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AIM: To report on cornea pseudoguttata which occurred in 44 eyes from 40 patients. METHODS: In 3521 consecutive patients seen at a local eye clinic, eyes were examined with a slit-lamp biomicroscope in specular illumination. When guttate appearance was found, specular microscopy was performed. RESULTS: Cornea pseudoguttata was found in 44 eyes of 40 patients (1.1%). All patients had some form of anterior-segment ocular diseases, including keratitis (corneal infiltration) with contact lens wear (n = 16), epidemic keratoconjunctivitis (n = 8), corneal epithelial defect (n = 6), superficial punctate keratitis (n = 4), corneal foreign body (n = 3), keratitis of unknown causes (n = 3), corneal ulcer (n = 2), herpetic keratitis (n = 1), and iritis (n = 1). Six eyes were lost to follow-up, but in the remaining 38 eyes, cornea pseudoguttata completely resolved as the primary anterior-segment diseases subsided. Specular microscopy, measured after resolution of cornea pseudoguttata, showed that corneal endothelial cell density was not different between the affected and contralateral healthy eyes. CONCLUSION: Cornea pseudoguttata is commonly found in cases with corneal infiltration and inflammation. These results indicate that cornea pseudoguttata is reversible in its nature and resolves completely without any damage to the corneal endothelial cells.

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OBJECTIVE: To investigate the incidence of spontaneous detachment of the anterior hyaloid membrane from the posterior lens capsule and to explore the possibility of surgical separation of the anterior hyaloid membrane. DESIGN: Prospective nonrandomized interventional comparative trial and comparative human tissue study. PARTICIPANTS: Thirty-eight eyes of 32 patients undergoing primary pars plana vitrectomy combined with cataract extraction and intraocular lens implantation and 3 eye bank eyes for histopathologic examination. METHODS: The anterior hyaloid membrane and posterior lens capsule were observed with a fiberoptic endoscope. Surgical separation of the anterior hyaloid membrane was attempted by either the hydrodissection method before cataract extraction (18 eyes) or the direct suction method after cataract extraction (20 eyes). In eye bank eyes, histopathologic examination was performed with (one eye) and without (two eyes) surgical separation of the anterior hyaloid membrane. MAIN OUTCOME MEASURES: Incidence of spontaneous detachment and success rate of surgical detachment of the anterior hyaloid membrane. RESULTS: No eye displayed spontaneous detachment of the anterior hyaloid membrane. Using the hydrodissection method, complete detachment of the anterior hyaloid membrane was achieved in 10 eyes (55.6%), partial detachment was attained in 2 eyes (11.1%), and detachment was not induced at all in 6 eyes (33.3%). With the direct suction method, the anterior hyaloid membrane was completely separated from the posterior lens capsule in 10 eyes (50%), partially detached in 10 eyes (50%), and not detached at all in any eye. The direct suction method had a significantly higher success rate than the hydrodissection method (P < 0.001, chi-square test). In eye bank eyes, the surgical manipulation induced complete separation of the anterior hyaloid membrane from the lens capsule. CONCLUSIONS: Spontaneous detachment of the anterior hyaloid membrane from the posterior lens capsule is very rare. Under endoscopic observation, surgical detachment of the anterior hyaloid membrane was possible in half of the patients.

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PURPOSE: To assess the incidence and related factors of the presumed interference colour phenomenon at the anterior lens capsule. METHODS: In 274 eyes of 137 normal subjects, ranging in age from 4 to 83 years old (50.1 +/- 24.9 years, mean +/- standard deviation), the anterior lens capsule was observed with slit-lamp microscopy under specular conditions to assess the presence and degree of presumed interference colours. RESULTS: The colouring phenomenon, which was thought to be relevant to the interference phenomenon induced at the level of the anterior lens capsule, was found in 67.5% of eyes. Typically, there was a colour spectrum with a greenish tint in the central area and a reddish tint at the periphery, which coincided with the area of capsular shagreen. Multiple regression analysis revealed a signigificant positive correlation between the degree of the interference colour phenomenon and the age of the subjects (r = 0.45, p < 0.0001, R2 = 0.713). CONCLUSION: Presumed interference colours are frequently seen at the human anterior lens capsule. Interference colours and capsular shagreen seem to reflect age-related changes in the lens.

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BACKGROUND: A prospective study was conducted to compare the analgesic effects of sub-Tenon's and retrobulbar anesthesia by assessing patients' response to the visceral stimulus. METHODS: Seven hundred and twenty eyes of 720 patients underwent extracapsular cataract extraction and posterior chamber intraocular lens implantation. They received retrobulbar anesthesia with 3 ml lidocaine (225 eyes), retrobulbar anesthesia with 5 ml lidocaine (216 eyes), or sub-Tenon's anesthesia with 3 ml lidocaine (279 eyes). Pain scores were recorded when an acetylcholine chloride solution was injected into the anterior chamber to attain miosis after lens implantation. RESULTS: Pain scores were significantly different among the three anesthesia groups (P<0.0001, Kruskal-Wallis test). The multiple comparison revealed that analgesic effects were highest with sub-Tenon's anesthesia, followed by 5-ml retrobulbar and 3-ml retrobulbar anesthesia. CONCLUSION: Sub-Tenon's anesthesia is an effective and reliable anesthetic method in cataract surgery.

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PURPOSE: To compare the analgesic effects of different doses of sub-Tenon's anesthesia in cataract surgery by assessing patient response to visceral stimulus. SETTING: Inouye Eye Hospital, Tokyo, Japan. METHODS: A prospective study was done of 1019 eyes of 1019 patients having phacoemulsification and posterior chamber intraocular lens implantation. They received a 1.0 mL (391 eyes), 2.0 mL (366 eyes), or 3.0 mL (262 eyes) anesthetic infiltration into the sub-Tenon's space. Pain scores were recorded when the anterior chamber was irrigated with an acetylcholine chloride solution to attain miosis after lens implantation. RESULTS: The distribution of pain scores was significantly different among the 3 groups (P < .0001, Kruskal-Wallis test). Multiple comparison revealed that the 3.0 mL anesthetic infiltration offered significantly higher analgesic effects than the 2 lower doses. The 3.0 mL sub-Tenon's anesthesia effectively blocked the visceral stimulus. CONCLUSION: For cataract surgery, 3 mL is the optimal dose of anesthetic solution in sub-Tenon's anesthesia.

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OBJECTIVE: To investigate whether any association exists between apparent accommodation in pseudophakic eyes and multifocal corneal effects. DESIGN: A prospective observational case series. PARTICIPANTS: A total of 121 eyes of 98 patients who had undergone phacoemulsification and posterior chamber intraocular lens implantation were studied. METHODS: The amount of apparent accommodation was measured using an accommodometer. The degree of corneal multifocality was determined on the corneal topography by measuring the maximum and minimum corneal refractive powers within the pupillary area. Refractive astigmatism, keratometric astigmatism, pupillary diameter, and age were also analyzed. MAIN OUTCOME MEASURES: Apparent accommodation, corneal multifocality, refractive and keratometric astigmatism, pupillary diameter, and age. RESULTS: Multiple regression analysis revealed that corneal multifocality and pupillary diameter had significant positive correlations with apparent accommodation, whereas other explanatory variables showed no relationship with apparent accommodation. CONCLUSION: Multifocal corneal effects contribute to apparent accommodation in pseudophakic eyes.

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PURPOSE: To assess the predictability and effectiveness of radial keratotomy in patients with myopic refractive error and unacceptable anisometropia after cataract surgery. SETTING: A prospective multicenter study. METHODS: This study comprised 40 eyes of 40 Japanese patients who had had cataract surgery. Radial keratotomy was performed, and the 6 month postoperative data were analyzed. RESULTS: Mean patient age was 71.0 years +/- 7.4 (SD) (range 51 to 84 years) and mean preoperative anisometropia -3.41 +/- 1.69 D (range -1.25 to -7.75 D). The surgery decreased mean anisometropia to -1.01 +/- 0.94 D (P < .000001, Wilcoxon signed-rank test), a mean reduction of 2.22 +/- 1.23 D (range 0.75 to 5.88 D). Postoperative anisometropia ranged from 0.81 to -3.13 D. The surgical effects were overestimated by the nomograms developed for the correction of naturally occurring myopia in the eyes of white patients. Multiple regression analysis revealed that optical zone size and number of incisions were significantly correlated with the amount of myopic correction, and the regression equation (R2 = 0.77) was expressed as follows: Effects = (-1.45 x optical zone size) + (0.24 x incision number) + 7.60. A new nomogram was derived based on this equation. CONCLUSIONS: Radial keratotomy was a safe and efficient procedure to treat myopic refractive error in pseudophakic eyes. Separate nomograms are necessary for white and Asian populations.

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PURPOSE: To compare the analgesic effects of three different delivery techniques of sub-Tenon's anaesthesia in cataract surgery by assessing patients' response to the visceral stimulus. METHODS: A prospective, randomised study was conducted on 345 eyes of 345 patients undergoing phacoemulsification and posterior chamber intraocular lens implantation. They received anaesthetic infiltration into the sub-Tenon's space through a conjunctival incision (115 eyes), infiltration into the posterior sub-Tenon's space (retrobulbar space) through a conjunctival incision (114 eyes), or injection into the intra-Tenon's space (subconjunctival space) without making a conjunctival incision (116 eyes). Pain scores were recorded when the anterior chamber was irrigated with an acetylcholine chloride solution to achieve miosis after lens implantation. RESULTS: There were no significant differences in pain scores among the three groups (chi-squared test of homogeneity, p = 0.814). Approximately 10-20% of patients reported slight to severe pain at the time of acetylcholine administration. CONCLUSIONS: The three anaesthetic delivery methods of sub-Tenon's anaesthesia possess similar and reasonable analgesic effects in cataract surgery, but may not block visceral stimuli completely.

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OBJECTIVE: Although several nomograms are available for the incisional keratotomy to correct naturally occurring astigmatism, astigmatic keratotomy in eyes after cataract surgery has not been well analyzed. The predictability and effectiveness of arcuate keratotomy in pseudophakic eyes were studied. DESIGN: A prospective, multicenter study. PARTICIPANTS: One hundred four eyes of 86 patients with residual corneal astigmatism of 1.5 diopters (D) or more after cataract surgery were examined. INTERVENTION: Arcuate keratotomy was performed in nine centers by nine surgeons. MAIN OUTCOME MEASURES: The amount of astigmatic correction was calculated using the vector analysis of preoperative and 6-month postoperative refractive cylinder results. RESULTS: Multiple regression analysis showed that optical zone size, number of incisions, and incision length had significant correlations with the amount of astigmatic correction. The regression equation was expressed as effects = (-0.643 x optical zone size) + (0.998 x incision number) + (0.057 x incision length) + 2.356. The parameter of predictability (r2: 35%) was lower than that reported for congenital astigmatism (48 to approximately 56%). A new nomogram was derived based on the multiple regression equation. CONCLUSIONS: Astigmatic keratotomy in pseudophakic eyes is less predictable than that in eyes with idiopathic astigmatism, but the procedure is sufficiently effective in reducing the residual astigmatism after cataract surgery. Individual nomograms are necessary for astigmatic keratotomy in eyes with naturally occurring and postsurgical astigmatism.

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PURPOSE: To compare the long-term clinical results of two small incision cataract surgery procedures. SETTING: Seven centers in Japan. METHODS: Two hundred eyes were randomly assigned to receive a silicone intraocular lens (IOL) through a 3.2 mm incision or a poly(methyl methacrylate) (PMMA) IOL through a 5.5 mm incision. Except for incision size and implantation technique, the surgical methods were identical. Uncorrected and corrected visual acuity, keratometry, flare-cell intensity, specular microscopy, and neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate were analyzed up to 3 years after surgery. RESULTS: Eyes in the 3.2 mm incision group had significantly better uncorrected and corrected visual acuity in the early postoperative period and lower aqueous flare intensity immediately after surgery, but these differences disappeared after the first postoperative month. However, surgically induced astigmatism was significantly less in the 3.2 mm incision group than in the 5.5 incision group throughout the study. The Nd:YAG laser capsulotomy rate was higher in the silicone IOL group (23.5% at 3 years postoperatively) than in the PMMA IOL group (18.4%) but the difference was not statistically significant. CONCLUSION: Smaller incision cataract surgery led to early recovery of visual function in the short term and less induced astigmatism in the long term.

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A pachymeter guide has been developed to facilitate precise positioning of the ultrasonic pachymeter tip, making corneal thickness measurement much faster and more reproducible. This guide also makes pachymetry more accurate by preventing dehydration of the cornea, avoiding undue pressure on the cornea, and limiting tilting of the pachymeter tip.

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PURPOSE: To prospectively and comprehensively compare the clinical results of two small-incision cataract surgery procedures, silicone intraocular lens (refractive index of 1.46) implantation through a 3.2-mm incision and polymethylmethacrylate intraocular lens implantation through a 5.5-mm incision. METHODS: Two hundred eyes with cataract randomly were assigned to either procedure. Except for incision size, identical surgical methods were used in every case. Data on uncorrected and corrected visual acuity, keratometry, corneal topography, flare-cell measurement, fluorophotometry, specular microscopy, glare disability measurement, and photographic examination of intraocular lens decentration were analyzed up to 6 months after surgery. RESULTS: Eyes in the 3.2-mm incision group displayed significantly better uncorrected and corrected visual acuity in the early postoperative period, lower aqueous flare intensity and cell counts immediately after surgery, less operatively induced astigmatism throughout the study period, and less corneal topographic changes taken 3 months after surgery. No significant between-group differences were noted for other parameters. Complications in the two groups were few and comparable. CONCLUSION: Both procedures of small-incision cataract surgery offered satisfactory clinical results, but 3.2-mm incision cataract surgery allowed significantly earlier recovery of visual function and better preservation of corneal shape.

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We compared the postsurgical results of two small incision cataract surgery procedures: silicone intraocular lens implantation through a 3.2 mm incision and polymethylmethacrylate intraocular lens implantation through a 5.5 mm incision. One hundred fifty eyes of 124 patients were randomly assigned to either procedure, and the patients underwent phacoemulsification and intraocular lens implantation without sutures or scleral cautery. Identical surgical techniques were employed in each case except for the size of the incision. Patients in the 3.2 mm incision group showed: (1) better uncorrected and corrected visual acuity in the early postoperative period, (2) lower aqueous flare intensity immediately after surgery, (3) less operatively induced corneal astigmatism throughout the study period up to 3 months after surgery, and (4) less corneal topographic change, i.e., less corneal flattening, 3 months after surgery. There were no significant differences between groups in the corneal endothelial cell loss, blood-aqueous barrier permeability measured by fluorophotometry, or postoperative complications. It was concluded that both procedures offer highly satisfactory clinical results, but that the 3.2 mm incision surgery allows a significantly earlier recovery of visual function and less surgery-induced corneal astigmatism.

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Human anterior subcapsular cataracts were examined by immunocytochemistry to investigate which types of collagen constitutes the subcapsular fibrous matrix. Types I, III, and IV collagen were shown to be immunologically positive by both light and electron microscopy. In light microscopy, types I and III collagen were stained diffusely whereas type IV collagen was stained in a streaky pattern in the opacities. The lens capsules were stained with antibody to type IV collagen, although the staining patterns were not homogeneous; the inner layers of the capsules were labeled more strongly than the outer layers. Neither type I nor III collagen was detected in the capsules. In electron microscopy, collagen fibrils were labeled with the antibodies to both type I and type III collagen. The lens capsules and multilamellae of the basement membranes in the opacities were labeled with the antibody to type IV collagen.

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We studied the quantitative fluctuations of tissue plasminogen activator (t-PA) activity and antigen in aqueous humor before and after extracapsular cataract extraction and poly(methyl methacrylate) posterior chamber lens implantation. The t-PA activity level was measured by solid phase bioimmunoassay using monoclonal antibody against an epitope apart from the active site of t-PA, and the antigen by ELISA. In our patients the mean preoperative level of t-PA activity was 0.0664 +/- 0.0472 IU/ml (mean +/- SD) and of the antigen, 0.175 +/- 0.024 ng/ml. The t-PA activity level in aqueous humor was markedly decreased on the first postoperative day (0.0042 +/- 0.0037 IU/ml), recovered on the second day (0.0403 +/- 0.0251 IU/ml), and then progressively decreased from the fourth to the seventh days. The t-PA antigen level in aqueous humor increased on the first (0.366 +/- 0.108 ng/ml) and second (0.403 +/- 0.251 ng/ml) postoperative days and gradually decreased from the fourth to seventh days. Under the intracameral condition of the fibrinolytic system, various factors, e.g., serious inflammation or events affecting the balance of coagulation and fibrinolysis, may induce the decrease or depletion of t-PA activity, followed by the pupillary fibrin membrane formation. We suggest that fluctuations of t-PA activity in aqueous humor may affect fibrinous membrane formation over the IOL surface.

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We studied four angle-supported anterior chamber lenses whose optics and haptics were made of poly(methyl methacrylate). All four lenses had been removed from human eyes because of bullous keratopathy. Using light and electron microscopy, we compared the cellular reaction on the optics, which had been in the anterior chamber, with that on the haptics, which had been in touch with the iris stroma. A typical foreign body granuloma was seen around the haptics, while the optics were free of foreign body reaction.

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The synthesis of prostaglandin I2 (PGI2) was found to decrease with age in cultured, porcine aortic endothelial cells. Arachidonic acid (AA)-induced PGI2 synthesis per cell at low cell density was higher than that at high cell density. PGI2 synthesis by cultured porcine aortic smooth muscle cells, without exogenous AA, was higher than that by cultured porcine aortic endothelial cells, while AA-induced PGI2 synthesis by cultured porcine aortic medial smooth muscle cells was lower than that by cultured endothelial cells. PGI2 synthesis by cultured smooth muscle cells incubated with fibrinogen degradation products (FDPs) for 24 h decreased. After incubation with FDPs for 24 h, AA-induced PGI2 synthesis by endothelial cells also diminished. These data suggest that PGI2 synthesis in the vascular wall is affected by FDPs, and that FDPs probably play an important role in the initiation of atherosclerosis.

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The local fibrinolytic activity of the human optic nerve vessels was investigated in 25 eyes obtained at autopsy using Todd's fibrinolysis autography. The veins generally showed higher fibrinolytic activity than the arteries except for the central retinal vessels, as was the case in the systemic blood vessels. Out of 25 cases, 6 (24%) showed a lower activity in the central retinal veins than in the arteries, 7 (28%) a higher activity in the veins than in the arteries and in 12 (48%) the tendency was transitional.

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This paper referred to primary immunodeficiency diseases (PID)-malignancy association in autopsy cases in Japan. The occurrence of malignant neoplasms almost centered upon ataxia-telangiectasia among PID in Japan. It seems to be due to extremely shorter life span in Japanese patients with PID except for in those with ataxia-telangiectasia, compared with that in European and American patients. Most of the malignant neoplasms seen in Japanese patients with PID were epithelial and were seen mostly in older patients, while lymphoreticular tumors were rare. Gastric cancer was the most frequent of the epithelial tumors.

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