (2 cases). All cases were suspected as autoimmune disease-related-corneal ulcers because of the pathogenic region and clinical appearance and later diagnosed as corneal disorders derived from nasolacrimal duct obstruction or canaliculitis. The autoimmune disease-like appearance and purulent secretion connecting the punctum with/without swelling were characteristic. The most common microorganism detected in the purulent secretions was Streptococcus spp.. The resolution of corneal lesions needed steroid eye drops with antibiotic eye drops. Two patients required a superficial corneal transplantation. The extraction of nasolacrimal calculus, punctal tube insertion, or dacryocystorhinostomy was necessary for complete healing of ocular surface disease. Conclusions and importance: Nasolacrimal duct diseases cause corneal disorders without bacterial colonization and growth. When corneal ulcers resemble autoimmune disease in shape and are not accompanied by systemic disease, attention should be paid to nasolacrimal duct obstruction or canaliculitis.

Monitoring, Scaffolding, Intervening, and Overriding: Adult Children's Perspectives on Supporting Older Parents.

When older parents experience age-related functional limitations, adult children may begin to monitor and try to control their parents' behavior. This shift can lead to tension due to differences in values both generations share, with parents prioritizing autonomy and self-sufficiency and adult children prioritizing safety and convention. Although a great deal of research on the transition from adolescence to adulthood focuses on governance transfer and changing boundaries of autonomy, monitoring, and control, less is known about how this happens in later life. The current study used qualitative methodology to explore the dynamic balance of autonomy, safety, and care between older parents and adult children who provide assistance in their daily lives. It focused on which areas adult children were most likely to monitor and try to control and how they did so, how parents respond to those efforts, and the dynamics of information management. Sixteen adult children who had at least one living parent (M age = 53, SD = 6.1) discussed the challenges of managing two conflicting caregiving goals: respecting parents' autonomy and ensuring parents' moral well-being, health, and safety. Data were analyzed using directive content analysis. Although participants were concerned about the negative consequences of their parents' current behaviors and health conditions, they rarely impinged on their parents' autonomy until they were prompted by an authority figure or had clear evidence that their parents' health or safety were threatened. Parents often kept information about their activities and well-being from their children in order to protect their autonomy. Implications for balancing parents and adult children's goals of governance transfer are discussed.

Synthetic rubber sheet to manage exposure keratopathy.

PURPOSE: Exposure keratopathy often progresses even with conventional various treatments and needs plastic surgery. However, plastic surgery of eye lid is often difficult in cases with poor general condition by cerebrovascular disorders. We will propose a novel method using synthetic rubber sheet to manage the exposure keratopathy under poor general conditions. OBSERVATIONS: We treated with synthetic rubber sheet on 9 eyes of 9 patients who suffered from refractory exposure keratopathy due to cerebrovascular disorders. Sheets cut from sterile surgical gloves made of synthetic rubber (SR sheets) were placed directly onto the ocular surface with antibiotic ointment and fixed with gauze and tape. Severity of the exposure keratopathy was scored before and after the application of SR sheet. Covered ocular surface with SR sheet could keep an adequate moist environment and exposure keratopathy was improved in all the cases with no adverse effects during an average observation period of 166.2 days. CONCLUSIONS AND IMPORTANCE: Sterile synthetic rubber sheet cut from surgical gloves is an effective, safe, easy, and economical material to maintain better condition of ocular surface and especially useful for refractory exposure keratopathy under poor general condition.

Relationships between the clinical characteristics and copy numbers of DNA of cytomegalovirus determined by real-time PCR.

PURPOSE: To determine whether there is a correlation between the clinicals characteristics including various types of keratic precipitates and the copy numbers of the DNA of cytomegalovirus (CMV) in eyes with CMV corneal endotheliitis. METHODS: We reviewed the medical charts of four cases of corneal endotheliitis that were CMV-positive. We have classified types of clinical phenomenon into four types: coin-shaped KPs, sectoral corneal edema with or without Khodadoust line-like KPs, mutton-fat KPs, and fine KPs and have graded their severity. We also determined the copy numbers of the DNA of CMV in the aqueous humor by real-time polymerase chain reaction before and during the treatment. We evaluated the correlation between the patterns of clinical characteristics and copy number of the DNA of CMV. RESULTS: There were clinical improvements in all eyes following topical ganciclovir in conjunction with low dose of topical steroid treatment, with or without oral valganciclovir. The clinical characteristics and the copy numbers of the DNA of CMV varied during the treatment period. The presence of coin-shaped KPs was correlated with high copy numbers (105-103 copies/ml) of the DNA of CMV. The copy numbers of the DNA of CMV with sectoral corneal edema with or without Khodadoust line-like KPs ranged from 104 to 102 copies/ml, and it was occasionally accompanied by high intraocular pressure. Mutton-fat KPs were observed inferiorly, sometimes together with coin-shaped KPs and sectoral corneal edema, or solely. The copy numbers in eyes with mutton-fat KPs varied and occasionally less than the cutoff level. Fine-pigmented KPs were observed after the resolution of the endotheliitis, and no DNA of CMV was detected in the aqueous humor. CONCLUSIONS: Careful observations of the clinical characteristics such as the KPs and corneal edema might be helpful in estimating the amount of the DNA of CMV in eyes with corneal endotheliitis.

Case of bilateral Mooren's ulcers following filtering surgery using EX-PRESS glaucoma filtering devices.

PURPOSE: To report our findings in a case of bilateral Mooren's ulcer that developed after filtering surgeries using the EX-PRESS glaucoma filtering device (EX-PRESS surgery). PATIENTS AND METHODS: A 71-year-old Japanese man with primary open angle glaucoma underwent EX-PRESS surgery first in his left eye and 1 month later in his right eye. He developed Mooren's ulcer in his right eye at 7 months and in his left eye at 10 months after the initial EX-PRESS surgery. Systemic examinations showed no collagen vascular disease, and he did not have a history of bacterial or viral infections. He was not allergic to metallic materials. Before the EX-PRESS surgery, he had underdone cataract surgery combined with trabeculotomy in both eyes, and a reoperation of trabeculotomy in his left eye. He had not developed Mooren's ulcer after these surgeries. The Mooren's ulcer after the EX-PRESS surgery was treated with oral prednisolone (30 mg tapering) in combination with topical 0.1% betamethasone sodium. The ulcers were responsive and healed well in three months. CONCLUSIONS: The EX-PRESS devices were most likely the cause of the Mooren's ulcers considering that they were located close to the site of EX-PRESS insertion and no peripheral corneal ulcer developed after prior intraocular surgeries.

Interaction effect of familism and socioeconomic status on academic outcomes of adolescent children of Latino immigrant families.

INTRODUCTION: Previous research has shown inconsistent findings of the effect of familism on academic outcomes among adolescents from Latino immigrant families. Guided by social capital theory and the concept of gendered familism, the current study examined differential effects of family obligation and family cohesion as subcomponents separately. This study also investigated the moderating effect of familial SES on the association of each component of familism and academic outcomes by gender. METHODS: Participants were 1801 adolescents from Latino immigrant families (Mage = 14.1 years, SD = 0.83, range = 14-17) drawn from the Children of Immigrant Longitudinal Studies. The current study employed a series of multiple regression analyses to examine the effects of familism, assessed by family obligation and family cohesion, on adolescents' grade point average (GPA), educational expectations and aspirations. Multigroup analyses were also conducted to examine gender differences in the effect of familism on adolescents' academic outcomes. RESULTS: Analyses revealed the positive main effect of family cohesion and the negative effect of family obligations on Latino and Latina adolescents' GPA and educational expectations. For Latino adolescents, negative effect of family obligation on GPA was stronger for adolescents from high-SES families than those from low-SES families. CONCLUSION: It is imperative for researchers to conceptualize familism and operationalize the construct clearly. The effect of differences in family context and gender role expectation also needs to be considered in examining the association between familism and the academic outcomes of adolescents from immigrant families.

The Concept of Familism in the Lived Experiences of Mexican-Origin Caregivers.

This study qualitatively examined the experiences of Mexican-origin women caring for elderly family members in order to identify aspects of familism in their caregiving situations. Data were collected from onetime interviews with 44 caregivers living in the greater East Los Angeles area. Kinscripts guided the framing of familism in this study. Data were analyzed using a grounded theory approach. Caregivers' descriptions of the Mexican family reflected an idealized view of familism. Caregivers reported a lack of support from others and relying for support on fewer family members than were potentially available to them. Findings suggest that the construct of familism has evolved from its long-standing portrayals in the literature. More research is needed to reexamine familism as a theoretical perspective to explain how Mexican-origin families negotiate and construct elder care over the family life course.

Incidence of late-onset ocular hypertension following uncomplicated pars plana vitrectomy in pseudophakic eyes.

PURPOSE: To determine the incidence of late-onset ocular hypertension following uncomplicated vitrectomy in pseudophakic eyes with an open angle. DESIGN: A retrospective observational case series. METHODS: Seven hundred and sixty-seven eyes of 767 patients that underwent vitrectomy combined with cataract surgery in 1 eye were studied. There were 383 men and 384 women. The indications for vitrectomy were: 308 eyes with rhegmatogenous retinal detachment, 202 eyes with epiretinal membrane, 169 eyes with macular hole, 44 eyes with vitreous hemorrhage, 16 eyes with subretinal hemorrhage, 15 eyes with vitreomacular traction syndrome, 12 eyes with vitreous opacity, and 1 eye with retinoschisis. Of these, 176 eyes underwent vitrectomy alone because of previous cataract surgery. Late-onset ocular hypertension was defined as an intraocular pressure (IOP) >21 mm Hg that developed more than 2 months postoperatively in at least 2 postoperative visits. An increase in the IOP >4 mm Hg over the preoperative IOP was necessary. Eyes with ocular hypertension, glaucoma (suspect), or a possibility of IOP elevation were excluded. RESULTS: The mean age was 63 ± 11 years. The mean follow-up duration after vitrectomy was 47.8 ± 25.3 months. Thirty-two eyes (4.2%) developed late-onset ocular hypertension. The mean age was 60 ± 10 years. The mean interval between vitrectomy and development of ocular hypertension was 31.1 ± 26.0 months. There were no significant differences in the incidence of late-onset ocular hypertension and the vitreoretinal disease for vitrectomy, sex, or gauge of instruments for vitrectomy. CONCLUSION: Long-term IOP monitoring is necessary after vitrectomy.

Difference in morning and evening choroidal thickness in Japanese subjects with no chorioretinal disease.

BACKGROUND AND OBJECTIVE: To determine whether the choroidal thickness varies significantly according to the time of measurement in Japanese subjects without chorioretinal diseases. PATIENTS AND METHODS: Twelve eyes of 12 subjects were examined with enhanced depth imaging spectral-domain optical coherence tomography. The choroidal thickness was measured in the mornings (9:00 to 9:30 AM) and evenings (7:30 to 8:00 PM) at three locations: the fovea, 1.5 mm temporal to the fovea, and 1.5 mm nasal to the fovea. RESULTS: The mean age of the subjects was 62.6 ± 14.5 years. For the morning measurements, the mean choroidal thickness was 308.5 ± 74.4 µm at the fovea, 276.2 ± 84.6 µm temporally, and 239.3 ± 98.4 µm nasally. For the evening measurements, the mean choroidal thickness was 328.8 ± 85.6 µm at the fovea, 284.8 ± 91.6 µm temporally, and 248.9 ± 101.5 µm nasally. The mean subfoveal (P < .0001) and nasal (P = .03) choroidal thicknesses were significantly thicker in the evenings than in the mornings. There was no significant difference in the mean temporal choroidal thickness (P = .08). CONCLUSION: The choroidal thickness varies according to the time of measurement.