The majority of dry eye symptoms are due to a chronic inflammation of the lacrimal functional unit resulting in a loss of tear film integrity and normal function. The tear secretion is controlled by the lacrimal functional unit consisting of the ocular surface (cornea, conjunctiva, and meibomian glands), the main lacrimal gland, and the interconnecting innervation. A lack of systemic androgen support to the lacrimal gland has been shown to be a facilitating factor in the initiation of ocular inflammation. If any portion of this functional unit is compromised, lacrimal gland support to the ocular surface is impeded. In this review, the classification and treatment of dry eye syndrome will be presented according to the A Delphi approach.
Classification ; Conjunctiva ; Cyclosporine ; Dry Eye Syndromes ; Inflammation ; Lacrimal Apparatus ; Tears

This study was done to report the epidemiologic characteristics of medical retirement from the Republic of Korea (ROK) Army due to visual impairment and to suggest a practical screening system for the draft. The medical records of 423 eyes of 301 patients who retired from the ROK Army due to visual impairment were reviewed retrospectively between January 2010 and December 2014. The patients were grouped by the presence of trauma, and each group was subdivided by military rank. We analyzed demographic and ophthalmic data, including the etiology of ophthalmologic disease. The etiology was classified into 5 anatomical categories (ocular surface, lens, retina, optic nerve and extraocular visual pathway, and extraocular muscle and orbit), which were then subdivided into the type of disease. The mean age was 24.5 years, and non-traumatic mechanisms accounted for 81.1% (343/423 eyes) of medical retirements. Visual acuity was better in patients without trauma. In enlisted soldiers, disease in the optic nerve and extraocular visual pathway was the most common anatomical category (40.5%), and primary open angle glaucoma (30.8%), retinal dystrophy (18.3%), congenital cataract (14.5%), and retinal detachment (9.7%) were the four most common diseases. Most medical retirements due to visual impairment resulted from non-traumatic mechanisms, even though patients were young. The fundus examination and visual field test would be more useful tools than a conventional vision test for large-scale draft screening for the most common two disease types: primary open angle glaucoma and retinal dystrophy.
Adult ; Cataract/epidemiology ; Cohort Studies ; Glaucoma, Open-Angle/epidemiology ; Humans ; Male ; Middle Aged ; Military Personnel ; Republic of Korea/epidemiology ; Retinal Dystrophies/epidemiology ; *Retirement ; Retrospective Studies ; Vision Disorders/epidemiology/*pathology ; Visual Acuity ; Young Adult

To evaluate the changes of the central corneal endothelial cell density and morphology after phacoemulsification and foldable silicone intraocular lens(IOL) implantation through a 3.2mm temporal clear corneal incision under topical anesthesia. On 43 patients(43 eyes) who had no systemic and ocular disease to influence the status of corneal endothelium , central corneal thickness, central corneal endothelial celldensity, pleomorphism index and polymegathism index, there was significant increase at 1 day postoperatively and recovery to preoperative state at 2 months poeroperatively. Central corneal endothelial cell losses were 8.92% at 1 day postoperatively and 15.95% at 2 months poeroperatively(p=0.00) and statistically significant increase of polymegathism index was noted at 1 day and 2 months poeroperatively. However no significant difference in central corneal endothelial cell loss and polymegathism index was noted at 6 months postoperatively. From the above results, we concluded that the phacoemulsification through a temporal clear corneal incision under topical anesthesia decreases the central corneal endothelial cell density and increase polymegathism index of the corneal endothelial cells, but these changes become stabilized after postoperative 2 months. Also proper control group must be set up to detect causes of corneal endothelial cell loss and it is neede to estalblish a new criteria for safe corneal endothelial cell density.
Anesthesia* ; Corneal Endothelial Cell Loss ; Endothelial Cells* ; Endothelium, Corneal ; Phacoemulsification* ; Silicones

PURPOSE: Transglutaminase 4 (TGase 4) belongs to a family of enzymes that catalyzes the post-translational modification of proteins. In an attempt to establish its physiological function(s), the distribution of TGase 4 expression in the human eye was determined. METHODS: Ocular tissues obtained from five human whole eyeball postmortem (40(+1) weeks at gestation age, 2 months, 48, 66, 76 years) were stained with monoclonal antibodies against human TGase 4 using indirect immunohistochemical method. RESULTS: TGase 4 was found in the lacrimal glands, corneal epithelium and endothelium, conjunctival epithelium, lens epithelium, retina (inner segment of photoreceptor, external limiting membrane, outer plexiform layer, inner plexiform layer, retinal nerve fiber layer and internal limiting membrane), iris, ciliary muscle, ciliary nonpigmented epithelium and trabecular meshwork. Endothelium of blood vessels in all ocular tissues was also stained. Conjunctival stroma, choroid, anterior tenon's capsule were faintly stained. No evidence of immunostaining for TGase 4 was found in the corneal stroma, iris stroma, lens nucleus, ciliary process, sclera, extraocular muscle and optic nerve. CONCLUSIONS: The expression pattern of TGase 4 was different from those of other TGase isoforms in the human eye. This result may be helpful in further investigation of the role of TGase 4 in the ocular tissue.
Antibodies, Monoclonal ; Blood Vessels ; Choroid ; Corneal Stroma ; Endothelium ; Epithelium ; Epithelium, Corneal ; Humans* ; Iris ; Lacrimal Apparatus ; Membranes ; Nerve Fibers ; Optic Nerve ; Pregnancy ; Protein Isoforms ; Protein Processing, Post-Translational ; Retina ; Retinaldehyde ; Sclera ; Tenon Capsule ; Trabecular Meshwork

PURPOSE: To evaluate the effects of ICL implantation on angle structures, intraocular pressure (IOP) and pupil diameter. METHODS: A Staar implantable contact lens (ICL) was implanted in 81 eyes of 43 patients with spherical equivalent over -6D. Gonioscopy was done 1 day after laser iridotomy and 6 months after ICL implantation and postoperative changes in gonioscopic findings were evaluated. Also IOP and pupil diameter were examined. RESULTS: There were occlusion or narrowing of the LI opening site in 10 eyes (12.3%). Width of angle was wide over 30 degrees in all cases but that was narrowed under 20 degrees in 16 eyes (19.8%) at postoperative 6 months. The mean pigmentation was 2.11 in inferior, 0.47 in nasal, 0.22 in temporal and 0.18 in superior angle at 6 months postoperatively by semiquantitative method (Grade 0~4). There was decrease of pigmentation in nasal and temporal angle but no change in inferior and superior angle after ICL implantation. There was temporary increase of IOP at 1 week and 1 month postoperatively due to steroid eye drops but returned to preoperative level and maintained until the 6 months postoperatively. There was significant decrease of pupil diameter at postoperative 1 and 3 months but returned to the preoperative level at postoperative 6 months. There was no evidence of pigment dispersion syndrome and pigmentary glaucoma. CONCLUSIONS: ICL implantation caused the narrowing of width of angle but did not increase trabecular pigmentation. We expect that ICL implantation is safe about pigment dispersion syndrome and pigmentary glaucoma.
Glaucoma, Open-Angle ; Gonioscopy ; Humans ; Intraocular Pressure ; Lenses, Intraocular* ; Ophthalmic Solutions ; Pigmentation ; Pupil

PURPOSE: To analyze the autofluorescence (AF) properties of pinguecula using cobalt-blue and yellow filters and to investigate the nature and pathogenesis of pingueculae using histochemical and immunohistochemical staining. METHODS: Fifty pingueculae in 40 patients were included in this study. AF of the pingueculae was observed and analyzed using a cobalt-blue filter with an additional yellow filter on a slit-lamp. Hematoxylin-eosin and immunohistochemical stainings were performed on surgical specimens of pingueculae that were prepared from each patient. Immunohistochemical staining included Congo red, Oil Red O, periodic acid-Schiff (PAS), Masson's trichrome, transglutaminase-2 (TG-2), mesenchymal stem cell markers CD29 (beta-1-integrin), and CD34. RESULTS: AF images revealed hyper-AF in the pinguecula area. The AF lesions of pingueculae showed superficial punctuate erosions and avascular lesions. Deposition of eosinophilic and amorphous materials in the subepithelial layer of the pinguecula were observed on hematoxylin-eosin staining. Historeactivities to Congo red, PAS, Oil Red O, alcian blue, and Masson's trichrome were not detected, but immunoreactivities to CD29, CD34, and TG-2 were detected in the pingueculae with AF. However, CD29, CD34, and TG-2 were not detected in the pingueculae without AF. CONCLUSIONS: The AF of pingueculae may be related to CD29, CD34, and TG-2. We suggest that pingueculae with AF have a different pathogenesis compared to pingueculae without AF.
Aged ; Coloring Agents/diagnostic use ; Female ; Fluorescence ; Follow-Up Studies ; Hematoxylin/*diagnostic use ; Humans ; Immunohistochemistry ; Male ; Microscopy, Confocal/*methods ; Middle Aged ; Pinguecula/*pathology ; Retrospective Studies

PURPOSE: To evaluate the therapeutic effects of topical heparin (Hylo-Parin(R), Ursapharm Saarbr cken, Germany) and spray type phospholipids (Tears Again(R), Optima Pharmazeutische GmbH. Freising, Germany) in severe dry eye syndrome resistant to conventional therapy. METHODS: Twenty eyes of ten patients with refractory severe dry eye were treated with Hylo-Parin(R) (two times a day) and Tears Again(R) (three times a day) for three months. Before and one and three months after treatment, a symptom questionnaire was administered to the patients. The ocular surface disease index (OSDI), tear film break-up time, Schirmer test, conjunctival fluorescein staining examinations and filamentary keratitis were evaluated. RESULTS: After using Tears Again(R) and Hylo-Parin(R), the OSDI score improved from 64.13 +/- 15.12 to 43.80 +/- 15.87 (p<0.01). Tear film break-up time significantly increased from 1.0 +/- 0.65 to 2.3 +/- 0.73 seconds (p<0.01) and conjunctival staining score (Oxford scale) significantly decreased from 3.85 +/- 0.75 to 3.25 +/- 0.97 (p<0.01). Filamentary keratitis in the slit-lamp examination showed significant improvement (p<0.01). CONCLUSIONS: Tears Again(R) and Hylo-Parin(R) are considered as new treatment modalities for severe dry eye syndrome and filamentary keratitis in patients with chronic ocular surface disease resistant to conventional therapy. These treatments require additional research.
Dry Eye Syndromes ; Eye ; Fluorescein ; Heparin ; Humans ; Keratitis ; Liposomes ; Phospholipids ; Surveys and Questionnaires ; Tears

PURPOSE: To investigate the characteristics of cultured rabbit corneal keratocytes in vitro and evaluate the possibility of differentiation of mesenchymal stem cells to keratocytes using the keratocyte conditioned medium (KCM). METHODS: Isolated keratocytes were seeded on the stromal side of amniotic membranes (AM) or plastic dishes, and morphologic changes were evaluated. Rabbit mesenchymal stem cells were cultured on AM with alpha-MEM (minimum essential medium alpha) and KCM. The gene expression patterns of specific keratocyte markers (keratocan, lumican, and aldehyde dehydrogenase family, member A1 (ALDH1A1)) of cultured cells were evaluated by RT-PCR. RESULTS: Keratocytes on AM showed dendritic morphology with slow proliferation in contrast, cells on dishes were stellate in shape with fast proliferation. Cultured keratocytes on AM maintained the expression of keratocan, lumican and ALDH1A1 while keratocytes on plastic dishes steadily lost their keratocyte marker gene expression. Additionally, mesenchymal stem cells cultured with KCM on AM induced expression of keratocan and ALDH1A1. CONCLUSIONS: Keratocytes cultured on AM stromal matrix maintained their characteristic morphology and marker gene expression. Morphology changes and marker gene expressions of mesenchymal stem cells suggest an ability to differentiate into keratocytes when grown on AM with KCM.
Aldehyde Dehydrogenase ; Amnion ; Cells, Cultured ; Chondroitin Sulfate Proteoglycans ; Corneal Keratocytes ; Culture Media, Conditioned ; Gene Expression ; Humans ; Keratan Sulfate ; Mesenchymal Stromal Cells ; Organic Chemicals ; Plastics ; Seeds

PURPOSE: To investigate the effect of an injection of bevacizumab into the sub-Tenon's capsule on ocular surface neovascularization disease including pterygium and corneal neovascularization. METHODS: Twenty-five eyes of 21 patients with pterygium and 19 eyes of 15 patients with corneal neovascularization were given an injection of 5 mg bevacizumab into the sub-Tenon's capsule. The clinical effects and complications were evaluated by analyzing the changes in anterior segment photo, visual acuity, and intraocular pressure at week one, week two, week four, and every month thereafter. RESULTS: After injections of bevacizumab, partial remission of corneal neovascularized lesion was observed in five eyes (20%) of the pterygium group, and there were no significant changes in the visual acuity and no complications. In the corneal neovascularization group, corneal neovascularized lesions of 18 eyes (95%: 2 eyes, complete remission 16 eyes, partial remission) improved after injections of the bevacizumab and the scores of extent and severity of corneal neovascularized lesion improved significantly, unlike the pterygium group. The visual acuity of two eyes (11%) improved more than two lines of Yong-Han Jin's distance visual acuity test and there were no systemic side effects. Localized side effects included four eyes (21%) with punctate epithelial erosions and two eyes (11%) with temporary, elevated intraocular pressure in the corneal neovascularization group. The side effects improved without any additional treatment. CONCLUSIONS: An injection of bevacizumab into the sub-Tenon's capsule is more effective in fresh lesions of corneal neovascularization disease than in old and stable lesions of pterygium. Therefore, it could be used as a prominent treatment of various corneal neovascularization diseases.
Antibodies, Monoclonal, Humanized ; Corneal Neovascularization ; Eye ; Humans ; Intraocular Pressure ; Pterygium ; Visual Acuity ; Bevacizumab

We report the first case of ocular benign lymphoid hyperplasia (BLH) treated with subconjunctival injection of bevacizumab (Avastin). A 27-year-old man presented to our clinic with conjunctival masses and limbal neovascularization. An incisional biopsy yielded the diagnosis of BLH. The patient was subsequently given a subconjunctival injection of bevacizumab (1.25 mg / 0.1 mL). The patient did not experience recurrence or malignant metaplasia during the one-year follow-up period. In patients with conjunctival BLH, subconjunctival injection of bevacizumab can be a useful treatment option in patients unable to undergo a surgical procedure due to limbal neovascularization.
Adult ; Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Conjunctiva ; Conjunctival Diseases/*drug therapy/*pathology ; Humans ; Hyperplasia ; Injections, Intraocular ; Limbus Corneae/blood supply ; Lymphoid Tissue/*pathology ; Lymphoproliferative Di ; Male ; Neovascularization, Pathologic/drug therapy