Yusaku Miura

To assess the efficacy of using a nylon suture as a stent in the PreserFlo MicroShunt (PMS) lumen to prevent postoperative hypotony, 59 eyes that underwent PMS implantation with follow-up for > 6 months were analyzed. Patients were divided into no intrastenting (NST) and intrastenting (ST) groups, with the ST group subdivided into 9 − 0 nylon suture fully placed (9 F), 9 − 0 nylon suture placement in only half of the lumen (9 H), 10 − 0 nylon suture fully placed (10 F), and 10 − 0 nylon suture placement in only half of the lumen (10 H). The distribution was as follows: 23 eyes in the NST group, 10 in the 9 F group, 9 in the 9 H group, 11 in the 10 F group, and 6 in the 10 H group. No significant differences were observed in preoperative and 6-month postoperative intraocular pressure, number of glaucoma medications, or cumulative survival rate between groups. Postoperative hypotony occurred in 13 eyes (56.5%) in the NST group, one (2.78%) in the ST group (p = 0.00014). Post-intrastent removal, hypotony occurred in 6 eyes (16.7%) in the ST group. These findings suggest that intrastent placement effectively prevents postoperative hypotony, regardless of nylon suture diameter or insertion length; however, timing is crucial as hypotony may occur after removal.

This study aimed to present an effective and minimally invasive method for treating prolonged hypotony after PreserFlo MicroShunt (PMS) implantation, which can cause serious complications. A 79-year-old man with primary open-angle glaucoma of the right eye underwent ab interno intraluminal stent insertion for prolonged hypotony after PMS implantation. After making two corneal incisions at the 5 and 8 o'clock positions in the right eye, a viscoelastic material was injected into the anterior chamber. A 10-0 nylon suture was inserted into the anterior chamber through a corneal incision in the 5 o'clock position. Next, the 10-0 nylon suture was grasped and inserted into the PMS lumen as a stent with forceps, following which it was cut approximately 1 mm from the tip of the PMS using micro-iris scissors. Finally, the viscoelastic material in the anterior chamber was washed with a balanced salt solution, and self-closure of the two corneal incisions was confirmed. After ab interno intraluminal stent insertion, hypotony improved and stabilized at approximately 10 mmHg. The shallow anterior chamber, choroidal detachment, and hypotonic maculopathy improved rapidly. This novel technique demonstrated effectiveness and minimal invasiveness in treating prolonged hypotony after PMS implantation.

Severe ocular allergic diseases, such as atopic keratoconjunctivitis and vernal keratoconjunctivitis, cause severe allergic inflammation in the conjunctiva and corneal epithelial damage, resulting in visual disturbances. The involvement of damage (danger)-associated molecular patterns (DAMPs/alarmins) in the pathogenesis of these diseases has been recognized. Alarmins released from damaged corneal epithelial cells or eosinophils play a critical role in the induction of corneal lesions, vicious loop of corneal injury, and exacerbation of conjunctival allergic inflammation. Alarmins in the conjunctiva also play an essential role in the development of both allergic inflammation, based on the acquired immune system, and type 2 inflammation by innate immune responses in the ocular surface. Therefore, alarmins may be a potentially important therapeutic target in severe refractory ocular allergic diseases.

The purpose of this study was to compare the clinical outcomes of ab interno microhook trabeculotomy (µLOT) before and after cataract surgery for the combination of µLOT and cataract surgery. This retrospective case series included 40 eyes that underwent µLOT combined with cataract surgery at Kochi University Hospital. Groups 1 (20 eyes) and 2 (20 eyes) included eyes that underwent µLOT before and after cataract surgery, respectively. The patient characteristics and clinical outcomes were also analyzed. The mean preoperative intraocular pressure (IOP) in Groups 1 and 2 (26.1 ± 12.2 mmHg and 20.6 ± 8.8 mmHg) was reduced significantly to 14.1 ± 3.3 mmHg and 12.9 ± 3.2 mmHg, respectively, at 5–7 months postoperatively. The median preoperative number of antiglaucoma medications in Groups 1 and 2 (4.0 and 3.5) also decreased significantly, to 2.5 and 1.0, respectively, at 5–7 months postoperatively. Postoperative hyphema with niveau formation in Groups 1 and 2 was observed in one eye (5.0%) and six eyes (30.0%), respectively. For the combination of µLOT and cataract surgery, performing µLOT before cataract surgery may be less likely to result in postoperative hyphema with niveau formation.

Relapsing polychondritis (RPC) is a rare systemic immune-mediated disease characterized by recurrent inflammation of cartilaginous and proteoglycan-rich tissues throughout the body. Auricular, nasal, tracheal, and articular chondritis and arthritis are common systemic symptoms in patients with RPC. Ocular tissues are also targets of inflammation in RPC, and a variety of ocular symptoms are observed in approximately half of the patients with RPC. Scleritis/episcleritis, uveitis, and conjunctivitis are common symptoms associated with RPC. Less frequently, keratitis, retinopathy, optic neuropathy, muscle palsy, and orbital inflammation are also observed. Ocular inflammation could also be the first manifestation of RPC. Although RPC is a potentially fatal and sight-threatening disease, the rarity of the disease and its protean clinical presentation may lead to delayed diagnosis or misdiagnosis. Given the high prevalence of ocular involvement in RPC, to avoid misdiagnosis, physicians should be suspicious of RPC when they see patients with recurrent ocular inflammatory conditions and various systemic symptoms. In this article, we provide a comprehensive review of ocular manifestations associated with RPC.

Purpose To evaluate the outcomes of flanged intraocular lens fixation combined with microhook trabeculotomy. Patients and methods This study was a retrospective case series and included nine eyes of nine exfoliation glaucoma patients with subluxated lens or intraocular lens who underwent flanged intraocular lens fixation combined with microhook trabeculotomy between May 2019 and February 2020 at the Kochi University Hospital. The mean best-corrected visual acuity, intraocular pressure, and number of antiglaucoma medications were compared before and after surgery. Results The mean follow-up period was 5.67 ± 2.50 months. The mean best-corrected visual acuity improved significantly from 0.83 ± 0.72 preoperatively to 0.22 ± 0.34 at the last visit (p = 0.015). The mean intraocular pressure had significantly reduced from 27.1 ± 8.12 mmHg preoperatively to 13.2 ± 3.73 at the last visit (p = 0.008). The mean number of antiglaucoma medications decreased significantly from 4.56 ± 1.88 to 2.0 ± 1.0 at the last visit (p = 0.008). Postoperative intraocular pressure control to 21 mmHg or lower was achieved or maintained in all patients. Postoperative vitreous hemorrhage was observed in six eyes (66.7%), two of which needed reoperation. Conclusions This study showed that flanged intraocular lens fixation combined with microhook trabeculotomy might be effective for exfoliation glaucoma with subluxated lens or intraocular lens.

Purpose. To compare the clinical outcomes of ab interno microhook trabeculotomy (µLOT) before and after cataract surgery for the combination of µLOT and cataract surgery. Methods. This retrospective case series included 24 eyes that underwent µLOT combined with cataract surgery at Kochi University Hospital. Groups 1 and 2 included eyes that underwent µLOT before and after cataract surgery (12 eyes each), respectively. The patient characteristics and clinical outcomes were also analyzed.Results. The mean preoperative intraocular pressure (IOP) in Groups 1 and 2 (25.3 ± 11.0 mmHg and 22.4 ± 10.5 mmHg) were reduced significantly to 14.5 ± 3.6 mmHg and 12.3 ± 3.0 mmHg, respectively, at 5–7 months postoperatively. The mean preoperative number of antiglaucoma medications in Groups 1 and 2 (4.3 ± 1.4 and 3.7 ± 1.5) had also decreased significantly to 2.7 ± 0.9 and 1.7 ± 1.6 at 5–7 months postoperatively. Postoperative hyphema with niveau formation was observed in five eyes in Group 2 (41.7%) but not in Group 1. Conclusion. For the combination of µLOT and cataract surgery, performing µLOT before cataract surgery may be less likely to result in postoperative hyphema with niveau.

Dying cells release endogenous molecules known as alarmins that signal danger to surrounding tissue. We investigated the effects of necrotic cell-derived alarmins on cytokine expression and barrier function in human corneal epithelial cells.