Macular fold after limited macular translocation treated with scleral shortening release and intravitreal gas.

PURPOSE: To describe a case developing a macular fold as a complication of limited macular translocation, which was successfully managed without repeat vitrectomy. METHODS: Interventional case report. A 34-year-old woman who underwent limited macular translocation for subfoveal choroidal neovascularization secondary to myopic degeneration developed a postoperative macular fold. Her visual acuity deteriorated from 20/100 to 20/200 postoperatively. RESULTS: She underwent scleral shortening release and intravitreal gas injection 4 days after the initial surgery and had a resolution of macular fold with adequate foveal displacement. Her visual acuity had improved to 20/40 3 months postoperatively. CONCLUSION: Scleral shortening release and intravitreal gas injection may be considered for the management of severe macular fold caused by limited macular translocation.

Simulation of air-bag impact on post-radial keratotomy eye using finite element analysis.

PURPOSE: To determine the physical and mechanical conditions of an impacting air bag that causes corneal rupture in a post-radial keratotomy (RK) eye using a simulation model of the human eye. SETTING: Numerical simulation study on a computer. METHODS: The simulations were performed by a computer using the finite element analysis program PAM-CRASH (Nihon ESI). The air bag was set to impact the surface of a post-RK eye with 4, 6, or 8 corneal incisions at various velocities. Strain on the corneal tissue including scarred incisions exceeding 9.0% was assumed to indicate the possibility of corneal rupture. RESULTS: At a medium velocity of 30 m/s, corneal rupture was likely to occur. At an air-bag impact velocity of 40 m/s, 3 of 4, 5 of 6, and 8 of 8 incisions were likely to rupture in the case of 4-, 6-, and 8-incision procedures, respectively, leading to likely globe rupture in all situations. Lacerations extended beyond the incisions and involved the intact cornea at a velocity of 40 m/s. If the corneal tissue strength reduction was increased to 90%, most incisions were likely to rupture at impact velocities greater than 35 m/s in all incision procedures. CONCLUSIONS: The results could partly reflect a reported case of globe rupture after RK and suggest that severe ocular trauma can be caused in the post-RK eye by air bags at ordinary impact velocities.

Genome typing of adenovirus type 34 isolated in two cases of conjunctivitis in Sapporo, Japan.

Two cases of conjunctivitis caused by adenovirus type 34 (Ad34) are reported. The isolates were identified as Ad34 by the neutralization test and the PCR-sequence method of the hexon gene but as Ad14 by PCR-restriction fragment length polymorphism analysis. The genome types of these two isolates were identical to that of Ad34a.

New genome type of adenovirus serotype 19 causing nosocomial infections of epidemic keratoconjunctivitis in Japan.

Twelve strains of adenovirus serotype 19, isolated from cases of epidemic keratoconjunctivitis in Japan in 1992, 1993, 1997, and 1998, were analyzed by DNA restriction analysis, using restriction endonucleases BamHI, BglI, BglII, EcoRI, HindIII, KpnI, PstI, SacI, SalI, SmaI, and XhoI. Among these 11 restriction endonucleases, EcoRI, PstI, SacI, and SmaI were discriminative enzymes, showing restriction patterns different from those reported previously for the prototype and the variant 19a. This new genome type was isolated in 1997 and 1998, when an increase of epidemic keratoconjunctivitis cases caused by adenovirus serotype 19 was observed for both sporadic and nosocomial infections. Strains from 1992 and 1993 showed restriction patterns similar to those of the worldwide reported variant 19a for all enzymes used. The changes detected in strains from 1997 and 1998 could be the reason for the recent epidemic.

Physiologic studies of male sexual dysfunction in multiple sclerosis.

OBJECTIVE: We conducted this investigation to better define the neural disruptions that result in sexual dysfunction in men with multiple sclerosis (MS), using genital electrodiagnostic testing and nocturnal penile tumescence and rigidity monitoring. METHODS: Thirteen men with MS and sexual dysfunction were recruited for the study. Twelve healthy, sexually potent men were enrolled as controls. All underwent pudendal somatosensory evoked potential (SEP) testing using standard methods, and a new modification to isolate the right and left dorsal nerves of the penis. RigiScan testing was performed on the MS subjects to assess nocturnal erectile function. RESULTS: Unilateral and bilateral DNP SEPs were able to be performed on the control subjects. In all but one MS subjects, DNP SEP abnormalities were found. Three men had normal latency bilateral DNP SEP latencies, but on unilateral DNP testing, abnormalities were identified. Seven men, including those with abnormal or absent SEP latencies, had normal nocturnal erectile activity. There was no correlation between overall functional status, presence of abnormal or absent SEP, and quality of nocturnal erectile activity. CONCLUSIONS: Genital SEP abnormalties are common in men with MS and sexual dysfunction. Unilateral DNP SEP testing was more sensitive in identifying abnormalities than the standard method of pudendal SEP testing. One of the causes of sexual dysfunction in men with MS may be due to genital somatosensory pathway disruption, with sparing of the efferent tracts in some men.

Bacterial Infection in the Conjunctiva of Patients with Adenoviral Conjunctivitis.

Purpose: We evaluate the microbiological features of mixed infection in adenovirus-infected conjunctiva.Subjects: Isolation of bacteria was performed in 82 samples of adenoviral conjunctivitis at six eye clinics in Japan.Methods: For microbiological diagnosis, we performed immunochromatography (IC) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis for detection and serotyping of adenovirus, and PCR for detection of herpes simplex virus (HSV) and Chlamydia trachomatis antigens out of 82 samples with adenoviral conjunctivitis.Results: Pathogenic bacteria were isolated in 6 samples out of 82. Out of these 6 cases, 5 samples were gram-negative rods and most of them were Flavobacterium meningosepticum (4 samples). Adenovirus type 8 was isolated from all these mixed infection cases. However, HSV-1 and Chlamydia trachomatis were not found.Conclusions: From these results, it is suggested that gram-negative rods, especially F. meningosepticum, are the most common bacteria causing mixed bacterial infection in adenoviral conjunctivitis.

Histamine release test and measurement of antigen-specific IgE antibody in the diagnosis of allergic conjunctival diseases.

Although systemic allergic laboratory tests for the quantification of allergen-specific serum IgE antibody have been widely used, in these tests a high titer of serum specific IgE does not necessarily indicate evidence of allergy. We evaluated the diagnostic value of the glass microfiber-based histamine release test (HRT) using small amounts of whole blood, in 36 cases of allergic conjunctival diseases: 17 cases of allergic conjunctivitis and 19 of atopic keratoconjunctivitis. The patients were evaluated by HRT, capsulated hydrolic carrier polymer (CAP)-RAST, and conjunctival provocation test (CPT) against ten allergens. The positive rates for all allergens were higher in CAP-RAST than in HRT. The mean concordance of HRT with CAP-RAST results was 0.789. The mean concordance of HRT with CPT was 0.892 and that of CAP-RAST with CPT was 0.693. A significantly higher concordance was observed in HRT than CAP-RAST for Japanese cedar and mite antigen. The mean sensitivity, specificity, and efficiency of HRT were higher than those of CAP-RAST. These results indicate that CAP-RAST is good for the screening of allergens and that HRT has an advantage in the confirmation of clinical allergens in allergic conjunctival diseases because of its high sensitivity, specificity, efficiency, and higher concordance with CPT.

Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal.

PURPOSE: To examine the efficacy of vitrectomy with internal limiting membrane removal for retinal detachment resulting from a macular hole in highly myopic eyes. METHODS: Eleven consecutive highly myopic eyes (11 patients) with retinal detachment resulting from a macular hole were treated by vitrectomy with removal of the internal limiting membrane, which was stained with indocyanine green and sulfur hexafluoride gas injection. Postoperatively, the patients were instructed to remain prone for 2 weeks. The excised specimens were evaluated with transmission electron microscopy. RESULTS: The mean postoperative follow-up was 9.2 +/- 2.3 months (range, 7 to 13 months). In 10 of the 11 eyes (91%) the retina was reattached during the initial surgery. Redetachment occurred in one eye, which was successfully treated during the second surgery. Best-corrected visual acuity improved in all eyes and ranged from 20/400 to 20/50. Pathologic examination showed that the internal limiting membrane and epiretinal tissues were present in all specimens. CONCLUSIONS: The use of indocyanine green staining can facilitate removal of a macular internal limiting membrane and overlying epiretinal membrane, resulting in complete relief of the macular traction. Primary removal of the internal limiting membrane may contribute to a high initial success rate for retinal reattachment and be an important adjuvant to the treatment of retinal detachment resulting from a macular hole in highly myopic eyes.

Iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy.

PURPOSE: To analyze the incidence of iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation using a small incision in the treatment of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: We studied a consecutive series of 46 eyes in which vitrectomy combined with phacoemulsification and IOL implantation had been performed, and compared the surgical results with a prior series of 40 eyes in which vitrectomy alone had been performed. RESULTS: Postoperative iris and angle neovascularization was found in 6 eyes (15%) treated by vitrectomy alone, but in only 1 eye (2%) treated by combined vitrectomy (P<0.05). Final visual acuity improved by two or more lines in 23 eyes (57%) in the vitrectomy alone group, and in 35 eyes (76%) in the combined vitrectomy group. CONCLUSIONS: The incidence of postoperative rubeosis iridis was significantly lower, and the visual results were satisfactory with vitrectomy combined with phacoemulsification and IOL implantation for PDR. These findings suggest that combined vitrectomy for PDR is a useful surgical procedure.

Cortical evoked potentials of the dorsal nerve of the clitoris and female sexual dysfunction in multiple sclerosis.

PURPOSE: We evaluated whether disrupting genital central nervous system pathways is associated with subjective reports of sexual dysfunction in women with multiple sclerosis. MATERIALS AND METHODS: We performed pudendal somatosensory evoked potential testing in and had sexual questionnaires completed by 14 women with a mean age of 47 years who had multiple sclerosis. RESULTS: The mean expanded disability status score was 5. All but 1 woman reported the desire for sexual intercourse. There was a high rate of dissatisfaction with their sex life and all study participants had concomitant bladder and bowel function problems. The most common sexual complaint was difficult or no orgasm, which was statistically associated with abnormalities or absence of 1 or both pudendal cortical evoked potentials. Fatigue and arousal disorders were also common. CONCLUSIONS: Women with multiple sclerosis have a high self-reported rate of sexual dysfunction, which decreases quality of life. Electrodiagnostic data imply that pudendal somatosensory innervation is necessary for normal female orgasmic function. More study is needed to confirm these findings.

[Immunological and clinical features of vernal keratoconjunctivitis between persons with and without systemic atopic dermatitis].

PURPOSE: The aim of this study was to evaluate whether there exists immunological or clinical difference between patients with vernal keratoconjunctivitis(VKC), which is characterized by conjunctival proliferative changes belonging to the serious spectrum of allergic conjunctival diseases, complicated by atopic dermatitis(AD) and those without AD. MATERIALS AND METHODS: The study population consisted of 52 patients with VKC (33 patients with AD, 19 without AD). Clinical severity was determined on the basis of clinical scores of conjunctival, corneal, and limbal lesions. The serum level of total IgE, the proportion of eosinophils in peripheral blood, antigen specific IgE antibodies (radioallergo sorbent test, RAST), and tear levels of interleukin (IL)-4 and IL-5 were measured. RESULTS: The serum level of total IgE and the number of positive RAST antigens were significantly higher in VKC patients with AD than in those without AD. No significant difference was observed in the proportion of peripheral blood eosinophils, distribution of clinical types of VKC, or clinical severity between VKC patients with and without AD. Although tear IL-4 level in VKC patients with AD was significantly higher than in those without AD, no difference was observed in tear level of IL-5 between these groups. CONCLUSIONS: These results indicate that clinical features are similar or identical in VKC regardless of the presence of AD. However, it is suggested that there may be a different immunological background between VKC patients with AD and those without AD.

Clinical and epidemiological features of acute follicular conjunctivitis with special reference to that caused by herpes simplex virus type 1.

BACKGROUND/AIMS: It is reported by the national surveillance of ocular infectious diseases in Japan that 4.3% of cases of epidemic keratoconjunctivitis (EKC) diagnosed clinically were caused by herpes simplex virus (HSV). Clinical and virological studies of patients with HSV conjunctivitis were carried out. METHODS: The study population consisted of 478 patients with acute follicular conjunctivitis. Virological analysis was carried out for adenovirus (Ad) and HSV by the cell culture method and fluorescein antibody (FA) method. Polymerase chain reaction for Chlamydia trachomatis was also carried out. RESULTS: From 23 patients, HSV type 1 was isolated but Ad or C trachomatis was not isolated. 87% of cases were unilateral. Most cases showed clinical resolution within 9 days. Early corneal lesions and preauricular lymphadenopathy were less frequent in HSV conjunctivitis than in adenoviral conjunctivitis, especially that due to subgenus D. No case showed a positive result for HSV by the FA method using conjunctival swabs; however, the FA test was positive in all strains isolated by cell culture. CONCLUSIONS: These results indicate that it is difficult clinically to differentiate HSV conjunctivitis from adenoviral conjunctivitis in the acute stage, since the clinical features of adenoviral conjunctivitis are similar to those of HSV conjunctivitis. A biological difference may exist between HSV strains causing keratitis and conjunctivitis.

[Bacterial infection in the conjunctiva of patients with adenoviral conjunctivitis].

PURPOSE: We evaluate the microbiological features of mixed infection in adenovirus-infected conjunctiva. SUBJECTS: Isolation of bacteria was performed in 82 samples of adenoviral conjunctivitis at six eye clinics in Japan. METHODS: For microbiological diagnosis, we performed immunochromatography (IC) and polymerase chain reaction--restriction fragment length polymorphism (PCR-RFLP) analysis for detection and serotyping of adenovirus, and PCR for detection of herpes simplex virus (HSV) and Chlamydia trachomatis antigens out of 82 samples with adenoviral conjunctivitis. RESULTS: Pathogenic bacteria were isolated in 6 samples out of 82. Out of these 6 cases, 5 samples were gram-negative rods and most of them were Flavobacterium meningosepticum (4 samples). Adenovirus type 8 was isolated from all these mixed infection cases. However, HSV-1 and Chlamydia trachomatis were not found. CONCLUSIONS: From these results, it is suggested that gram-negative rods, especially F. meningosepticum, are the most common bacteria causing mixed bacterial infection in adenoviral conjunctivitis.

Staining of internal limiting membrane in macular hole surgery.

Removal of internal limiting membranes (ILMs) is a potentially useful surgical approach to close an idiopathic macular hole. However, the removal of ILMs is difficult to perform because of poor visibility of the ILMs. We have developed a technique for staining the ILM with a solution of indocyanine green to facilitate the removal of ILMs in eyes with an idiopathic macular hole. Thirteen eyes of 13 patients (8 women and 5 men, aged from 54 to 68 years) with idiopathical macular hole stage 3 or stage 4 that underwent removal of ILMs using this technique had an anatomical closure rate of 92% and an improvement of visual acuity of 89% (>/=2 Snellen letter chart lines). The excised specimens were evaluated using transmission electron microscopy. Our results show that this technique is safe and useful in visualizing the ILM, leading to the performance of successful removal of an ILM with least damage to the retina. Arch Ophthalmol. 2000;118:1116-1118

Genetic characterization of adenovirus strains isolated from patients with acute conjunctivitis in the city of São Paulo, Brazil.

Genome analysis was carried out on adenovirus strains isolated from patients with acute follicular conjunctivitis in the city of São Paulo, Brazil. Eighteen conjunctival scrapings, collected between December 1993 and March 1994, were analyzed by two methods: a combination of polymerase chain reaction with restriction fragment length polymorphism and viral DNA restriction analysis, carried out using 10 restriction endonucleases: BamHI, BglI, BglII, HindIII, KpnI, SacI, SalI, SmaI, XbaI, and XhoI. Among 11 adenovirus detected by cell culture isolation, nine were Ad8, and two were Ad7. By restriction analysis the Ad8 isolates were typed as two new variants-Ad8/D11 (seven of nine samples) and Ad8/D12 (two of nine samples). Ad7 isolates were identified as a subtype of the widespread genome type Ad7b and the virulent type Ad7h, a predominant genome type circulating in Argentina, Chile, and Uruguay but absent in Brazil until 1991.

[Antiviral effect of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine on adenovirus].

PURPOSE: Adenovirus is the most frequent causative virus of conjunctivitis in Japan. Recently (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine (HPMPC) has been promoted as a new drug against adenoviral conjunctivitis. So we examined the antiviral activity of HPMPC against adenoviruses in vitro. METHOD: The antiviral activity of HPMPC against adenovirus (Ad) type 3, type 4, type 19, and type 37 isolated from conjunctivial scrapings in Japan and the prototype of adenovirus type 5 was examined by plaque reduction assay using A 549 cells in vitro. RESULTS: The 50% inhibitory dose (ID50) of HP-MPC was 3.50 (1.44-4.79) micrograms/ml for Ad type 3, 4.50 (4.17-4.92) micrograms/ml for Ad type 4, 2.11 (1.03-3.13) micrograms/ml for Ad type 5, 1.64 (1.40-2.02) micrograms/ml for Ad type 19, and 2.02 (1.17-2.73) micrograms/ml for type 37. The 50% cytotoxic dose of HPMPC for A 549 cells was 205 micrograms/ml by the deoxythimidine uptake inhibition test, and 537 micrograms/ml by the trypan blue exclusion inhibition test. CONCLUSIONS: HPMPC proved to be highly effective in inhibiting replication of adenoviruses at lower concentrations than the cytotoxic level in vitro.

Unique characteristics of lacrimal glands as a part of mucosal immune network: high frequency of IgA-committed B-1 cells and NK1.1+ alphabeta T cells.

PURPOSE: Immunologic characterization of IgA-committed B-1 and B-2 cells, and unique subsets of T cells isolated from the murine lacrimal gland (LG), the primary exocrine tissue for the ocular surface, which is considered to be a part of the mucosal immune system. METHODS: Single cells were obtained from LGs of C57BL/6 mice by the enzyme dissociation method using collagenase type IV. Samples underwent flow cytometric analysis to characterize the unique subsets of T and B cells. To test the effectiveness of ocular vaccination, mice were immunized ocularly or nasally with cholera toxin (CT; 10 microg/mouse) suspended in phosphate-buffered saline. Antigen-specific immune responses were determined by isotype and CT-specific enzyme-linked immunosorbent assay (ELISA) and enzyme-linked immunospot (ELISPOT) assay. RESULTS: When mononuclear cells (MC) isolated from LG samples were examined by flow cytometry, approximately 28% of cells were characterized as B220+ B cells. Because surface IgA+ (sIgA+) B cells develop from B-1 and B-2 lineages, it was important to examine which subset of B cells gives rise to LG sIgA+ B cells. Examination of the MC isolated from LG samples showed that approximately 4% of cells were sIgA+ B cells. Furthermore, nearly all these sIgA+ B cells (97.5%) belonged to the B-1 lineage, especially the B-1a cell line (B220low, CD5+). Of the isolated CD3+ T cells, 75% were alpha(beta) and 25% were gamma(delta)T-cell receptor positive. The proportion of NK1.1+ alpha(beta) T cells was higher (3%) in LG samples than in submandibular gland samples (0.5%). Ocular immunization with CT-induced antigen-specific mucosal (e.g., found in tear-wash and saliva samples) and systemic (e.g., serum) immune responses. The magnitude of antigen-specific antibody responses was comparable to those induced by nasal immunization. CONCLUSIONS: These results show that LG contains unique subsets of B (e.g., sIgA+ B-1 cells) and T (e.g., NK1.1+ alpha(beta)T cells) cells. Furthermore, as a part of the mucosal immune barrier, the LG is an important immunologic tissue for the ocular surface.

Tear levels of interferon-gamma, interleukin (IL) -2, IL-4 and IL-5 in patients with vernal keratoconjunctivitis, atopic keratoconjunctivitis and allergic conjunctivitis.

BACKGROUND: A predominance of TH2 activity in chronic allergic diseases, such as vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC), has been suggested recently. However, there is no published study on tear levels of cytokines of the two different subgroups, TH1 and TH2, in patients with ocular allergy. OBJECTIVES: We measured interferon (IFN)-gamma, interleukin (IL)-2, IL-4 and IL-5 levels in tears by ELISA, to determine whether the levels of these cytokines are elevated in allergic ocular diseases when compared among patient groups and normal controls. METHODS: Tear levels of IL-2, IFNgamma, IL-4 and IL-5 were measured by ELISA using samples from patients with VKC, AKC (AKC-NP, without proliferative lesions; and AKC-P, with proliferative lesions), allergic conjunctivitis (AC) and normal subjects. The levels of these cytokines in tears and the clinical severity of AD were also compared. RESULTS: Tear IL-4 level in patients with AKC was significantly higher than those in VKC, AC and controls, and tear IL-4 levels in patients with AKC-P vs VKC differed significantly. Tear IL-5 levels in patients with diseases associated with proliferative lesions, VKC and AKC-P, were higher than those in AC and normal controls. However, tear level of IL-5 in patients with AKC-P was significantly higher than that in AKC-NP. Although the dermatological severity of AD correlated significantly with tear IL-4 level, IFNgamma, IL-2 and IL-5 levels did not correlate with dermatological severity of AD. CONCLUSION: These results indicate that the TH2-like cytokines play an important pathophysiological role in severe ocular allergic conditions such as AKC and VKC and that tear level of IL-5 may be a candidate marker to evaluate the clinical status of ocular allergy. The different patterns of tear levels of IL-4 and IL-5 among ocular allergic diseases may reflect the origin and immunological basis of these cytokines.