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PURPOSE: The purpose of this study was to determine whether a second trabeculotomy (LOT) can reduce the intraocular pressure (IOP) in eyes with primary open-angle glaucoma (POAG) that had undergone an unsuccessful LOT as the initial surgery. PATIENTS AND METHODS: LOT ab externo was performed as a second surgery on 37 eyes of 34 POAG patients who had undergone an unsuccessful LOT as the initial surgery. The main outcome measure was the postoperative IOPs, and surgical failures were defined as eyes with a post-LOT IOP>20 mm Hg. The eyes were divided into 3 groups; those that underwent LOT as both the initial and additional surgery (L-L group), those that underwent LOT as the initial surgery and combined LOT and cataract surgery (cLOT-IOL) as the additional surgery (L-cL group), and those that underwent cLOT-IOL as the initial surgery and LOT as the additional surgery (cL-L group). RESULTS: The IOP was reduced after the additional LOT at postoperative 24 months in the L-L group from 20.0±3.0 mm Hg to 15.3±2.6 mm Hg (P<0.001), the L-cL group from 19.8±1.6 mm Hg to 15.8±3.2 mm Hg (P=0.029), and the cL-L group from 20.1±2.7 mm Hg to 15.5±2.3 mm Hg (P=0.014). There were no differences in the preoperative and postoperative IOPs between the initial-operated and additional-operated eyes. The success rates were improved by the additional surgery in the L-L group (P<0.001) and the L-cL group (P=0.029), but the rate was worsened in the cL-L group (P<0.001). CONCLUSIONS: These results indicate that LOT is a reasonable choice as an additional glaucoma surgery after failure of an initial LOT.

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PURPOSE: To describe a case of primary intraocular lymphoma (PIOL) with an extension through the sclera that was confirmed to be part of the PIOL by histopathological examinations. CASE: An 89-year-old woman was referred to a local clinic with a 1-year history of persistent blurred vision in her left eye. After 2 years without aggressive treatments, she had a marked reduction of vision and pain in her left eye. The clinical diagnosis was panophthalmitis, and the eye was enucleated and submitted for histopathological study. RESULTS: Light microscope examination showed that atypical lymphocytic cells had infiltrated into both the intraocular and extraocular areas. The anterior chamber angle was blocked by infiltrating tumor cells, which were also detected around the optic nerve. The tumor cells destroyed Bruch's membrane and infiltrated around the perineural and perivascular areas within the sclera. Immunohistochemistry showed that the tumor cells were positive for B-lymphocyte surface antigen (CD20), B-cell antigen receptor complex-associated protein alpha chain (CD79-alpha), and had a high positive rate for anti-Ki-67 antibody. CONCLUSION: The finding in our case indicates that early diagnosis and treatment are important for eyes with PIOL because the tumor can spread and penetrate the sclera and invade extraocular tissues.

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Fatty acids and their derivatives play a role in the response to retinal injury. The effects of dietary arachidonic acid (AA) supplementation on N-methyl-N-nitrosourea (MNU)-induced retinal degeneration was investigated in young Lewis rats during the gestational, lactational and post-weaning periods. Dams were fed 0·1, 0·5 or 2·0% AA diets or a basal (< 0·01% AA) diet. On postnatal day 21 (at weaning), male pups received a single intraperitoneal injection of 50 mg MNU/kg or vehicle, and were fed the same diet as their mother for 7 d. Retinal apoptosis was analysed by the terminal deoxynucleotidyl transferase-mediated dUTP digoxigenin nick-end labelling (TUNEL) assay 24 h after the MNU treatment, and retinal morphology was examined 7 d post-MNU. Histologically, all rats that received MNU and were fed the basal and 0·1% AA diets developed retinal degeneration characterised by the loss of photoreceptor cells (disappearance of the outer nuclear layer and the photoreceptor layer) in the central retina. The 0·5 and 2·0% AA diets rescued rats from retinal damage. Morphometrically, in parallel with the AA dose (0·5 and 2·0% AA), the photoreceptor ratio significantly increased and the retinal damage ratio decreased in the central retina, compared with the corresponding ratios in basal diet-fed rats. In parallel with the increase in serum and retinal AA levels and the AA:DHA ratio, the apoptotic index in the central retina was dose-dependently decreased in rats fed the 0·5 and 2·0% AA diets. In conclusion, an AA-rich diet during the gestation, lactation and post-weaning periods rescued young Lewis rats from MNU-induced retinal degeneration via the inhibition of photoreceptor apoptosis. Therefore, an AA-enriched diet in the prenatal and postnatal periods may be an important strategy to suppress the degree of photoreceptor injury in humans.

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PURPOSE: To evaluate retrospectively the long-term effects of initial trabeculotomy combined with sinusotomy performed inferiorly. PATIENTS AND METHOD: Enrolled were 128 eyes of 100 patients who received initial glaucoma surgery. In 36 eyes, the removal of Schlemm's canal endothelium was also performed (removed group). The results were compared with the intact group RESULTS: In the primary open angle glaucoma (POAG), mean intraocular pressure (IOP) at 3 years after surgery was 14.6 (intact) and 15.4 mmHg (removed). Kaplan-Meier life-table analysis showed that qualified success rates for the intact group at 8 years were 62.2% and for the removed group at 5 years 45.2% defined by 20 mmHg or lower. The results in developmental glaucoma (DG) were similar to those in POAG. No statistical differences in postoperative IOP between the intact and removed groups were seen in either POAG or DG. In exfoliation glaucoma (XFG), mean IOPs for the intact group at 3 years were 17.3 mmHg and for the removed group at 2 years 15.4 mmHg. The success rates for the intact group at 3.5 years were 25.2% and for the removed group at 4.5 years 64.3%. The results in the intact group were worse than in the POAG patients. Although visual disturbance was seen in 13% of the patients, the major cause was the progression of the cataracts. CONCLUSIONS: The long-term results were the same as those of previous reports on surgery performed superiorly, including the frequency of visual disturbance. However the removal of Schlemm's canal endothelium is necessary in XFG for better IOP control.

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Seven-week-old male Lewis rats received a single intraperitoneal injection of N-ethyl-N-nitrosourea (ENU) (100, 200, 400 or 600 mg/kg), and retinal damage was evaluated 7 days after the treatment. Sequential morphological features of the retina and retinal DNA damage, as determined by a TUNEL assay and phospho-histone H2A.X (γ-H2AX), were analyzed 3, 6, 12, 24 and 72 hr, 7 days, and/or 30 days after 400 mg/kg ENU treatment. Activation of the nuclear enzyme poly (ADP-ribose) polymerase (PARP) was analyzed immunohistochemically by poly (ADP-ribose) (PAR) expression in response to DNA damage of the retina. All rats that received ≥ 400 mg/kg of ENU developed retinal degeneration characterized by the loss of photoreceptor cells in both the central and peripheral retina within 7 days. In the 400 mg/kg ENU-treated rats, TUNEL-positive signals were only located in the photoreceptor cells and peaked 24 hr after ENU treatment. The γ-H2AX signals in inner retinal cells appeared at 24 hr and peaked at 72 hr after ENU treatment, and the PAR signals selectively located in the photoreceptor cell nuclei appeared at 12 hr and peaked at 24 hr after ENU treatment. However, degeneration was restricted to photoreceptor cells, and no degenerative changes in inner retinal cells were seen at any time points. Retinal thickness and the photoreceptor cell ratio in the central and peripheral retina were significantly decreased, and the retinal damage ratio was significantly increased 7 days after ENU treatment. In conclusion, ENU induced retinal degeneration in adult rats that was characterized by photoreceptor cell apoptosis through PARP activity.

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AIM: The morphological response and cell kinetics of the mouse cornea to various doses of N-ethyl-N-nitrosourea (ENU) was examined. MATERIALS AND METHODS: ENU at a dose of 50, 100, 200, 400, or 600 mg/kg was injected intraperitoneally into female BALB/c mice at seven weeks of age. Sequential morphological features and cell kinetics (TUNEL assay as apoptosis marker, PCNA immunostaining as proliferative activity marker, and p63 immunostaining as corneal stem cell marker) of corneal damage caused by 600 mg/kg of ENU were also analyzed 6, 12, 24 and 72 h, and 7 days after exposure. Moreover, older mice (25 to 34 weeks of age) received the same dosage and were sacrificed 7 days later. Both eyes of all mice were analyzed histopathologically and morphometrically, by using the parameters of corneal epithelial thickness. RESULTS: All ENU-treated mice in the 600 mg/kg group developed corneal damage characterized by desquamation and loss of epithelial cells within 7 days. Corneal epithelial thickness was significantly reduced in the 600 mg/kg group as compared to the control group and decreased to approximately half of the normal thickness. Although the number of TUNEL-positive epithelial cells in the ENU-treated mice was similar to that of the control mice, ENU inhibited the proliferative activity of epithelial cells showing PCNA-positivity 72 h after treatment. The p63-positivity of epithelial cells decreased in the central cornea of mice treated with 600 mg/kg of ENU. Older mice did not develop corneal damage from exposure to ENU. CONCLUSION: ENU induced corneal damage in adult mice, and epithelial cell loss was caused by the inhibition of corneal epithelial proliferation. This is the first report to describe ENU-induced corneal injury in adult mice.

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AIM: A single systemic administration of N-methyl-N-nitrosourea (MNU) causes retinal degeneration involving photoreceptor cell death within 7 days. MNU-induced photoreceptor cell death is due to apoptosis, and is a reliable animal model for human retinitis pigmentosa. The purpose of this study was to elucidate the involvement of calpain-mediated autophagy, as well as apoptosis on the cell death cascade caused by MNU and to evaluate the efficacy of calpain inhibitor SNJ-1945. MATERIALS AND METHODS: Seven-week-old BALB/c mice were left untreated or received an intraperitoneal (i.p.) injection of MNU. The MNU-exposed mice received an i.p. injection of SNJ-1945 or vehicle alone (distilled water containing 0.5% carboxymethyl cellulose) 3 h prior to MNU and once daily thereafter until sacrifice. Eyes were examined histologically, histochemically, and morphometrically to analyze the photoreceptor cell ratio and retinal damage ratio. The retinal expression of caspase-3, microtubule-associated protein light chain 3 (LC3), autophagy-related protein 5 (Atg5), and α-spectrin was determined by Western blot analysis. RESULTS: During the 72-h period after MNU exposure, the caspase-3 expression increased and the LC3 and Atg5 expression decreased, indicating increased levels of apoptosis and decreased levels of autophagy, as compared with the MNU-unexposed control mouse retina. MNU-induced photoreceptor cell death was caused by increased calpain activation as measured by α-spectrin proteolysis products, while SNJ-1945 ameliorated photoreceptor cell death by blocking calpain activation and restoring basal autophagy. CONCLUSION: Calpain activation is involved in MNU-induced photoreceptor cell death, and calpain inhibition effectively restored photoreceptor cell autophagy and photoreceptor cell death in mice.

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The anticancer effects of sulforaphane (SFN), which is found in cruciferous vegetables, were studied on KPL-1 human breast cancer cells in vitro and in vivo. Cell proliferation in vitro was assessed by a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and tumor growth and metastasis in vivo were examined in orthotopically (right thoracic mammary fat pad) transplanted KPL-1 cells in female athymic BALB/c mice. The MTT assay showed that SFN directly inhibited KPL-1 cell growth in vitro (IC50 at 48 h, 19.1 µM; IC50 at 72 h, 17.8 µM). Athymic mice received a KPL-1 cell transplant, and SFN treatment (intraperitoneal injection of 25 or 50 mg/kg SFN) was started the next day. Mice received five injections each week during the 26-day experimental period (for a total of 20 injections). Compared with the SFN-untreated controls, SFN suppressed primary tumor growth. At the termination of the experiment, the final tumor volume was 686±94 mm3 for the control group, 516±70 mm3 (75% of control value) for the 25 mg/kg SFN group and 351±55 mm3 (51% of control value) for the 50 mg/kg SFN group. The final tumor weight was 571±69 mg in the control group, 416±63 mg (73% of the control value) in the 25 mg/kg SFN group and 338±56 mg (59% of the control value) in the 50 mg/kg SFN group. SFN caused a dose-dependent decrease in the proliferation ratio and an increase in the apoptotic ratio of the primary tumor cells. SFN treatment tended to reduce regional (axillary) lymph node metastasis. Treatment with 50 mg/kg SFN significantly inhibited KPL-1 cell growth in vivo by suppressing cell proliferation and inducing apoptosis, and it tended to reduce axillary lymph node metastasis of KPL-1 human breast cancer cell xenografts in female athymic mice.

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