Pterygium surgery using the principle of contact inhibition: results of 13 years' experience.

PURPOSE: To report a technique to prevent pterygium recurrence using the principle of contact inhibition. METHODS: Two hundred and fifteen patients (232 eyes; average age, 64.1 years) with primary pterygia who underwent pterygium surgery at the Hara Eye Hospital between 1999 and 2012. We retrospectively evaluated the patients who underwent the following procedure to prevent pterygium recurrence. The surface conjunctiva on the pterygium body was not removed. After removing the pterygium body, by placing a narrow pedicle autoconjunctival flap along the corneal limbus and tying it tightly to the front area of the residual conjunctiva, there is no room for the active residual tissue to proliferate, thus preventing a recurrence by contact inhibition. The key factor is conjunctival suturing, which establishes face-to-face contact of both areas of cut conjunctival tissue. Mitomycin C is applied locally for 3 min intraoperatively and 5 days postoperatively. The main outcome measure was the prevention of pterygium recurrence using this technique. RESULTS: By the end of the average follow-up of 5 years 4 months, three eyes (1.3%) had a recurrence. Among the 232 eyes, 23 eyes had large pterygia extending to the pupillary area. Using the surgical technique, there were no recurrences. No specific characteristic of the recurrence was found in association with the eye, sex, and preoperative grade. CONCLUSIONS: This surgery has three relevant features: (1) reconfirmation of the effect of contact inhibition, (2) the anatomic structure of the conjunctival sac scarcely changes postoperatively, because the surface conjunctiva of the pterygium body is not removed, and (3) a low recurrence rate.

Posterior capsular opacification in highly myopic eyes with an endocapsular equator ring.

PURPOSE: Closed 9.5-mm-diameter endocapsular equator rings (E-rings) prevent posterior capsular opacification (PCO). However, in our research, some highly myopic patients unexpectedly developed late, extensive PCO that required capsulotomy. We also report for the first time how the capsule reacted to neodymium-doped yttrium aluminium garnet (Nd:YAG) laser shots. METHODS: Sixty-two eyes (39 patients; average age, 48 ± 13.2 years) were implanted with a closed, square-edged silicone E-ring (outer diameter, 9.5 mm) and an intraocular lens between April 16, 2008, and November 30, 2011. RESULTS: During the postoperative, minimal 2-year follow-up, PCO requiring Nd:YAG laser capsulotomy developed in six (9.7 %) of 62 eyes, of which five had -8.75 to -12.5 diopters (D) of myopia preoperatively. The axial lengths of those eyes ranged from 25.86 to 29.97 mm. However, none of the 13 eyes with higher myopia had severe PCO that required capsulotomy. All capsulotomies were performed uneventfully. CONCLUSION: The standard 9.5-mm-diameter closed E-ring does not prevent extensive PCO in eyes with preoperative myopia ranging between -8.75 and -12.5 D and an axial length between 25.86 and 29.97 mm. Posterior capsulotomies were performed safely. Further study is needed to determine why PCO did not occur in more high myopic eyes (larger axial length eyes).

Structure of the entire capsular bag containing an endocapsular equator ring and intraocular lens.

UNLABELLED: We report in vivo observation of a capsular bag containing an endocapsular equator ring and intraocular lens that was explanted 5 years after the initial surgery. The capsule equator remained completely circular. The inside of the capsular bag retained the open space, and the endocapsular equator ring blocked proliferative tissue under the anterior capsule at the equator and prevented posterior capsule opacification. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Long-term study of posterior capsular opacification prevention with endocapsular equator rings in humans.

OBJECTIVE: To confirm the effect of a square-edged, closed endocapsular equator ring (E-ring) for preventing posterior capsular opacification (PCO) after cataract extraction. METHODS: Fifty-one eyes underwent cataract surgery associated with E-ring implantation between October 2002 and March 2008. Group 1 included 14 patients (14 eyes) who received an E-ring and intraocular lens (IOL) in 1 eye before March 2006. Their fellow eyes received only an IOL as controls. Group 2 included 23 patients (37 eyes) who received an E-ring and IOL in 1 or both eyes after March 2006 and another 37 age-matched control eyes with only IOL implants. After cataract removal, the E-ring (1.0 mm wide and thick and 9.0 or 9.5 mm long) was implanted in the capsule and an IOL was fixed in the ring. In the control eyes, only an IOL was implanted. The follow-up periods were 2 to 7 years. The PCO value was determined using the Hayashi method. RESULTS: Two years postoperatively in group 1, the PCO value in the central area of the eyes with an E-ring was significantly lower than in the controls (4.4 vs 11.4, respectively; P = .005). No eyes with an E-ring required Nd:YAG laser posterior capsulotomy postoperatively compared with 23 of 51 control eyes (45%). The posterior capsule in the eyes with an E-ring remained transparent without touching the IOL optic. The 9.5-mm ring fit all eyes. CONCLUSION: The 9.5-mm E-ring, which fit all eyes, prevented PCO in human eyes 2 to 7 years postoperatively.

Infero-eyebrow blepharoplasty for the upper eyelids of elderly patients.

AIMS: To describe a procedure for removing excess wrinkles from the upper lids of elderly patients. METHODS: Excess wrinkles were resected with a razor blade and scissors or CO(2) laser along the lower eyebrow margin. Ninety-five patients (average age 74 ± 8.1 years) (157 eyes) underwent this procedure and were followed for at least 6 months postoperatively. RESULTS: The average size of the excised skin was 40 ± 9.7 × 12 ± 3.9 mm. Complications included under-resection, which required another resection in six eyes (4%) and a subcutaneous haemorrhage in two eyes (1%). All patients expressed satisfaction with the final cosmetic results. The incision faded almost completely by 6 months postoperatively without camouflage. CONCLUSION: The design and technique were extremely uncomplicated. The main drawbacks were the long incision line under the eyebrow, a slightly slimmer eyebrow and postoperative brow drop. However, all incision lines faded almost completely by 6 months postoperatively, and brow drop was not problematic in bilateral surgeries. This procedure does not replace the current popular procedure for lid crease formation. However, general ophthalmologists can perform the current simple procedure to remove excess wrinkles from the upper lids of elderly patients.

Generation of high-quality higher-order Laguerre-Gaussian beams using liquid-crystal-on-silicon spatial light modulators.

We report on the high-quality holographic generation of higher-order Laguerre-Gaussian (LG) beams using a liquid-crystal-on-silicon spatial light modulator. The effects of the input beam pattern on the output LG beam quality are investigated in detail through theoretical discussions and experiments. Correlation analyses between observed beam patterns and theoretical mode profiles reveal that higher beam quality is achieved for output LG beams generated from a top-hat input beam than from a Gaussian input beam.

Epithelial photorefractive keratectomy as an enhancement procedure after laser in situ keratomileusis.

The authors describe the refractive effect of epithelial photorefractive keratectomy (E-PRK) on 10 eyes that had undergone LASIK (group 1) and 13 eyes that had not been operated on (group 2). The central 6 mm was ablated. The mean corneal epithelium removed was 15.64 +/- 8.703 microm in group 1 and 25.23 +/- 7.069 microm in group 2. In group 1, the mean postoperative best uncorrected visual acuity (BUCVA) was 1.24 +/- 0.344, which was sustained for a mean of 2.75 +/- 3.456 months and returned to the preoperative value in 6.1 +/- 4.61 months. In group 2, all patients reported severe ocular pain and the BUCVA decreased except for 2 patients whose eyes reached 1.0 at 1 week postoperatively. All eyes reached the preoperative BUCVA by 1 month. This method is contraindicated for previously unoperated corneas but may be useful to enhance post-LASIK eyes when standard enhancement surgery is problematic.

Universal generation of higher-order multiringed Laguerre-Gaussian beams by using a spatial light modulator.

Laguerre-Gaussian (LG) beams of various higher-order radial modes are generated by using a reflective phase-only liquid crystal on silicon (LCOS) spatial light modulator (SLM). Because of the LCOS SLM's phase-modulation characteristic of a wide spatial bandwidth, a phase modulation scheme effectively generates higher-order LG beams of up to the fifth-order radial mode. We also perform correlation analyses between the observed and the theoretical two-dimensional mode profiles to universally obtain correlation coefficients of more than 0.946, which suggest mode generations of high quality.

Preventing posterior capsular opacification with an endocapsular equator ring in a young human eye: 2-year follow-up.

OBJECTIVE: To report the results of a specially designed closed ring with a square edge (endocapsular equator ring) in a young patient to prevent posterior capsular opacification. METHODS: One eye of a 22-year-old atopic patient underwent endocapsular equator ring implantation with a 1-piece polymethylmethacrylate intraocular lens immediately after phacoemulsification at Hara Eye Hospital on January 10, 2003. The solid flexible silicone ring has an outer diameter of 9.0 mm, is 1.0 mm wide and 1.0 mm thick, and has a square edge. The loops of the intraocular lens are fixed in the inner groove of the ring. The contralateral control eye underwent phacoemulsification and implantation with a conventional intraocular lens implantation. The Hayashi method was used to determine the posterior capsular opacification score. RESULTS: The ring retained the transparency of the entire posterior capsule. Two years postoperatively, the posterior capsular opacification score in the central area was 3.75 in the ring eye and 15.25 in the control eye, which underwent Nd:YAG laser capsulotomy 2.5 years postoperatively. CONCLUSION: An endocapsular equator ring effectively prevents posterior capsular opacification in a young patient with atopic cataracts.

Total care system for maintaining a comfortable prone position after vitreoretinal surgery.

A care system to maintain a comfortable prone position after vitreoretinal surgery was developed. Four positions and face-down gear including a TV-watching table were prepared in patients' rooms. Patients could take one position and then change to another position actively as desired. Thirty-nine patients used this system for 4 days after vitreoretinal surgery with intravitreal gas injection. Patients rated the system on a questionnaire. Patients who used the TV-watching table expressed more satisfaction than the patients who did not use it. Also, patients' active selection of various prone postures was important physically and mentally.

Increase of peak intraocular pressure during sleep in reproduced diurnal changes by posture.

OBJECTIVE: To characterize diurnal intraocular pressure (IOP) changes in primary open-angle glaucoma by reproducing IOPs based on patient posture. METHODS: In 148 patients with untreated primary open-angle glaucoma who had IOPs recorded during clinic hours that were less than 21 mm Hg (average, 14.8 +/- 3.2 mm Hg), we measured IOP by noncontact tonometry every 2 hours from 6 am to midnight and every 3 hours from midnight to 6 am with patients sitting and supine. The IOP was reproduced by designating the sitting IOP as measurements taken when the patient was awake and the supine IOP as measurements taken when the patient was asleep for each individual. The reproduced diurnal IOP was composed of 12 measurements that included 2 to 4 IOP levels measured with the patients supine and the rest while they were sitting. RESULTS: The peak of sitting diurnal IOP (mean +/- SD) for 148 patients was 16.0 +/- 2.7 mm Hg, which was significantly lower than the peak of supine IOP (18.9 +/- 3.9 mm Hg) or the reproduced IOP (17.5 +/- 3.6 mm Hg) (P<.001 for both comparisons). The average reproduced IOP at each measurement time peaked at 3 am during sleep; with sitting diurnal IOP or supine diurnal IOP, the peak IOPs were at noon. Twenty-nine patients (20%) with an IOP less than 21 mm Hg during clinic hours had a reproduced IOP of 21 mm Hg or greater while asleep, compared with only 5 patients (3%) when the patients were sitting only. CONCLUSIONS: In patients with primary open-angle glaucoma and IOPs less than 21 mm Hg during clinic hours, 20% of patients had a reproduced IOP of 21 mm Hg or greater, compared with only 3% who had an IOP of 21 mm Hg or greater while sitting. Intraocular pressures peaked in most patients during sleep.

Ten-year results of anterior chamber fixation of the posterior chamber intraocular lens.

OBJECTIVE: To report the outcomes in eyes in which a Sinskey-type conventional posterior chamber intraocular lens (PC-IOL) was fixed in the anterior chamber and followed up for an average of 10 years. METHODS: Twenty-one eyes were included in the study. The IOLs were conventional hard PC-IOLs, 13.0 mm in overall length with 6.0-mm polymethylmethacrylate optic and polyvinylidene fluoride loops that tilted 10 degrees anteriorly. RESULTS: At implantation the corneal endothelial cell density in 13 of 21 eyes was 382 to 1580 cells/mm(2) owing to the previous implantation of iris-clip or iridocapsular IOLs. The overall postoperative corneal endothelial cell loss was 30.9%. Six of 14 eyes with a preoperative corneal endothelial cell density less than 2000 cells/mm(2) developed bullous keratopathy. Although serious complications did not occur in 7 eyes with a cell density exceeding 2000 cells/mm(2), an average corneal endothelial cell loss of 26.5% still occurred. Except for 2 eyes, all loops were fixed at the scleral spur and a slight pupillary transformation occurred in only 1 eye. CONCLUSION: Although this procedure is easy to perform and pupillary transformation does not occur, it is not recommended for aphakic eyes owing to the high corneal endothelial cell loss after an average 10-year follow-up.

Lipoprotein lipase activator NO-1886 improves fatty liver caused by high-fat feeding in streptozotocin-induced diabetic rats.

NO-1886 is a lipoprotein lipase (LPL) activator. Administration of NO-1886 results in an increase in plasma high-density lipoprotein cholesterol (HDL-C) and a decrease in plasma triglyceride (TG) levels. The aim of this study was to ascertain whether NO-1886 improves fatty liver caused by high-fat feeding in streptozotocin (STZ)-induced diabetic rats. Administration of NO-1886 resulted in increased plasma HDL-C levels and decreased TG levels without affecting total cholesterol and glucose levels in the diabetic rats. NO-1886 dose-dependently decreased liver TG contents and cholesterol contents, resulting in improvement of fatty liver. NO-1886 also reduced plasma aspartate aminotransferase (AST) and alanine aminotransferase (ALT) that accompany fatty liver. The liver cholesterol contents were inversely correlated with plasma HDL-C levels (r = -0.5862, P <.001) and were positively correlated with plasma TG levels (r = 0.4083, P <.003). The liver TG contents were inversely correlated with plasma HDL-C levels (r = -0.6195, P <.001) and were positively correlated with plasma TG levels (r = 0.5837, P <.001). There was no correlation between plasma cholesterol levels, and cholesterol and TG contents in liver. These results indicate that reducing plasma TG levels and elevating in HDL-C levels may result in improving fatty liver.

Ethyl icosapentate (omega-3 fatty acid) causes accumulation of lipids in skeletal muscle but suppresses insulin resistance in OLETF rats. Otsuka Long-Evans Tokushima Fatty.

Ethyl icosapentate (EPA) is known to improve insulin resistance in non-insulin-dependent diabetes mellitus (NIDDM); however, its mechanism is unclear. In this study, we attempted to determine the mechanism of EPA's effects on insulin resistance in Otsuka Long-Evans Tokushima Fatty (OLETF) rats. Administration of EPA caused a reduction in plasma cholesterol and triglycerides, but increased cholesterol and triglyceride contents in skeletal muscle. EPA did not have an effect on glucose or insulin levels. EPA accelerated the glucose infusion rate (GIR) and improved the endothelium-dependent relaxation of OLETF rat the thoracic aorta caused by addition of acetylcholine. However, the improvement observed in endothelium-dependent relaxation disappeared after addition of N(w)-nitro-L-arginine (L-NA). Furthermore, when L-NA and indomethacine were added to the medium, relaxation of the aorta in EPA-treated rats was weaker than that in control rats. These actions may cause NO induction in the endothelium and an increase in prostaglandin I(2) (PGI(2)) and prostaglandin I(3) (PGI(3)) action, which in turn may result in improvement of insulin resistance.

A lipoprotein lipase activator, NO-1886 prevents impaired endothelium-dependent relaxation of aorta caused by exercise in aged rats.

Exercise decreases plasma total cholesterol and triglycerides, and simultaneously, increases high density lipoprotein (HDL) cholesterol. As a result, exercise is believed to aid in preventing atherosclerosis. However, we do not know whether exercise protects against the development of atherosclerosis in the elderly. The aim of this study was to ascertain whether the lipoprotein lipase activator NO-1886 had an effect on the prevention of atherosclerosis in aged rats which undergo exercise. Exercise for 3 months did not affect plasma lipids but decreased the accumulation of visceral fat in 2-year-old rats (aged rat). Exercise also resulted in an elevation of plasma lipid peroxide (LPO) levels and impaired the endothelium-dependent relaxation of the thoracic aorta caused by acetylcholine in aged rats. On the other hand, NO-1886 decreased plasma triglycerides and increased HDL cholesterol and suppressed the elevation of plasma LPO levels caused by exercise. Furthermore, NO-1886 prevented impaired endothelium-dependent relaxation caused by exercise. In summary, the results of our study indicate that exercise may cause impaired endothelium-dependent relaxation by elevation of LPO in aged rats, and that NO-1886 prevents this impaired endothelium-dependent relaxation of aorta by reducing plasma triglycerides, elevating HDL cholesterol, and suppressing the elevation of plasma LPO caused by exercise.

Correlation between lipid and glycogen contents in liver and insulin resistance in high-fat-fed rats treated with the lipoprotein lipase activator NO-1886.

Insulin resistance results in accumulation of triglyceride content and reduction of glycogen content in skeletal muscle. However, very few studies have measured lipid content and glycogen content in liver associated with insulin resistance. We studied the relationship between liver lipid content, liver glycogen, and insulin resistance in high-fat-fed rats, which are animal models of insulin resistance. High-fat-fed rats were hyperlipidemic, hyperglycemic, and hyperinsulinemic. Furthermore, the glucose infusion rates (GIR) were lower (normal rats, 10.35 +/- 1.66; high-fat-fed rats, 4.86 +/- 0.93 mg/kg/min; P <.01) and the triglyceride and cholesterol contents in liver were higher in the high-fat-fed rats than in normal rats. On the other hand, the glycogen content in liver was lower than in normal rats. There was an inverse relationship between liver triglyceride content and liver glycogen content. When the lipoprotein lipase (LPL) activator NO-1886 was administered to the high-fat-fed rats at a daily dose of 50 mg/kg body weight for 10 weeks, GIR (9.87 +/- 3.76 mg/kg/min, P <.05 v high-fat-fed control group) improved, causing an improvement of the hyperlipidemia, hyperglycemia, and hyperinsulinemia. Furthermore, NO-1886 decreased triglyceride and cholesterol concentrations and increased glycogen content in liver of the high-fat-fed rats. In this study, we found that insulin resistance caused fatty liver and reduced glycogen content in liver. Administration of the LPL activator NO-1886 improved the insulin resistance, resulting in an improvement in the relationship between triglyceride and glycogen content in liver of high-fat-fed rats.