Tsutomu Inatomi

To survey indications and outcomes of amniotic membrane transplantation (AMT) performed under Advanced Medical Healthcare (AMH) in Japan. Questionnaires were sent to 21 facilities performing AMT under AMH from 2010-2012. Diagnosis, effectiveness, and final outcomes were surveyed. Moreover, we retrospectively examined the diagnosis, treatment effectiveness, and final outcomes in all AMTs performed under AMH at Kyoto Prefectural University of Medicine (KPUM) from April 2009 through June 2013. Clinical data of 311 eyes that underwent AMT under AMH was obtained. Of those, diagnoses included pterygium (n = 148), corneal ulcer/epithelial defect (n = 60), corneal perforation (n = 28), intractable glaucoma (n = 24), and others (n = 51). The surgical outcome was completely or partially successful in 287 eyes (92.3%). The final outcome was effective in 281 eyes (90.4%). A total of 45 eyes of 37 patients underwent AMT under AMH at KPUM. Of those, diagnoses included pterygium (n = 15), recurrence of pterygium (n = 27), and symblepharon (n = 3). The surgical outcome was completely successful in 98% and partially successful in 2%. The final outcome was effective in all cases. AMT performed under AMH in Japan was most common in eyes with pterygium, and was highly effective in these cases, as well as corneal ulcer/epithelial defect, corneal perforation, and intractable glaucoma.

Our previous study of polymorphisms in the HLA-class I genes of 71 Japanese SJS/TEN patients with ocular surface complications and 113 Japanese healthy controls showed that in the Japanese, HLA-A*0206 was strongly associated with SJS/ TEN. In this study, we examined 118 Japanese SJS/ TEN patients with ocular surface complications and a new control group consisting of 220 healthy Japanese volunteers, and investigated the association between HLA class I antigens, HLA-A, B, C, and the SJS/ TEN. For HLA genotyping we enrolled 118 Japanese patients with SJS/TEN in the chronic or sub-acute phase at Kyoto Prefectural University of Medicine; all presented with ocular surface complications. We also enrolled 220 healthy Japanese volunteers. We performed polymerase chain reaction amplification followed by hybridization with sequence-specific oligonucleotide probes (PCR-SSO). Results : HLA-A*0206 was most strongly associated with Japanese SJS/TEN patients with ocular surface complications (carrier frequency: p = 0.0000000002, OR = 5.2; gene frequency : p = 0.000000007, OR = 4.2). HLA-A* 0206 is strongly associated with Japanese SJS/TEN patients with ocular surface complications.

To evaluate the indications and surgical outcomes of amniotic membrane transplantation (AMT) for ocular-surface disease. This study involved 304 AMTs performed at Kyoto Prefectural University of Medicine between April 1998 and March 2008. Preoperative diagnoses, clinical features, surgical procedures and postoperative outcomes were analyzed retrospectively. Of 304 cases, 145 cases had a pterygium (48 primary, 82 recurrent, and 15 pseudo-pterygium). The recurrence rate at one year was 6.1% among the 99 cases of pterygium followed for at least one year postoperatively. Ninety-three cases had severe ocular surface diseases including ocular pemphigoid (30), chemical or thermal burn (29), Stevens-Johnson syndrome (23), and others (11) AMT and epithelial transplantation was combined in 64 cases, and successful ocular-surface reconstruction was obtained in 88 cases (94.6%). Neoplasia was observed in 22 cases (12 benign, 10 malignant). The ocular-surface was successfully reconstructed in all cases by AMT combined with complete tumor resection. Other preoperative diagnoses included persistent epithelial defects (PED) (15), conjunctival chalasis (12) and uncontrollable glaucoma (11). No cases experienced any AMT-related complication. AMT proved effective for preventing the recurrence of pterygium and for ocular-surface reconstruction in patients with severe ocular-surface disease or ocular-surface neoplasia.

To clarify the characteristic appearances of early-stage Acanthamoeba keratitis (AK) and to investigate the effects of topical steroids on those appearances. This study involved 25 eyes of 24 patients diagnosed as early-stage AK at Kyoto Prefectural University of Medicine between October 2002 and June 2008. All patients were contact lens wearers, and 23 patients (96%) were referred from other hospitals. Clinical findings in the medical records of all patients were analyzed retrospectively. Radial keratoneuritis was observed in 20 of 25 eyes (80%), and pseudodendritic lesions were observed in 15 eyes (60%). Only 1 eye (4%) showed neither of these two findings. Of the 10 eyes treated with topical steroids until the first presentation at our hospital, 6 eyes manifested radial keratoneuritis and/or pseudodendritic lesions after the discontinuation of that treatment. The visual prognosis was good in both groups, with or without topical steroid treatment. We found that radial keratoneuritis and pseudodendritic lesions are characteristic appearances of early-stage AK, and that topical steroid treatment might mask these characteristic findings.

Prostanoids are a group of lipid mediators that form in response to various stimuli, including prostaglandin (PG) D₂ (PGD₂), PGE₂, PGF_2α, PGI₂, and thromboxane A₂. There are 8 types of prostanoid receptors that are conserved in mammals ranging from mice to humans: the PGD receptor, 4 subtypes of the PGE receptor (EP1, EP2, EP3, and EP4), the PGF receptor, the PGI receptor, and the thromboxane A receptor.¹ In regard to PGE receptor subtype EP4, it was reported that EP4 messenger RNA was present in the intestinal epithelium² and that EP4 maintained intestinal homeostasis and downregulated immune response.³ Like the intestine, the ocular surface is also one of the mucosa that are in contact with commensal bacteria. In this study, we examined the expression of EP4 in human conjunctival epithelium and compared its expression between various ocular surface diseases.

To study the relationship between ocular surface colonization or infection and nasal carriage of methicillin-resistant Staphylococcus aureus(MRSA) among patients at high risk of infection and those who have already been infected. We isolated MRSA from ocular surface and anterior nares in 35 patients at high risk of MRSA colonization and from 4 patients who had developed an active MRSA ocular infection in the conjunctiva. Of the 7 patients who were carriers of conjunctival MRSA, 5 patients (78%) were found to be carriers of MRSA in the anterior nares. This ratio of nasal carriers is very high compared to the 11% in 28 patients without MRSA in the conjunctiva. All 4 cases who had active infections of MRSA in the cornea or conjunctiva showed MRSA from the nares. Even after MRSA was negative in their eye lesions, MRSA colonization in their nares continued for a long time. A significant relationship exists between MRSA in the ocular surface and MRSA found in the nares.

We studied retrospectively the background of postoperative infection after corneal transplantation. We reviewed the records of 753 eyes that had undergone corneal transplantation at Kyoto Prefectural University of Medicine or the Baptist Eye Clinic over a period of 6 years from April 1994 to March 2000. Patients who developed microbial keratitis after corneal transplantation were evaluated for the incidence of infection, age, the interval between transplantation and infection, microbiological etiology, the use of topical steroids, therapy, and complications. Follow-up after keratoplasty averaged 43.2+/-25.6 months (mean+/-standard deviation). Among 753 eyes examined, microbial keratitis developed in 27 eyes (3.6%), 14 eyes had bacterial, and 13 had fungal infections. The ages at presentation were 51.4+/-21.5 years for bacterial infections, and 66.5+/-11.1 for fungal infections. The time intervals between transplantation and the onset of infection averaged 7.8+/-7.9 months for bacterial infections, and 24.2+/-17.2 for fungal infections. Infections in 7 (50.0%) of the bacterial eyes were caused by methicillin-resistant Staphylococcus aureus (MRSA) or epidermidis (MRSE), and 9 (69.2%) of the fungal infections by yeast type fungus (8 were Candida species). At onset of keratitis, 3 (21.4%) of the bacterial eyes and 6 (46.2%) of the fungal eyes were treated with fluorometholone, and 11 (78.6%) of the bacterial eyes and 7 (53.8%) of the fungal eyes were treated with betamethazone or dexamethasone. The treatment duration until the focus of disappeared was 32.8+/-19.7 days for bacterial eyes, and 74.8+/-56.3 for fungal eyes. Major complications associated with infection included corneal perforation in 2 eyes of both the bacterial (14.3%) and fungal (15.4%) eyes, graft rejection in 4 (28.6%) bacterial eyes and 1 (7.7%) fungal eye, there was no recurrence of infection in the bacterial eyes but there were 3 (23.1%) cases of recurrence in the fungal eyes. Infection after corneal transplantation is opportunistic. Fungal infections occurred later than bacterial infections. Also in fungal infections, the mean age at presentation was higher and the recurrence of infection was more frequent.