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Dear Editor: The calcyclin-binding protein (CacyBP) was initially named for its ability to interact with calcyclin (S100A6) at a physiological range of Ca2+ concentration1. However, Matsuzawa and Reed2 found that the human analog of mouse CacyBP interacted with Siah-1 and named this protein the Siah-1 interacting protein (SIP); therefore, it is now widely called CacyBP/SIP. Additionally, CacyBP/SIP and Siah-1 associate with Skp-1, acting as an ubiquitinating complex that degrades non-phosphorylated β-catenin in the presence of p532. In breast cancer, CacyBP/SIP mRNA and protein levels were significantly higher than that of adjacent non-tumor tissues. Poor cellular differentiation, lymph node invasion, and clinicopathological staging in breast cancer were associated with CacyBP/SIP expression3, with similar findings in pancreatic cancer4. Although initially identified as a binding protein of S100A6, CacyBP/SIP has demonstrated an ability to bind with other S100 proteins such as S100B, S100P, S100A1, and S100A125. Widely and routinely used for immunohistochemical detection of malignant melanoma (MM), protein S100 and the upregulated expression of S100A6 were correlated with unfavorable prognoses of MM6,7,8; however, the expression levels of CacyBP/SIP have not been investigated. In this study, we compared the immunohistological expression of CacyBP/SIP in 20 primary MM, 20 metastatic MM, 20 benign melanocytic nevus (BN), and 10 normal skin samples. Paraffin-embedded sections (4-µm in thickness) were deparaffinized with xylene for 10 min and rehydrated through a graded ethanol series. Antibody-binding epitopes were retrieved by pressure-cooking the tissue sections in 10 mM/L sodium citrate buffer (pH 7.0; Yatoro, Tokyo, Japan) for 10 min and the nonspecific binding was blocked using 10% normal rabbit serum (Novus Biologicals, Littleton, CO, USA). The sections were then incubated with an antibody against CacyBP/SIP (1 : 200; Novus Biologicals, Littleton, CO, USA) at 4℃ overnight. Immunodetection was conducted using a standard streptavidinbiotin amplification method with 3-amino-9-ethylcarbazole as a chromogen followed by light counterstaining with hematoxylin. In each specimen, 3 high-power fields (HPFs, ×200) of strong reaction were randomly selected, 100 tumor cells were counted in each field, and the average percentage of positively stained cells in each of the 3 HPFs was computed for each sample. We also evaluated the staining intensity of the specimens using the staining intensity of sebaceous glands as internal positive control. The staining intensity was semiquantitatively classified as negative, mild, moderate, and strong. The results of the one-way ANOVA were considered statistically significant at p

Clinical findings and treatment of keratomycosis caused by Beauveria bassiana, an entomopathogenic filamentous fungus, are described for an 80-year-old woman, who was referred to the hospital for ocular pain and redness on the 9th day after an ocular injury caused by the frame of her glasses. She had a long history of recurrent diabetic iritis and continuously used topical antibiotics and corticosteroids. At her first visit, a slit-lamp examination indicated a corneal ulcer confined within the superficial stromal layer, along with a slight infiltration and edema. Only a very few inflammatory cells were seen in the anterior chamber. Direct microscopic examination of corneal scrapings revealed septate fungal hyphae with zig-zag rachis and budding that was subsequently identified as B. bassiana by slide culture. Topical voriconazole with miconazole, pimaricin and oral itraconazole were effective and the lesion disappeared leaving only a mild scar at 2 months. The sensitivity of B. bassiana to various antimycotic agents was confirmed by broth microdilution, agar dilution with the Clinical Laboratory Standard Institute standard, and a disk method using topically applied concentrations. B. bassiana, which exhibits a characteristic appearance in smears and causes superficial keratomycosis, is sensitive to voriconazole with miconazole, pimaricin, and itraconazole.

The purpose of this study was to report a patient with Oguchi disease whose ophthalmological characteristics were masked by retinitis pigmentosa (RP). The method used in this study was case report. A 53-year-old man had a progressive decrease in his visual acuity and was diagnosed with RP because of night blindness, fundoscopic findings, ring scotoma, and extinguished single-flash electroretinograms (ERGs). However, a faint golden-yellowish reflex of the retina prompted us to make a more detailed examination of the fundus after a long period of dark adaptation, ERGs, and genetic analysis. Examinations showed the Mizuo-Nakamura phenomenon, relative intact photopic ERGs, and a SAG mutation, and the patient was diagnosed with RP associated with Oguchi disease. When RP accompanies Oguchi disease, the clinical characteristics of Oguchi disease might be masked. In such a situation, the correct diagnosis is difficult. However, careful analysis of clinical findings will suggest Oguchi disease, which can be confirmed by molecular genetics.

PURPOSE To report the detection of cytomegalovirus (CMV) DNA in the cornea of a CMV endotheliitis patient after penetrating keratoplasty (PKP). CASE A 71-year-old man without immunodeficiency developed corneal endotheliitis in the right eye. The patient had previously received PKP several times. Polymerase chain reaction (PCR) detected CMV-DNA in the aqueous humor in his affected eye, and we started administration of ganciclovir. There was resolution of the inflammation; however, bullous keratopathy was subsequently noted in the cornea. Additional PKP was performed with perioperative intravenous administration of ganciclovir. The failed graft obtained during the additional PKP was subjected to PCR analysis and histopathological examination. PCR analysis showed CMV-DNA in the failed graft. Little inflammatory change was noted in either the epithelial or stromal layers of the failed graft. With continued ganciclovir treatment, the graft remained clear and no recurrence or rejection occurred until 12 months after the last PKP. CONCLUSION Our PCR analysis showed the presence of CMV-DNA within the cornea of the patient with corneal endotheliitis.

Kaoru Araki-Sasaki1, Hiroko Sonoyama1, Tsutomu Kawasaki1, Nariyasu Kazama1, Hidenao Ideta1, Yoshitsugu Inoue21Ideta Eye Hospital, Kumamoto City, Kumamoto, Japan; 2Department of Ophthalmology, Tottori University, Koyama-Minami, Tottori, Japan Abstract: The paper reports on Candida albicans ocular infection modified by steroid eye drops. A 74-year-old male complained of conjunctival injection and pain in his right eye three months after pterygium and cataract surgery. After treatment with antibiotics and steroid eye drops for three days, he was referred to our hospital. Clear localized corneal endothelial plaque with injection of ciliary body was observed. No erosion of the corneal epithelium, or infiltration of stromal edema was observed, suggesting that the pathological organism derived from the intracameral region. Because ocular infection was suspected, steroid eye drops were stopped, which led immediately to typical infectious keratitis in the pathological region, with epithelial erosion, fluffy abscess, stromal infiltration, and edema. For diagnostic purposes, the plaque was surgically removed with forceps and the anterior chamber was irrigated with antibiotics. The smear and culture examination from the plaque revealed C. albicans surrounded by neutrophils. However, aqueous fluid and fibrous tissue after gonio procedure contained no mycotic organisms. Topical fluconazole, micafungin, and pimaricin with oral itraconazole (150 mg/day) were effective. Special attention is needed when prescribing steroid eye drops to treat corneal disease especially postoperatively. Diagnosing infectious keratitis is sometimes difficult because of modification by some factors, such as postoperative conditions, scarring, and drug-induced masking. Here, we report on mycotic keratitis modified by postoperative steroid administration. Keywords: Candida albicans, cataract surgery, steroid, mycotic keratitis