Z-shaped incision without epithelial resection in pterygium surgery

AIM:To introduce a novel surgical technique using a Z-shaped incision without epithelial resection in ophthalmic pterygia.METHODS:This was a prospective study.During pterygium surgery,all proliferative tissues were separated from the cornea and conjunctiva without resection of the tissues.The unaffected conjunctiva was incised in a Z-shape.The upper(or lower)conjunctival flap was sutured to the lower(or upper)normal conjunctiva on the limbal sclera,while the proliferative tissue was sutured to the upper conjunctiva(or lower)near the fornix.RESULTS:Ten patients with pterygia were eligible for this study.Eight patients with primary pterygia and 2 with recurrent pterygia were included.The age of patients at surgery ranged from 47 to 90y(average:71.9y).Five patients each showed right and left-sided pterygia.The postoperative follow-up periods were from 8 to 78mo(average:25.0mo).The surgery was successfully conducted and wounds were favorably reconstructed in all patients.The proliferative tissues sutured to the normal conjunctiva showed palor and attenuated neovessles,and never showed re-growth after surgery.Nine patients did not show recerrence.Recerrent pterygium was noted in 1 patient,but additional treatments were not required.CONCLUSION:The procedure involves the reconstruction of pterygial tissue and normal conjunctiva using a Z-shaped incision.The scleral limbal wound can be covered with nonaffected conjunctiva without any excision of conjunctival epithelia in patients with primary or recurrent pterygia.

Conjunctival cyst with apocrine hidrocystoma-like features:a case report

Dear Editor,I am Takafumi Igarashi from Hokkaido University Hospital,Japan.Apocrine hidrocystoma is a benign cystic tumor arising in the apocrine sweat glands proposed by Mehregan^([1])in 1964.It is likely that apocrine hidrocystoma arises in the uvula,ears,chest,and shoulders,as well as the (peri)ocular regions such as the eyelid,and sclera^([2-4]).

Increased plasma galectin-1 correlates with advanced glycation end products and interleukin-1β in patients with proliferative diabetic retinopathy

Dear Editor,Galectin-1, one of galactoside-binding lectin family proteins, has been shown to regulate cell growth, migration, and proliferation, where it binds many receptors depending on their glycosylation profile, rather than its specific receptors.

Phosphorylation of alphaB-crystallin in epiretinal membrane of human proliferative diabetic retinopathy

AIMTo examine phosphorylation of alphaB-crystallin (p-αBC), a vascular endothelial growth factor (VEGF) chaperone, and immunohistochemically investigate relationship between p-αBC, VEGF and phosphorylated p38-mitogen-activated protein kinase (p-p38 MAPK) in the epiretinal membrane of human proliferative diabetic retinopathy (PDR).METHODSEleven epiretinal membranes of PDR surgically excised were included in this study. Two normal retinas were also collected from enucleation tissues due to choroidal melanoma. Paraformaldehyde-fixed, paraffin-embedded tissue sections were processed for immunohistochemistry with anti-p-αBC, VEGF, CD31, and p-p38 MAPK antibodies.RESULTSImmunoreactivity for p-αBC was observed in all of the epiretinal membranes examined, where phosphorylation on serine (Ser) 59 showed strongest immunoreactivity in over 70% of the membranes. The immunolocalization of p-αBC was detected in the CD31-positive endothelial cells, and co-localized with VEGF and p-p38 MAPK in PDR membranes. Immunoreactivity for p-αBC, however, was undetectable in endothelial cells of the normal retinas, where p-p38 MAPK immunoreactivity was less marked than PDR membranes.CONCLUSIONPhosphorylation of αBC, in particular, phosphorylation on Ser59 by p-p38 MAPK may play a potential role as a molecular chaperon for VEGF in the pathogenesis of epiretinal membranes in PDR.

Histological observation of trabecular meshwork in a patient with Axenfeld-Rieger syndrome——a new theory for the mechanism of ectropion uvea in congenital glaucoma

Dear Editor,I am Dr.Satoru Kase,from the Department of Ophthalmology,Faculty of Medicine and Graduate School of Medicine,Hokkaido University.I write to present the case of clinicopathological findings in Axenfeld-Rieger syndrome(ARS).

Immunolocalization of advanced glycation end products in human diabetic eyes: an immunohistochemical study

Background: Advanced glycation end-products (AGEs) play a critical role in the pathology of diabetic complications. The aim of this study is to examine the immunolocalization of advanced glycation end products (AGE) and receptor for AGE (RAGE) in human diabetic and non-diabetic donor eyes using immunohistochemistry. Materials and Methods: Eight globes were obtained from human postmortem donors: six diabetic donors and two non-diabetic. Formalin-fixed, paraffin-embedded tissue sections were subjected to immunohistochemistry with anti-AGE, and RAGE antibodies. Results: In eyes from diabetic donors, the blood vessels of the iris and choroid had relatively thickened walls. The ciliary body showed decreased capillaries with hyalinization in the stroma. Neovascularization or proliferative changes were not observed in the tissues. Immunoreactivity for AGE was highly detected in the stroma and blood vessels of the iris, ciliary body, choriocapillaris, choroidal large vessels, and central retinal artery/vein. Immunoreactivity was also detected in the retina, corneal endothelium, and lens. RAGE immunoreactivity was weakly detected in choroidal vessels and Bruch’s membrane. In eyes from non-diabetic donors, AGE was weakly detected in the iris, ciliary body stroma, and choriocapillaris, but RAGE was hardly detected. Conclusion: AGE is highly accumulated in vascularized intraocular tissues of diabetic eyes, suggesting that AGE accumulation may play an important role in the pathogenesis of diabetic vasculopathy. This study indicates that inhibition of AGE formation may be an important therapeutic strategy for suppressing the progression of diabetic ocular complications.

Anterior proliferative vitreoretinopathy in a patient with Coats disease

Dear Editor,I am Satoru Kase,from the Department of Ophthalmology,Faculty of Medicine and Graduate School of Medicine,Hokkaido University,Sapporo,Japan.I write to present a case of Coats disease showing anterior proliferative vitreoretinopathy（PVR）and neovascular glaucoma.

A case of nodular posterior scleritis simulating intraocular tumor

Dear Editor,I am Dr. Yukiko Shibata, from the Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University. I write to present the case of posterior scleritis simulating intraocular tumor.

Vascular anomaly in the levator aponeurosis of neurofibromatosis type 1

Dear Editor,I am Satoru Kase,from the Department of Ophthalmology,Faculty of Medicine and Graduate School of Medicine,Hokkaido University,Sapporo City,Japan.I write to present a case of neurofibromatosis type 1（NF1）showing massive hemorrhage during involutional blepharoptosis surgery.

A clinicopathological study on IgG4-related ophthalmic disease

AIM： To investigate clinicopathological features of immunoglobulin G4-related ophthalmic disease（IgG4-ROD）, and analyze the recurrence rates following systemic corticosteroid administration.METHODS： We retrospectively searched clinical features, laboratory and histological findings based on the medical records of 21 patients with IgG4-ROD. All the patients examined in this study underwent surgical resection in the ocular adnexal lesions and underwent histological evaluation. This study further investigated clinical and histopathological features of 15 patients who received systemic corticosteroid after the resection.RESULTS： The mean age of the patients consisting of 7 males（33%） and 14 females（67%） was 61y. Fourteen patients were diagnosed as definitive, and 2 and 5 patients were probable and possible IgG4-ROD, respectively. Eyelid swelling was an initial symptom in 11 patients（52%） who did not show systemic involvements at a diagnosis. Fifteen patients received systemic corticosteroid administration, and all showed remission of inflammation. Among them, 10 patients did not recur, whereas 5 patients（33%） recurred during tapering. There were no significant difference between patients with or without recurrence in clinicopathological features.CONCLUSION： In this study, female patients are more predominant in IgG4-ROD. While inflammation recurs in one-third of patients, this study do not identify factors associated with recurrence after systemic corticosteroid administration.

Histological observation in pachyvessels in a patient with choroidal melanoma

Dear Editor,I am Dr.Satoru Kase,from the Department of Ophthalmology,Faculty of Medicine and Graduate School of Medicine,Hokkaido University.I write to present a case of choroidal melanoma arising from a thickened choroid.The"pachychoroid"has recently been proposed as an entity comprising an increase in the choroidal thickness and dilatation of large choroidal vessels(so-called pachyvessels)[1].

A case of conjunctival intraepithelial neoplasia with spheroidal degeneration:a clinicopathological study

Dear Editor,I am Shoichiro Ota from Hokkaido University hospital,Japan.Conjunctival intraepithelial neoplasia(CIN)is a disease concept that includes dysplasia and carcinoma in situ.Pathologically,CIN is characterized by tumor cell proliferation located within the epithelium with preservation of the basement membrane[1].In addition to histological diagnosis,anterior segment optical coherence tomography(ASOCT)plays an important role in clinical diagnosis,showing diffuse epithelial thickening with homogeneous high-intensity reflection in case of CIN[2-3].

Laser speckle flowgraphy findings in a patient with radiation retinopathy

Dear Editor,I am Satoru Kase, from Hokkaido University Hospital, Japan. Choroidal melanoma is a serious intraocular tumor, which threatens patients’ vision and life. Treatments for choroidal melanoma consist of surgery and radiotherapy.