Aging is associated with increases in ocular HOAs, independent of other possible confounding factors. The association of ocular HOAs with corneal parameters indicates that ocular HOAs are mainly generated by the cornea. Internal HOAs, supposedly generated from cataract progression, may be associated with systemic factors, including serum creatinine levels and blood pressure.

The AM transplantation procedure may be an effective option for treating corneal perforations when the wound is circular or irregular, except for incised wounds. Our "Pleats Fold" AM transplantation technique can achieve definite closure and effectively repair wounds of various sizes. Postoperative astigmatic values were acceptable. Therefore, we recommend this procedure for repairing lesions <3 mm in diameter that do not involve the central cornea and that are infection free.

Compared with the peripheral corneal limbus, the human central cornea lacks blood vessels, which is responsible for its immunologically privileged status and high transparency. Dendritic cells (DCs) are present in the central avascular area of inflamed corneas, but the mechanisms of their migration to this location are poorly understood. Here, we investigated the contribution of vessel formation to DC migration into the central cornea, and analyzed the DC chemotactic factors produced by human corneal epithelial (HCE) cells. Using human eyes obtained from surgical procedures, we then assessed vessel formation, DC distribution, and activin A expression immunohistochemically. The results demonstrated increased numbers of vessels and DCs in the central area of inflamed corneas, and a positive correlation between the number of vessels and DCs. Activin A was expressed in the subepithelial space and the endothelium of newly formed blood vessels in the inflamed cornea. In infected corneas, DCs were present in the central area but no vascularization was observed, suggesting the presence of chemotactic factors that induced DC migration from the limbal vessels. To test this hypothesis, we assessed the migration of monocyte-derived DCs toward HCE cell supernatants with or without lipopolysaccharide (LPS) stimulation of HCE cells and inflammatory cytokines (released by HCE cells). DCs migrated toward tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, and activin A, as well as LPS-stimulated HCE cell supernatants. The supernatant contained elevated TNF-α, IL-6, and activin A levels, suggesting that they were produced by HCE cells after LPS stimulation. Therefore, vessels in the central cornea might constitute a DC migration route, and activin A expressed in the endothelium of newly formed vessels might contribute to corneal vascularization. Activin A also functions as a chemotactic factor, similar to HCE-produced TNF-α and IL-6. These findings enhance our understanding of the pathophysiology of corneal inflammation during infection.

ABSTRACT.Purpose: To confirm the efficacy of liquid-based cytology (LBC) method in the observation of vitreous cells in various vitreoretinal diseases in human. Methods: Vitreous fluid samples from 30 eyes were obtained by 23-gauge 3-port pars plana vitrectomy. After making three ports, we collected vitreous specimen from the core vitreous cavity without infusion. We divided the samples into a quiescent group and an active group based on clinical signs of inflammation. To confirm availability of LBC preparation slides for immunostaining, we also performed immunocytochemistry (ICC) for CD68, RPE65 and DEC-205 (CD205) using LBC slides of 10 cell-rich cases including retinal detachment and endophthalmitis. Results: Using LBC method, small amounts of vitreous cells were observed efficiently. Vitreous cells were observed in inflammatory quiescent cases including macular pucker and macular hole. The number of vitreous cells increased significantly in the cases with clinically active inflammation (2297 versus 207 cells/ml, respectively, p < 0.01, Mann-Whitney U-test). The ICC results showed the presence of CD68 + cells in all 10 cases. Large numbers of DEC-205 + cells were observed in one case with infectious endophthalmitis. In the cases with retinal detachment, the predominant cell type was RPE65 + . Neutrophils and lymphocytes were also observed. Conclusions: The LBC method makes it possible to examine vitreous specimens easily and efficiently, facilitating the expedient diagnosis of vitreoretinal diseases, and the preparation slides are available for immunocytochemistry. This study also showed that vitreoretinal disease involves the migration of various types of cells including macrophages, neutrophils, lymphocytes, RPE65 + pigmented cells and DEC-205 + cells.

Purpose: To describe the pathophysiological findings of a patient with pemphigus vulgaris (PV) showing giant conjunctival papillae. Methods: A 64-year-old man who had mucosal-dominant PV with giant conjunctival papillae, resembling those of vernal keratoconjunctivitis (VKC), underwent an ophthalmological workup. The clinical and pathological findings were investigated. Results: Ophthalmic interventions were unable to provide the desired beneficial effects, and multiple excisions were necessary to remove the proliferative conjunctival lesions. Histopathological investigations of the excised tissues demonstrated acantholysis and a subconjunctival infiltration with numerous inflammatory cells such as lymphocytes, plasma cells, and neutrophils. However, in contrast to typical VKC, mast cells and eosinophils were rarely found in the subconjunctival tissues. Direct immunofluorescent staining showed a significant deposition of immunoglobulin G and complement component 3 in the epithelial intercellular substance, consistent with mucosal-dominant PV. Then, the patient was hospitalized because of oral erosion exacerbation and malnutrition. Because of the patient's declining general condition, we administered an increasing dose of a systemic steroid with an intravenous immunoglobulin, after which his ocular lesions and symptoms improved. Conclusions: The histological conjunctival papilla findings were quite different from those of VKC papillae. If PV causes a lesion in a patient, systemic immunosuppression might be more effective than topical ophthalmic treatment because of overall immunological involvement.