Aqueous Humor Levels of Cytokines in Patients with Age-Related Macular Degeneration.

PURPOSE: To compare aqueous humor levels of various cytokines between patients with age-related macular degeneration (AMD) and cataract patients. METHODS: Thirteen eyes with wet-type AMD (AMD group) and 14 eyes with cataract (cataract group) were studied. Aqueous humor levels of 11 factors (vascular endothelial growth factor receptors, growth factors, and inflammatory factors) were measured by the suspension array method. RESULTS: Aqueous humor levels of vascular endothelial growth factor, soluble vascular endothelial growth factor receptor (sVEGFR)-1, sVEGFR-2, and inflammatory factors (monocyte chemotactic protein (MCP)-1, interleukin (IL)-6, and IL-8) were significantly higher in the AMD group than in the cataract group (all p < 0.05). In contrast, aqueous humor levels of placental growth factor (PGF), tumor necrosis factor-α, soluble intercellular adhesion molecule (sICAM)-1, IL-12 (p70), and IL-13 showed no significant difference between the two groups. There were significant correlations between sVEGFR-1 or sVEGFR-2 levels and some of the inflammatory molecules (PGF, sICAM-1, MCP-1, IL-6, and IL-8). CONCLUSIONS: These findings suggest that various cytokines/growth factors involved in inflammation and angiogenesis may be associated with the pathogenesis of AMD.

Letter to the Editor: Corneoscleral Melt 50 Years after Excision of Pterygium.

PURPOSE: To report a case of corneoscleral melt that occurred 50 years after resection of pterygium with postoperative administration of mitomycin C (MMC). RESULTS: A 93-year-old woman developed acute corneal perforation and scleral melt in her left eye at 50 years after pterygium surgery with postoperative topical MMC. She underwent limbal transplantation. The anterior chamber reformed postoperatively and her intraocular pressure was normal. At 12 months after transplantation, best-corrected visual acuity was 20/500 and the graft-host junction was well apposed. CONCLUSION: This case shows that corneoscleral melt can occur even 50 years after resection of pterygium combined with postoperative topical MMC.

Changes of conjunctivochalasis after cataract surgery via a superior transconjunctival sclerocorneal incision.

The purpose of this study was to evaluate the changes in the severity of conjunctivochalasis after cataract surgery performed via a superior conjunctival sclerocorneal incision. Prospective investigation was performed in a consecutive series of 36 eyes of 36 patients aged 62-85 years who underwent phacoemulsification and implantation of a 6.0-mm foldable intraocular lens through a 2.8-mm superior sclerocorneal incision. The age, gender, medical history, ocular history, grade, refraction, and axial length were determined in all subjects. The conjunctivochalasis score (0-3) and other parameters were determined at three sites (nasal, middle, and temporal) according to the system for grading conjunctivochalasis proposed by Meller and Tseng (at baseline and at 1, 4, and 12 weeks postoperatively). The total conjunctivochalasis score (sum of the scores for the temporal, middle, and nasal regions: 0-9) increased significantly from 4.0 ± 1.9 at baseline to 4.8 ± 2.1 at 1 week postoperatively (p = 0.0048), and subsequently decreased again at 4 weeks (4.3 ± 2.0) and 12 weeks (4.0 ± 1.9). Multivariate logistic regression analysis showed that progression of conjunctivochalasis at 12 weeks was significantly associated with the axial length [odds ratio (OR) = 1.21, p = 0.0118] and with conjunctival suture placement (OR = 1.34, p = 0.0493). When cataract surgery was performed via a superior sclerocorneal incision, the severity of conjunctivochalasis at 12 weeks postoperatively was similar to that at baseline. Our findings suggest that a superior sclerocorneal incision has no influence on the progression of conjunctivochalasis after cataract surgery.

A diagnostic method for herpes simplex keratitis by simultaneous measurement of viral DNA and virus-specific secretory IgA in tears: an evaluation.

PURPOSE: We performed simultaneous measurement of herpes simplex virus (HSV) DNA by real-time polymerase chain reaction (real-time PCR) and of HSV-specific secretory IgA antibody (HSV-sIgA) by enzyme-linked immunosorbent assay (ELISA) in tears obtained using Schirmer strips in order to investigate its diagnostic efficacy for herpes simplex keratitis (HSK). METHODS: A total of 59 affected eyes from 59 patients with clinically suspected HSK (HSK group) and 23 eyes from 23 healthy volunteers (control group) were enrolled in this study. The HSK group was divided into five subgroups: dendritic/geographic keratitis, disciform keratitis, necrotizing keratitis, atypical keratitis, and others. The tear samples were taken using Schirmer strips to determine the HSV DNA and HSV-sIgA levels. RESULTS: The overall sensitivity and specificity were 55.8 and 100 % for HSV DNA and 49.2 and 82.6 % for HSV-sIgA. The HSV DNA levels in the disciform keratitis subgroup (median, 3.1 × 10(2) copies/sample) were significantly lower than those in the dendritic/geographic keratitis subgroup (median, 2.3 × 10(4) copies/sample) (P < 0.05, Mann-Whitney test). The HSV-sIgA levels in the disciform keratitis subgroup (median, 50.0 NU/ml) were significantly higher than those in the control group (median, 18.0 NU/ml) (P < 0.05, Steel test). The positive and negative predictive values obtained by simultaneous measurement of HSV DNA and sIgA were 90.9 and 61.3 %, respectively. CONCLUSION: The combination of laboratory detection of HSV DNA by real-time PCR and of HSV-sIgA by ELISA using tear samples enables higher reliability in diagnosing the subgroups of HSK, although the HSV DNA value is relatively lower in disciform HSK than in dendritic/geographic HSK.

Effect of aflibercept in patients with age-related macular degeneration.

The purpose of this study was to evaluate the efficacy of standard induction therapy with intravitreal aflibercept (IVA) in patients with exudative age-related macular degeneration (AMD) at 6 months after completion of induction therapy. Eleven eyes with typical AMD (tAMD) and 13 eyes with polypoidal choroidal vasculopathy (PCV) received three monthly doses of IVA (2 mg/0.05 ml in weeks 0, 4, and 8) for treatment of exudative AMD. Best-corrected visual acuity (BCVA) was measured, and optical coherence tomography was performed at baseline and at each monthly visit until 6 months after IVA. Treatment failure was defined as persistent or recurrent AMD that presented with cystoid macular edema, serous retinal detachment, and pigment epithelium detachment. Mean logMAR BCVA was improved from 0.62 ± 0.46 at baseline to 0.54 ± 0.43 at 6 months after IVA (p < 0.05). The success rate was 95.8 % at 3 months and 75.0 % at 6 months after IVA. Failure of IVA was positively associated with the absence of PVD before treatment (r = 0.35) and with the AMD type (tAMD, r = 0.43) by univariate analysis. Cox proportional hazards analysis demonstrated that the absence of PVD before treatment was associated with an increased risk of failure of IVA (OR = 33.17, p = 0.0219). Three months of induction IVA achieved a high success rate in patients with AMD monitored for up to 6 months. Factors associated with failure of IVA were the absence of PVD and the presence of tAMD. Accordingly, continuation of IVA following induction therapy may be beneficial to manage AMD in patients with tAMD or those without PVD.

LETTER TO THE EDITOR Excision of Congenital Bilateral Persistent Pupillary Membrane in a Child with Exotropia.

PURPOSE: To report the clinical and histopathological findings of a patient who had bilateral persistent pupillary membrane with exotropia and high hyperopia. CASE REPORT: A 7-year-old boy presented with a persistent pupillary membrane in both eyes. His best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/32 in the left eye with exotropia of 18 prism diopters. He underwent surgical resection of both membranes. At 5 months postoperatively, BCVA was 20/20 with final bilateral refraction of +6.5 D in both eyes. Exotropia and photophobia showed improvement immediately after surgery. Histopathological examination revealed typical features of normal iris tissue in the excised membranes. CONCLUSION: Bilateral persistent pupillary membranes were excised successfully without injury to other ocular tissues, including the crystalline lens. Surgical treatment may be required for the management of persistent pupillary membrane associated with visual impairment such as exotropia or photophobia.

Specific IgG for cat allergens in patients with allergic conjunctivitis.

Immunoglobulin G (IgG) antibodies are involved in type II and type III hypersensitivity. We evaluated the relation between perennial allergic conjunctivitis and serum levels of specific IgG for cat allergens. A prospective study was conducted in patients with seasonal allergic conjunctivitis (seasonal group, n = 10), patients with perennial allergic conjunctivitis (perennial group, n = 10), and healthy control subjects (control group, n = 10). Serum levels of specific IgE and IgG for cat allergens and total tear IgE were measured, and a skin prick test was also performed. In addition, a severity score associated with allergic conjunctivitis was calculated (0-30). The positive rates and scores of for total tear IgE, serum cat-specific IgE, and serum cat-specific IgG were all higher in the seasonal and perennial groups than in the control group (all p < 0.05). Serum cat-specific IgG levels were higher in the perennial group than in the seasonal group (p = 0.0156), but there was no significant difference in the grade of cat-specific IgE between the two groups (p = 0.3008). On multivariate analysis, the mean wheal diameter for cat allergen was associated with the serum level of cat-specific IgG (not IgE) in all patients [odds ratio (OR) = 31.979, p < 0.0001]. Multivariate analysis revealed that the total objective score was strongly associated with serum cat-specific IgG (OR = 23.015, p < 0.0001). These findings suggest that specific IgG antibodies may be involved in perennial allergic symptoms caused by indoor allergens such as cat allergens.

Specific IgE for wheat in tear fluid of patients with allergic conjunctivitis.

CONTEXT: Allergy to hydrolyzed wheat protein in facial soap has become a major social issue in Japan. It has been reported that the most frequent early symptoms of allergy to hydrolyzed wheat protein in soap are allergic conjunctivitis and rhinitis, while wheat-dependent exercise-induced anaphylaxis can be induced by long-term use. OBJECTIVE: We evaluated the relation between tear fluid levels of specific IgE for wheat and the features of allergic conjunctivitis. METHODS: A prospective, non-randomized, cross-sectional study was conducted in 103 patients with moderate to severe allergic conjunctivitis (allergic group) and 20 age- and sex-matched healthy control subjects (control group). Specific IgE for wheat was measured in tear fluid with an immunochromatography assay, and a skin prick test (SPT) was also performed. Symptoms (sneezing, rhinorrhea, nasal obstruction, ocular itching, and lacrimation) were assessed in each subject along with the activities of daily living (ADL) score and the total ocular symptom score for allergic conjunctivitis. A severity score (0, 1, 2, or 3) was assigned for various changes of the palpebral and bulbar conjunctiva, as well as for limbal and corneal lesions associated with allergic conjunctivitis. RESULTS: The IgE positive rate and specific IgE score were both higher in the allergic group than in the control group (71.8% versus 40.0% and 1.9 ± 0.7 versus 1.4 ± 0.5). A positive SPT for wheat was also more frequent in the allergic group than in the control group (6.8% versus 0.0%). Within the allergic group, patients with a positive SPT had higher specific IgE scores than patients with a negative SPT (3.3 ± 0.5 versus 1.8 ± 0.6, p < 0.001). In the allergic group, the wheat IgE level in tear fluid was correlated with the severity of allergic conjunctivitis symptoms, including ocular itching (r = 0.665), tearing (r = 0.672), and the total ocular symptom score (r = 0.204). Wheat IgE in tear fluid was also correlated with the severity of rhinitis symptoms, including sneezing (r = 0.610), nose blowing (r = 0.640), and nasal obstruction (r = 0.677). Furthermore, the tear fluid wheat IgE score was correlated with five objective features of allergic conjunctivitis (p < 0.05). CONCLUSIONS: These results suggest that wheat allergy may be involved in the development of allergic conjunctivitis.

Glycolysis in patients with age-related macular degeneration.

PURPOSE: Retinal adenosine triphosphate is mainly produced via glycolysis, so inhibition of glycolysis may promote the onset and progression of age-related macular degeneration (AMD). When glycolysis is inhibited, pyruvate is metabolized by lactic acid fermentation instead of entering the mitochondrial tricarboxylic acid (TCA) cycle. We measured urinary pyruvate and lactate levels in patients with AMD. METHODS: Eight patients with typical AMD (tAMD group) and 9 patients with polypoidal choroidal vasculopathy (PCV group) were enrolled. Urinary levels of pyruvate, lactate, α-hydroxybutyrate, and ß-hydroxybutyrate were measured in all patients. RESULTS: The mean urinary levels of pyruvate and lactate were 8.0 ± 2.8 and 7.5 ± 8.3 µg/mg creatinine (reference values: 0.5-6.6 and 0.0-1.6), respectively, with the mean increase over the reference value being 83.6 ± 51.1% and 426.5 ± 527.8%, respectively. In 12 patients (70.6%), the lactate/pyruvate ratio was above the reference range. Urinary levels of α-hydroxybutyrate and ß-hydroxybutyrate were decreased by -31.9 ± 15.2% and -33.1 ± 17.5% compared with the mean reference values. There were no significant differences of any of these glycolysis metabolites between the tAMD and PCV groups. Multivariate analysis revealed that none of the variables tested, including patient background factors (age, hypertension, diabetes, hyperlipidemia, cerebrovascular disease, alcohol, smoking, visual acuity, and AMD phenotype), were significantly associated with the lactate/pyruvate ratio. CONCLUSION: A high lactate/pyruvate ratio is a well-known marker of mitochondrial impairment, and it indicates poor oxidative function in AMD. Our results suggest that increased lactate levels may be implicated in the pathogenesis of AMD.

Airborne particulate matter (PM2.5) and the prevalence of allergic conjunctivitis in Japan.

OBJECTIVE: Exposure to particulate matter less than 2.5 µm in diameter (PM2.5) is associated with asthma and respiratory symptoms, but little is known about the influence of PM2.5 on allergic conjunctivitis. The purpose of this study was to examine the association of PM2.5 with outpatient attendance for allergic conjunctivitis. METHODS: We conducted a time-series analysis of the association between outpatient attendance for allergic conjunctivitis and PM2.5 levels from May to July (non-pollen season) and from August to October (the autumnal pollen season) in 2012. Air pollution data (including the levels of PM2.5, oxidants, nitric oxide, nitrogen dioxide, nitrogen oxide, carbon monoxide, methane, non-methane hydrocarbons, and total hydrocarbons) and data on the daily weather conditions (temperature, wind speed, and humidity) were collected at a centrally located monitoring station in Tokyo. We calculated weekly average values for the daily number of outpatient visits, as well as the air pollution and weather data, and used the weekly average values for analysis. RESULTS: There was a significant association between the number of outpatient visits for allergic conjunctivitis and the PM2.5 level (r=0.62, p=0.0177) from May to July, while no correlation was found between the number of outpatient visits and any variable assessed from August to November. Multivariate analysis also showed that PM2.5 was a significant predictor of the number of outpatient visits from May to July (odds ratio=9.05, p=0.0463), while there were no significant predictors of the number of outpatient visits from August to October. From May to July, PM2.5 showed a negative correlation with humidity (r=-0.53, p=0.0499). CONCLUSIONS: These findings suggest a possible role of PM2.5 in the development of allergic conjunctivitis during the non-pollen season. This association between PM2.5 and allergic conjunctivitis may have broad public health implications in relation to allergic diseases.

Sensitization to Asian dust and allergic rhinoconjunctivitis.

OBJECTIVE: Asian dust storms frequently occur in northeast Asia and the dust occasionally even spreads as far as North America during spring. Asian dust can be harmful to human health and the environment, and thus has become one of the most serious problems for Asian countries. In the present study, we evaluated sensitization to Asian dust in Japanese patients with rhinoconjunctivitis. METHODS: In March 2011, a prospective, non-randomized, cross-sectional study was conducted in 10 patients with allergic rhinoconjunctivitis (allergic group), 3 patients with atopic keratoconjunctivitis (atopic group), and 10 age- and sex-matched healthy control subjects (control group). Skin prick tests (SPT) were performed with untreated Asian dust, Asian dust extract, heat-sterilized Asian dust, silicon dioxide (SiO2), and phosphate-buffered saline (PBS). A panel of 14 allergen extracts was also tested, comprising extracts of pollens (cedar, orchard grass, ragweed, and mugwort), house dust (house dust mixture and Dermatophagoides pteronyssinus), animal dander (cat and dog), fungi (Alternaria tenuis, Candida, and Aspergillus), and foods (milk, egg, and wheat). Then the SPT-positive rate and the mean wheal diameter for each allergen were compared among the three groups. RESULTS: The SPT-positive rates for untreated Asian dust, Asian dust extract, and sterilized Asian dust were significantly higher in the allergic and atopic groups than in the control group (all p<0.05). In the allergic group, there were a significant differences of the SPT-positive rates for untreated Asian dust (70%), Asian dust extract (50%), sterilized Asian dust (20%), SiO2 (20%), and PBS (0%) (p=0.0068). The SPT response to untreated Asian dust was correlated with the mean wheal diameters for four plant pollens (r=0.71, p=0.0104) and for three fungi (r=0.57, p=0.0426). Multivariate logistic regression analysis showed that significant predictors of the SPT reaction to untreated Asian dust were the mean wheal diameter for the four plant pollen (odds ratio=2.54, p=0.0138) and that for the three fungi (odds ratio=1.84, p=0.0273). CONCLUSIONS: Asian dust may act as an adjuvant to promote allergic disease induced by inhaled allergens such as pollen and fungi.

Influence of axial length on conjunctivochalasis.

PURPOSE: To investigate the relation between the severity of conjunctivochalasis and the axial length (AL) of the eyeball. METHODS: A prospective nonrandomized study was performed on 165 patients aged 51 to 88 years. The age, gender, medical history, ocular history, grade and other parameters of inferior conjunctivochalasis (classified as nasal, middle, and temporal), and AL were determined in all patients. Patients were divided into a short AL group (≤ 22.0 mm), a medium AL group (>22.0 to ≤ 24.0 mm), and a long AL group (>24.0 mm). RESULTS: The short AL group tended to have higher grades of temporal and nasal conjunctivochalasis compared with the medium and long AL groups. Multivariate logistic regression analysis showed that the total conjunctivochalasis score (the sum of the scores for the temporal, middle, and nasal regions) was significantly associated with the age [odds ratio (OR) = 1.32, P = 0.001] and the AL (OR = 0.81, P = 0.029). In addition, the AL was independently associated with the grade of conjunctivochalasis after adjustment for age (OR = 0.80, P = 0.020). CONCLUSIONS: This was the first assessment of the relationship between the AL and the grade of conjunctivochalasis. Our findings suggest that the severity of conjunctivochalasis is dependent on the AL, with a short AL contributing to the pathogenesis of conjunctivochalasis.

Specific IgE in tear fluid and features of allergic conjunctivitis.

PURPOSE: The level of specific class E immunoglobulins (IgE) in tear fluid is a useful diagnostic indicator for allergic conjunctivitis, but it is still unclear whether the measurement of tear fluid IgE is helpful for assessing the severity of allergic conjunctivitis. In this study, we evaluated the relation between tear fluid levels of specific IgE and features of allergic conjunctivitis. METHODS: A prospective, nonrandomized, cross-sectional study was conducted in patients with allergic conjunctivitis (n = 55, allergic group) and age- and sex-matched healthy control subjects (n = 50, control group). Levels of specific IgE for cedar pollen, cat epithelium/dander and Dermatophagoides pteronyssinus were measured in tear fluid with the Immfast Check J1®. A severity score (0, 1, 2 or 3) was assigned for various changes of the palpebral and bulbar conjunctiva, as well as for limbal and corneal lesions. RESULTS: The levels of specific IgE for both cedar pollen, and D. pteronyssinus were significantly higher in the allergic group compared with the control group (p < 0.0001), while the level of specific IgE for cat epithelium/dander showed no significant difference between the two groups (p = 0.0777). When IgE levels were divided into four classes, the classes for both D. Pteronyssinus and cat epithelium/dander IgE were correlated with four features of allergic conjunctivitis. On the other hand, no correlation was found between the class of cedar pollen IgE and any of the features of allergic conjunctivitis. CONCLUSIONS: This study demonstrated that measurement of specific IgE in tear fluid may be useful for determining the severity of allergic conjunctivitis induced by indoor allergens. Although measurement of IgE in tear fluid is only a supplemental tool for evaluating the clinical activity of allergic conjunctivitis, the test can be useful for detecting specific IgE antibodies responsible for this condition.

Evaluation of a new preoperative ophthalmic solution.

BACKGROUND: Maximum mydriasis and corneal clarity during intraocular surgery are important to ensure operational safety. However, repeated instillation of mydriatic and anti-inflammatory ophthalmic solutions during surgery may affect compliance and may damage the corneal epithelium. We developed an ophthalmic solution containing tropicamide, phenylephrine hydrochloride and diclofenac sodium, and compared the properties and effect on corneal epithelial barrier function and on mydriasis of the solution and of its individual components. METHODS: We developed the ophthalmic solution by mixing 10 mL of 0.5% tropicamide/0.5% phenylephrine, 10 mL of 5% phenylephrine and 10 mL of 0.1% diclofenac (TPD). We determined the stability of the chemicals in solution using high-performance liquid chromatography immediately, 1 week and 1 month after mixing. Corneal epithelial barrier function was assessed before and after instillation of the solutions in 26 eyes of 17 patients (5 with proliferative diabetic retinopathy or diabetic maculopathy, 8 with cataract and 4 with no eye disease). The fluorescent intensity was measured 10 times at the central cornea 30 minutes after instillation of 3 mL of 0.5% fluorescein solution and the average value calculated. Finally, the pupil diameter of 50 eyes of 38 patients undergoing cataract surgery was measured before and immediately after the operation. RESULTS: No remarkable changes in the pH or pharmacologic activity of the TPD solution were observed at any time after mixing. In the patients with diabetic retinopathy or cataract, the increase in mean fluorescent intensity was significantly greater with the individual solutions than with the TPD solution (p < 0.01); there was no significant difference in mean fluorescent intensity in the subjects with no eye disease. No statistically significant difference in pupil diameter was observed between the eyes that received the TPD solution and those that received the individual solutions. INTERPRETATION: TPD ophthalmic solution is simple to prepare and use. The TPD solution had a similar effect on mydriasis as the three individual solutions but was less destructive to the corneal epithelium.

Histologic and histochemical changes in rabbit cornea produced by an orthokeratology lens.

PURPOSE: To report the histologic and histochemical properties of rabbit cornea after insertion of an orthokeratology lens. METHODS: An orthokeratology lens was placed on the left corneas of rabbits for 8 hours daily, and their eyes were enucleated after 7, 14, 21, and 28 days and examined histologically and histochemically. The right eyes were used as controls. RESULTS: After 7-14 days, hematoxylin and eosin staining of the cornea revealed that the epithelial layer was slightly thinner in the central area and thicker in the intermediate area, but its thickness gradually became normal toward the limbus. Periodic acid-Schiff staining showed no abnormal distribution of glycogen granules or glycogen producing cells. 5-bromo-2-deoxyuridine staining revealed more mitoses in the central area than in the intermediate area. Histochemical staining showed lactic dehydrogenase activity in the central area of the lens, whereas alkaline phosphatase activity and beta-glucuronidase activity were slightly increased in the intermediate area. There were no other clearly abnormal findings. CONCLUSIONS: The thickness of the corneal epithelium showed topographical variation consistent with the effect of orthokeratology. The result of histochemical studies suggested that there were no marked alterations in epithelial function.

[TPD ophthalmic solution (mixture of tropicamide, phenylephrine hydrochloride, and diclofenac sodium) for cataract surgery].

PURPOSE: We made a TPD ophthalmic solution by combining tropicamide solution(Mydrin-P: T), phenylephrine hydrochloride(Neosynesin Kowa: P) and diclofenac sodium(Diclod: D), and evaluated its efficiency in mydriasis during cataract surgery compared to T, P, and D. SUBJECTS AND METHODS: Twenty-five eyes(19 patients) were given either TPD solution(10 eyes) or T, P, and D solution(15 eyes), and the treatment was given six times before surgery. Pupil diameters were measured before and after surgery. RESULT: The operation time was 10.0 +/- 5.2(mean +/- standard deviation) minutes in the TPD group, and 9.0 +/- 3.6 minutes in the T, P and D group. The preoperative and postoperative one pupil diameter was 8.65 +/- 0.34 mm and 8.20 +/- 0.35 mm in the TPD group and 8.80 +/- 0.49 mm and 8.37 +/- 0.61 mm in the T, P, and D group, respectively. The rate of miosis was 5.1 +/- 4.2% in the TPD group and 4.8 +/- 5.1% in the T, P, and D group, respectively. There was no statistically significant difference between the two groups. CONCLUSION: TPD ophthalmic solution maintains the mydriasis as potent by as T, P and D solution.

[Availability of TPD ophthalmic solution (mixture of Mydrin-P solution, Neosynesin Kowa solution, and Diclod solution) in regard to the corneal barrier function--clinical evaluation for vitrectomy in patients with diabetic retinopathy].

PURPOSE: We made TPD ophthalmic solution by combining Tropicamide solution(Mydrin-P: T), Phenylephrine Hydrochloride(Neosynesin Kowa solution: P) and Diclofenac Sodium(Diclod solution: D), and evaluated its efficiency in terms of corneal epithelial damage in patients with diabetic retinopathy. SUBJECTS AND METHODS: Five patients(10 eyes) who were to undergo vitrectomy were enrolled in this study. They each received T, P, and D 6 times and TPD solution in the same way. Before and after the instillation, superficial punctate keratopathy (SPK) was evaluated and corneal epithelial permeability was determined by anterior fluorophotometry. RESULTS: After the instillation of T, P, and D, corneal damage increased in all eyes. After the instillation of TPD, three eyes showed only one grade change up in AD(A: area, D: density) classification of SPK. The fluorescein uptake change between pre- and post-instillation was 457.5 +/- 468.8 (mean +/- standard deviation) ng/ml with T, P, and D and 100.5 +/- 235.6 ng/ml with TPD(p < 0.01). CONCLUSION: TPD solution decreases both corneal epithelium damage and barrier function change of corneal epithelium.