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Background: We present a clinical case report including in vivo laser confocal microscopic findings of keratitis complicated with Takayasu's arteritis (aortitis syndrome)., Case: A 47-year-old woman was referred to the outpatient clinic of ophthalmology with blurred vision in her both eyes at the onset of Takayasu's arteritis. Since multifocal infiltrates in the stromal corneas with injection were observed with slit-lamp biomicroscope in the both eyes, the diagnosis was keratitis. A large amount of cells infiltrating the stromal cornea and activated keratocytes were also observed with in vivo laser confocal microscope in the both eyes. Systemic and local steroidal agents were initiated, which resolved the keratitis, and the active lesions turned into mild corneal scars. In vivo laser confocal microscopy showed no infiltrating cells in the stromal cornea of both eyes. No recurrence has been observed since., Conclusion: A rare case of keratitis complicated with Takayasu's arteritis is reported. An immune response to the stromal cornea as the etiology of the keratitis may be indicated by in vivo laser confocal microscopy.

Stromal cells and/or soluble factors such as growth factors have been considered until now as the main niche of corneal epithelial stem cells. We found that cultivated epithelial cells had epithelial clusters when cultured, maintaining the sheet structure. Therefore, we hypothesized that the epithelial cells themselves might be a niche of the stem cells, and the cell clusters could be maintained during the gentle enzymatic digestion of the limbal epithelial sheets. The main methods of generating cultivated limbal epithelial sheet for clinical application are, the cell suspension method (complete enzymatic digestion of limbal epithelia), and the explant method (cells grown from limbal explants). For cell suspension, it is good to expand cells and generating sheets quickly, but it is not clear wheather these sheets maintain the normal homeostatic levels of the progenitor cells. Explants maintain homeostatic levels more similar to in vivo homeostasis, but the low proliferative speed of epithelial expansion and reproducibility are the problem. In this review, we hypothesize that to generate cultivated epithelial sheets while maintaining a corneal epithelial stem cells' niche is a better way to proceed as it includes the advantages of both the cell suspension and explant methods. The growth potential, colony-forming efficiency of p63-positive cell clusters, and immunostaining by differentiation/ undifferentiation markers, demonstrated that progenitor cells could be maintained by these gentle enzymatic digestion maintaining cell clusters.

Purpose: To evaluate the risk factors of severe peripheral corneal ulcers., Patients and Methods: Twenty three eyes of 15 patients (9 eyes of 7 men and 14 eyes of 8 women) with severe peripheral corneal ulcers, who were treated during the past 10 years at Keio University Hospital, were reviewed about the original disease, status of ulcer, treatment, and visual prognosis., Results: Fifteen eyes of 10 patients with Mooren's ulcer, 4 eyes of 3 patients with rheumatoid arthritis, and 4 eyes of 2 patients with Terrien corneal degeneration were included. Mooren's ulcer tends to advance widely. Systemic administration of immunosuppressive and corticosteroidal agents was required in addition to surgical treatment. Visual prognosis was poor in the Mooren's ulcer and perforated cases., Conclusion: Mooren's ulcer and perforated cases are risk factors in peripheral corneal ulcer.

Purpose: Some marginal blepharitis is related to demodex, but this has not yet been reported in Japan. In this study, patients with severe marginal blepharitis with cylindrical dandruff were studied to examine the number of demodex in their cilia., Methods: Ten eyes of 10 patients (7 men and 3 women, mean age: 62.9 +/- 9.0 years) with unilateral marginal blepharitis which had cylindrical dandruff in their cilia were studied. Three cilia which had the most cylindrical dandruff were removed from the eyelids for microscopic examination. After cleaning the eyelid margins for 1 week, the examination was repeated. Scoring of itching and foreign body sensation of the patients was performed both before and after the treatment., Results: Demodex folliculorum was detected in the cilia of 8 out of 10 eyes (80%), and 22 cilia out of 30 with cylindrical dandruff. The average number of demodex/cilia was 1.6 +/- 0.9. In all cases, the number of demodex/cillium decreased significantly with the improvement in symptoms and blepharitis., Conclusion: An Increase in the number of demodex might be the pathogen causing blepharitis with cylindrical dandruff, and cleaning of the eyelid margin is effective as a therapeutic method.