Descemet stripping automated endothelial keratoplasty via a frown incision.

PURPOSE: To assess the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) via a sclerocorneal frown incision. STUDY DESIGN: Retrospective comparative study. METHODS: The outcomes of Descement stripping endothelial keratoplasty (DSAEK) were retrospectively compared between 36 patients (36 eyes) who underwent surgery via a 3.8-mm frown incision (frown incision group) and 20 patients (20 eyes) who underwent surgery via a 4.6-mm straight incision (straight incision group). In all patients, an NS Endo-Inserter was used as the graft inserter and the incision for a frown incision was via the superior sclerocorneal site and for the straight incision via the temporal cornea. DSAEK was performed by the standard technique, except for the incision. At 1 year after surgery, the two groups were compared with respect to the visual acuity, decrease of corneal endothelial cell density, the severity of corneal astigmatism (diopters), the number of sutures for wound closure, and intraoperative/postoperative complications. RESULTS: There was no significant difference between the two groups in terms of postoperative visual acuity, corneal astigmatism, and intraoperative/postoperative complications one year after surgery. On the other hand, the number of sutures required for wound closure was 1.13 ± 0.42 in the frown incision group, whereas in the straight incision group, it was 3.20 ± 0.40, showing a significant difference (P<0.001). In addition, there was no decreased corneal endothelial cell density associated with the reduction in incision width. CONCLUSIONS: A sclerocorneal frown incision is useful for performing DSAEK with an NS Endo-Inserter as it does not affect endothelial cell loss despite its short incision width.

Characteristics and Clinical Ocular Manifestations in Patients with Acute Corneal Graft Rejection after Receiving the COVID-19 Vaccine: A Systematic Review.

This study aimed to determine the characteristics and clinical ocular manifestations of acute corneal graft rejection after coronavirus disease 2019 (COVID-19) vaccination. We conducted an online search of the PubMed and EMBASE databases. Data on recipients' characteristics, corneal transplantation types, interval between vaccination and allograft rejection, clinical manifestations, and graft rejection medication were extracted. Thirteen articles on 21 patients (23 eyes) with acute corneal graft rejection after COVID-19 vaccination, published between April and December 2021, were included. The median (interquartile range) age at the onset of rejection was 68 (27-83) years. Types of transplantation included penetrating keratoplasty (12 eyes), Descemet membrane endothelial keratoplasty (six eyes), Descemet stripping automated endothelial keratoplasty (four eyes), and living-related conjunctival-limbal allograft (one eye). The interval between vaccination and rejection ranged from 1 day to 6 weeks. Corneal edema was the leading clinical manifestation (20 eyes), followed by keratic precipitates (14 eyes) and conjunctival or ciliary injection (14 eyes). Medications included frequently applied topical corticosteroids (12 eyes), followed by a combination of topical and oral corticosteroids (four eyes). In addition, the clinical characteristics of corneal allograft rejection after COVID-19 vaccination were identified. Corneal transplant recipients may require further vaccination, necessitating appropriate management and treatment.

Donor characteristics and risk factors for methicillin-resistant Staphylococcus aureus contamination in storage medium for corneal transplantation: A 10-year retrospective study.

PURPOSE: This study investigated the donor characteristics of methicillin-resistant Staphylococcus aureus (MRSA) contamination in storage medium before transfer of corneas to preservation medium for corneal transplantation, in order to identify donor characteristic risk factors for MRSA contamination. METHODS: This retrospective, cross-sectional study was performed using Juntendo Eye Bank records for all corneal transplantation procedures. Storage medium (EP-II® ) cultures for right eyes were included for the period between July 2008 and December 2017. The following donor characteristics were collected: age, sex, cause of death, history of cataract surgery, death-to-enucleation interval, death-to-preservation interval, and endothelial cell density (ECD). Donor characteristics were compared between MRSA and non-MRSA contamination groups. Odds ratios (ORs) for donor-related risk factors for MRSA contamination were determined using logistic regression. RESULTS: In total, 370 storage medium samples were examined; 222 were positive for bacterial cultures (60.0%) and 36 were MRSA-positive (9.7%). Donor age was significantly higher in the MRSA contamination group than in the non-MRSA contamination group (86.1 ± 9.5 years vs 75.9 ± 15.9 years, P < 0.001). Univariate logistic regression analysis showed that MRSA contamination risk factors were older age (OR = 1.07; 95% confidence interval [95% CI]: 1.03-1.11) and decreased ECD (OR = 0.9993; 95% CI: 0.9986-0.9992). The fully adjusted OR for every year of age as a risk factor for MRSA contamination was 1.07 (95% CI: 1.03-1.11). CONCLUSIONS: Aging was a risk factor for MRSA contamination in storage medium. Careful pre-banking assessment of elderly donor corneas is needed to prevent intractable postoperative MRSA infection.

Pre-banking microbial contamination of donor conjunctiva and storage medium for penetrating keratoplasty.

PURPOSE: The aims of this study were to investigate the incidence of positive donor tissue cultures before transfer to preservation medium (Optisol™-GS) for penetrating keratoplasty, to verify the efficacy of antibiotics contained in Optisol™-GS by examining the drug susceptibility and to assess the relationship between the results of our microbial assessments as well as donor factors and the incidence of contamination. METHODS: We conducted a retrospective, cross-sectional study using Juntendo Eye Bank records for all corneal transplantations. Two hundred donor conjunctiva harvestings and storage medium (EP-II®) cultures were performed between July 2008 and June 2011. We analyzed the associations between donor factors (age, gender, history of cataract surgery, death-to-preservation interval, cause of death) and contamination rates using multivariate analysis by the generalized estimating equation model. RESULTS: We obtained positive bacterial cultures from 154 of the 200 eyes (77.0%). The isolated bacteria were indigenous, such as coagulase-negative Staphylococci, Corynebacterium sp., and methicillin-resistant Staphylococcus aureus (MRSA). There was significant resistance to levofloxacin (18 eyes, 9.0%) and gentamicin (12 eyes, 6.0%), and no vancomycin-resistant bacteria were detected. The donor factors did not correlate with the prevalence of bacterial contamination in our criteria. CONCLUSIONS: Pre-banking microbial assessment allows for microbial detection, bacterial susceptibility and resistance testing. This is useful for developing preservation mediums containing effective spectrum antibiotic agents for high quality control of corneal banking.

Descemet stripping automated endothelial keratoplasty using corneas from elderly donors.

PURPOSE: To evaluate the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) using corneas from elderly donors. METHODS: A total of 90 eyes that underwent DSAEK at Juntendo University Hospital between January 2008 and December 2012 were divided into two groups. Group 1 was eyes that received corneas from elderly donors aged 80 years or older (29 eyes), and group 2 was eyes that received corneas from donors aged 79 years or younger (61 eyes). Patient characteristics and visual acuity, endothelial cell density, and postoperative complications at 2 years after surgery were examined retrospectively. RESULTS: The mean age of the donors was 86.3 ± 28.9 years (range, 80-98 years) in group 1 and 62.1 ± 23.2 years (range, 26-79 years) in group 2. At 2 years after surgery, median logMAR visual acuity was 0.48 ± 0.38 in group 1 and 0.42 ± 0.47 in group 2, while the median loss of endothelial cell density was 38.9 ± 22.5 % and 39.7 ± 23.8 %, respectively. There was no significant difference between the two groups for all the parameters. CONCLUSIONS: The rate of endothelial cell loss at 2 years after surgery was similar regardless of donor age (≥80 years vs ≤79 years). It seems reasonable to use corneas from donors aged 80 years or older for DSAEK provided the selection criteria are fulfilled.

Cataract Surgery in Eyes with Corneal Endothelial Disorders.

Purpose: To investigate the outcome of cataract surgery in patients with corneal endothelial disorders. Subjects and methods: Twenty patients (29 eyes) with Grade 2 or 3 (corneal endothelial cell density <1,000 cells/mm2) corneal endothelial disorders underwent cataract surgery from 2009 to 2013 at Juntendo Hospital without complications and were followed for ≥1 year. We retrospectively investigated demographic data, visual acuity, endothelial cell density, and bullous keratopathy. Results: At 1 year postoperatively, mean visual acuity was 0.43 and the mean decrease of endothelial cell density was 13.9±14.5%. In 5 eyes with bullous keratopathy (17.2%), the mean time until onset was 3.0±3.7 months. Grade 3 patients had a significantly higher incidence of bullous keratopathy and more advanced hardening of the lens nucleus than Grade 2 patients. Conclusions: Cataract patients with severe corneal endothelial disorders often present advanced nuclear hardening whereas bullous keratopathy occurs relatively early after cataract surgery. Timing of surgery needs to be determined while taking these factors into consideration.

[Two cases of conjunctival intraepithelial neoplasia in immunosuppressed patients].

UNLABELLED: Background: Conjunctival intraepithelial neoplasia (CIN) is a precursor lesion of conjunctival squamous cell carcinoma (SCC). CIN recurs frequently but progresses less aggressively than SCC. We report 2 cases of recurrent CIN in immunosuppressed patients. CASE 1: A 60-year-old woman had been taking oral immunosuppressive drugs for 30 years for systemic lupus erythematosus. In 2005, both conjunctival tumor and high serum SCC levels were noted. Biopsy revealed right eye CIN and left eye SCC, and extended resection was performed. In 2008, right eye CIN recurred accompanied by high serum SCC levels and another extended resection was performed. The patient was free from recurrence for 1 year until her death. CASE 2: A 43-year-old woman who had been taking oral immunosuppressive drugs for 3 years for nephrotic syndrome. She had twice undergone right corneal transplantation for keratoconus. In 2011, right conjunctival tumor and high serum SCC levels were noted. Biopsy revealed right eye CIN, for which an extended resection was performed. At present she remains free from recurrence. CONCLUSION: CIN can recur in immunosuppressed patients. We suggest that serum SCC levels be monitored to help detect recurrence.

Three-year outcome of Descemet stripping automated endothelial keratoplasty for bullous keratopathy after argon laser iridotomy.

PURPOSE: The aim of this study was to evaluate the 3-year outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of bullous keratopathy secondary to argon laser iridotomy (ALI). METHODS: A total of 22 consecutive patients (22 eyes) with ALI who underwent DSAEK were retrospectively analyzed. Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complications were investigated over 3 years postoperatively. The outcome of DSAEK was also compared between the ALI group and 21 other patients with Fuchs endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) (FED/PBK group). RESULTS: The median BSCVA improved from logarithm of the minimum angle of resolution 1.40 before DSAEK to 0.30 at 6 months, 0.30 at 12 months, 0.22 at 24 months, and 0.15 at 36 months after surgery. The median endothelial cell loss was 20.3% at 6 months, 18.4% at 12 months, 32.5% at 24 months, and 46.5% at 36 months. Comparison of the ALI group with the FED/PBK group showed no significant difference in the BSCVA or endothelial cell density. Rejection affected 9.1% of the ALI group versus 0% of the FED/PBK group (P = 0.49), the graft dislocation rate was 0% versus 9.5% (P = 0.23), and posterior synechiae were found in 31.8% versus 4.8% (P = 0.046). CONCLUSIONS: The 3-year outcome of DSAEK for bullous keratopathy after ALI was excellent. However, caution should be exercised in patients with a history of ALI to avoid posterior synechiae after DSAEK.

Descemet stripping automated endothelial keratoplasty for bullous keratopathy after anterior-posterior radial keratotomy.

PURPOSE: To report the outcome of Descemet stripping automated endothelial keratoplasty (DSAEK) for bullous keratopathy after Sato anterior-posterior radial keratotomy (APRK). METHODS: The clinical records of patients who had DSAEK surgery for bullous keratopathy after APRK were reviewed. RESULTS: Five eyes of 4 patients (4 men) were included. The mean age at DSAEK surgery was 81.8 ± 7.1 years (range, 73-90 years), and the mean follow-up period after the surgery was 19.8 ± 16.9 months (range, 6-48 months). The mean preoperative logarithm of the minimum angle of resolution-corrected visual acuity was 1.96 ± 0.50 (range, 1.2 to counting fingers), and this improved to 0.49 ± 0.43 (range, 0.05-1.2) at the final follow-up. The mean preoperative donor cornea central endothelial cell density was 2826.0 ± 335.7 cells per square millimeter (range, 2352-3150 cells/mm), and this declined to 863.5 ± 501.7 cells per square millimeter (range, 500-1255 cells/mm) at the final follow-up, a mean reduction of 68.2%. The mean graft size was 8.2 ± 0.21 mm (range, 8.0-8.5 mm). Postoperative complications included early graft dislocation in 3 eyes (60.0%), with successful repositioning by a single rebubbling in all cases. There was no graft rejection, and no patient required repeat DSAEK or penetrating keratoplasty for graft failure. CONCLUSIONS: This small series suggests that DSAEK is an effective surgical option after APRK. Although there was a high rate of graft dislocation, this was successfully managed by rebubbling. Subsequently, the attachment of each graft improved gradually over time. DSAEK seems to be a reasonable alternative to penetrating keratoplasty for patients with bullous keratopathy after APRK.

[Descemet's stripping automated endothelial keratoplasty for endothelial failure after penetrating keratoplasty].

PURPOSE: To evaluate the outcome of Descemet's stripping automated endothelial keratoplasty (DSAEK) in eyes with endothelial failure after penetrating keratoplasty (PK). SUBJECTS AND METHODS: DSAEK was performed on 13 eyes of 13 patients with failed PK. Their mean age was 73.2 years. Evaluation of visual acuity, subjective astigmatism, corneal endothelial cell density, and complications was performed. RESULTS: In four eyes, PK was performed after previous surgery for hypometropia by Sato's anterior-posterior radial keratotomy. Mean followup time was 20.3 +/- 8.6 months. Mean logarithmic minimum angle of resolution (logMAR) visual acuity was 1.92 before DSAEK and 0.89 at final follow-up. Mean subjective astigmatism was 5.10 +/- 3.09D before surgery and 7.25 +/- 4.16 D at 6 months postoperatively. Mean corneal endothelial cell density at 6, 12, 24 months after DSAEK was 42.8%, 51.3%, 72.1%, respectively. Regarding postoperative complications, air was reinjected in four eyes, persistent epithelial defect and rejection occurred in one eye each, and PK was repeated in three eyes. CONCLUSION: DSAEK rapidly improved visual acuity after failed PK, but some eyes required repeat PK. Eligibility criteria for DSAEK after failed PK should be established.

Involvement of plasminogen activator inhibitor-1 in the pathogenesis of atopic cataracts.

PURPOSE: Further to our previous report of a genetic association between interferon-gamma (IFN-γ) receptor 1 gene and atopic cataract, we investigated the roles of plasminogen activator inhibitor-1 (PAI-1), a fibrosis-related, IFN-γ downstream molecule, in the pathogenesis of atopic cataracts. METHODS: Cultured lens epithelial cells (LECs) were stimulated by IFN-γ and quantified by PAI-1 mRNA/protein expression. PAI-1 and TGF-ß mRNA expression was quantified using cDNA samples obtained from the lens epithelium of atopic cataract patients (n = 7) and of senile cataract patients (n = 8). The anterior capsules obtained from atopic cataracts (n = 9) were immunostained with anti-PAI-1 and anti-alpha smooth muscle actin (α-SMA) antibodies. PAI-1 gene expression was knocked down by PAI-1 siRNA, and α-SMA expression was examined under TGF-ß1 stimulation. Expression of α-SMA was examined as a pathological hallmark of anterior subcapsular cataracts, commonly observed in atopic cataracts. RESULTS: The IFN-γ stimulation induced PAI-1 mRNA/protein expression in the LECs from 24 to 48 hours after stimulation. The expression of PAI-1 mRNA and TGF-ß1 mRNA was significantly higher in the cDNA samples obtained from the atopic cataracts than those obtained from the senile cataracts. PAI-1-positive immunostaining was observed at the fibrotic lesion of the atopic cataracts, and α-SMA-positive myofibroblasts were observed at the vicinity of the PAI-1-positive lesion in all nine samples examined. PAI-1 gene knockdown resulted in reduced α-SMA expression in the LECs. CONCLUSIONS: The findings of this study suggest that the IFN-γ, PAI-1, and TGF-ß1 are involved in the pathophysiology of atopic cataracts.

Stem cell factor in the tear fluid of vernal keratoconjunctivitis patients.

PURPOSE: To evaluate the contribution of stem cell factor (SCF) to the pathogenesis of vernal keratoconjunctivitis (VKC), we determined levels of soluble SCF in the tear fluid of VKC patients. METHODS: Samples of tear fluid were obtained from 38 VKC patients and 13 normal controls after we received informed consent from each participant. In the 38 VKC patients, disease severity was mild in 13, moderate in 17, and severe in 8. The levels of soluble SCF in tear fluid were determined by enzyme immunoassay. RESULTS: Mean +/- SD SCF levels in tears were 90.3 +/- 23.4 pg/ml in patients with mild VKC, 225.3 +/- 101.2 pg/ml in those with moderate VKC, and 872.0 +/- 313.2 pg/ml in those with severe VKC, and 68.3 +/- 15.3 pg/ml in healthy controls. The increase in SCF levels in patients with moderate or severe VKC was statistically significant compared with the level in healthy controls. CONCLUSION: Soluble SCF may make a crucial contribution to the pathogenesis of VKC.

In situ preparation of colloidal iron by microwave irradiation for transmission electron microscopy.

We attempted to prepare colloidal iron within tissues by means of microwave irradiation. Mouse tissue blocks were fixed with a mixture of paraformaldehyde and ferric chloride in a cacodylate buffer, immersed in a cacodylate buffered ferric chloride solution, and irradiated in a microwave processor. Colloidal iron was prepared within tissues or cells, and was observed in the form of electron dense fine granules (1-2 nm in diameter) by transmission electron microscopy. Collagen fibrils in the connective tissue showed colloidal iron deposition at regular periodical intervals. Cells in the splenic tissue showed that fine colloidal granules were deposited on the ribosomes but not on the nuclear chromatin. This finding suggests that ferric ions could not diffuse into the nucleus, which was surrounded by the nuclear envelope. The podocyte processes of the renal glomerulus were stained diffusedly. Though this microwave in situ colloidal iron preparation method has some limitations, it is convenient for use in biomedical specimen preparation in transmission electron microscopy.

Three-dimensional ultrastructure of the brush border glycocalyx in the mouse small intestine: a high resolution scanning electron microscopic study.

The three-dimensional ultrastructure of the filamentous glycocalyx of the brush border in the mouse small intestine was successfully demonstrated by high resolution scanning electron microscopy (SEM). The specimens were fixed with 2% glutaraldehyde in a 0.1M phosphate buffer (pH 7.4), and rinsed with buffered solutions with differently adjusted pH values (pH 3.0, 7.0 or 11.0). They were then osmicated, dried, spatter-coated with gold (1.0-1.5 nm), and observed under a high resolution SEM. The glycocalyx on the luminal surface of the intestinal villi covered the top of the microvilli of the epithelial cells and were well preserved in the specimens treated with an alkaline buffer (pH 11.0). The glycocalyx was observed as filamentous structures, 7 to 15 nm thick in diameter. These filaments repeatedly branched and anastomosed with neighboring ones to form an actual network or plexus as a whole, in contrast with superimposed images in transmission electron microscopy (TEM) which suggested that such anastomoses were pseudo-networks. The filaments thickened globularly at the sites of the filament bifurcation or branching. On the other hand, specimens rinsed with an acid or neutral buffer showed no glycocalyx on their microvilli, whose naked top had knob-like structures. Thus, the pH values of the washing buffer solutions were considered to affect the preservation of the surface coat due to molecular characteristics.

A case of Kniest dysplasia with retinal detachment and the mutation analysis.

PURPOSE: To report a case of Kniest dysplasia with retinal detachment associated with a novel type II collagen gene (COL2A1) mutation. DESIGN: Interventional case report. METHODS: DNA was isolated from peripheral lymphocytes, and mutational analysis was carried out using polymerase chain reaction and direct sequencing. RESULTS: A 14-year-old Japanese boy was diagnosed with Kniest dysplasia, and ophthalmic examination revealed a retinal detachment in the right eye. He was successfully treated by vitrectomy and silicon oil injection, and his visual acuity improved from 0.01 to 0.22. DNA analysis of COL2A1 revealed a single base-pair substitution at position +5 of intron 20. CONCLUSION: Vitrectomy and silicon oil injection were effective in reattaching the retinal detachment in a Kniest dysplasia patient. The genetic alteration found in this patient suggested that this prevented the normal splicing of COL2A1, resulting in an abnormal type II collagen product.