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Abstract This retrospective study compared postoperative prediction errors of recent formulas using standard- or total keratometry (K or TK) for intraocular lens (IOL) power calculation in post-myopic LASIK patients. It included 56 eyes of 56 patients who underwent uncomplicated cataract surgery, with at least 1-month follow-up at Keio University Hospital in Tokyo or Hayashi Eye Hospital in Yokohama, Japan. Prediction errors, absolute errors, and percentage of eyes with prediction errors within ± 0.25 D, ± 0.50 D, and ± 1.00 D were calculated using nine formulas: Barrett True-K, Barrett True-K TK, Haigis-L, Haigis TK, Pearl-DGS, Hoffer QST, Hoffer QST PK, EVO K, and EVO PK. Statistical comparisons utilized Friedman test, Conover’s all-pairs post-hoc, Cochran’s Q, and McNemar post-hoc testing. Root-Mean-Square Error (RMSE) was compared with heteroscedastic testing. Barrett True-K TK had the lowest median predicted refractive error (-0.01). EVO PK had the smallest median absolute error (0.20). EVO PK had the highest percentage of eyes within ± 0.25 D of the predicted value (58.9%), significantly better than Haigis-L (p = 0.047). EVO PK had the lowest mean RMSE value (0.499). The EVO PK formula yielded the most accurate IOL power calculation in post-myopic LASIK eyes, with TK/PK values enhancing accuracy.

Corneal alterations due to radial keratotomy (RK) complicate intraocular lens calculations, which may explain why there have been few reports of toric intraocular lens (TIOL) implantation after excessive or multiple operations. A 71-year-old male with a history of repeated RKs and at least 30 corneal incisions in each eye was referred for cataract surgery. Preoperatively, the best-corrected distance visual acuity was 0.7 decimal (0.15 logMAR) in the right eye and 0.9 decimal (0.05 logMAR) in the left eye. The refractive errors were −8.00 −3.00 × 80 and −6.00 −3.50 × 80, respectively. The total corneal cylindrical powers (real power; anterior and posterior) were, respectively, −0.90 D and −3.60 D at 9 a.m., compared to −1.60 D and −3.80 D at 1 p.m. Corneal astigmatism in the left eye was considered symmetric and diurnally stable; therefore, an XY1AT6 TIOL (Hoya, Tokyo, Japan; cylindrical power at the plane, +3.75 D) was implanted. A non-toric intraocular lens, the XY1 (Hoya), was implanted in the right eye. Six-month postoperative best-corrected distance visual acuities were 1.2 decimal (−0.08 logMAR) and 1.0 decimal (0.00 logMAR) in the right and left eyes, respectively. Post-operative manifest refractions were +0.00 −3.00 × 70 and −1.00 −2.00 × 85, respectively. The TIOL reduced refractive astigmatism in the left eye; therefore, we believe that even after multiple RKs, the TIOL can be a suitable candidate to correct astigmatism if the corneal astigmatism is diurnally stable and symmetric.

Glycemic control is essential to manage metabolic diseases such as diabetes. Frequent measurements of systemic glucose levels with prompt managements can prevent organ damages. The eye is a glucose highly demanding organ in our body, and the anterior chamber (AC) in the eye has been suggested for a noninvasive blood glucose monitoring site. However, calculating blood glucose levels from measuring glucose levels in AC has been difficult and unclear. In this study, we aimed to examine glucose levels from AC and find a correlation with blood glucose levels. A total of 30 patients with cataracts (men and women, study 1; 7 and 3, study 2; 9 and 11) who visited Keio University Hospital from 2015 to 2018 and agreed to participate in this study were recruited. Glucose levels from AC and the blood were examined by a UV-hexokinase or H2O2-electrode method before/during the cataract surgery. These values were analyzed with regression analyses depending on the groups (blood glucose-ascending and descending groups). In the blood glucose-descending group, glucose levels from AC were strongly correlated with blood glucose levels (a high R2 value, 0.8636). However, the relatively moderate correlation was seen in the blood glucose-ascending group (a low R2 value, 0.5228). Taken together, we showed different correlation ratios on glucose levels between AC and the blood, based on blood glucose dynamics. Stacking data regarding this issue would enable establishing noninvasive blood glucose monitoring from measuring glucose levels in AC more correctly, which will be helpful for proper and prompt managements for glucose-mediated complications.

PurposeTo investigate refractive stability and characterize corneal incision repair up to 3 months after implantation of a new hydrophobic acrylic intraocular lens (IOL) with hydroxyethylmethacrylate using a new automated IOL delivery system.MethodsThis prospective case series included 50 eyes of 50 patients undergoing phacoemulsification and implantation of the Clareon® CNA0T0 IOL using the AutonoMe® automated delivery system in the Department of Ophthalmology, Keio University School of Medicine. The clinical data were collected from 46 eyes of 46 patients preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. Endothelial-side incision gaping, posterior incision retraction, and Descemet's membrane detachment were recorded as present or absent using anterior-segment optical coherence tomography postoperatively.ResultsThe uncorrected distance and corrected distance visual acuities improved and stabilized 1 week postoperatively. The anterior chamber depth was stable from 1 week postoperatively. The subjective refraction was stable from 1 day postoperatively. Descemet's membrane detachments and endothelial-side wound gaping were seen in 19 (41.3%) eyes and 34 (73.9%) eyes 1 day postoperatively and decreased gradually. Posterior incision retraction was seen in eight eyes (17.4%) on day 1 and increased to 19 eyes (41.3%) 3 months postoperatively.ConclusionsThe Clareon IOL had excellent refractive stability from day 1 postoperatively. The AutonoMe automated delivery system enables safe IOL implantation through a 2.4-mm corneal incision, although the wound required longer than 1 month to heal postoperatively.

The functional visual acuity test which is the average of the visual acuities measured during a specific time frame (standard, 60 seconds) has been used recently to assess the visual function in various conditions. The availability of a shorter version of the functional visual acuity test promises to be patient friendly in that it is a simple screening test performed in a shorter period of time than the standard test. The results of measurements of the FVA test between the 30-second measurement time (short-version FVA test) and the standard 60-second measurement are compared, and the feasibility of the short-version FVA test instead of the standard FVA test is investigated. Twenty-eight healthy volunteers (25 men and 3 women) were enrolled in this prospective observational study. All subjects underwent measurement of the binocular distance-corrected visual acuity and the binocular distance-corrected FVA with the 60-second and 30-second measurement times. The interchangeability of the corrected-distance FVA, maximal VA, visual maintenance ratio, and average response time in the short-version and the standard FVA tests was evaluated using the Bland–Altman method, and the results showed agreements of the two tests except for the minimal VA. The short-version FVA test is equivalent to the standard method except for evaluating the visual acuity fluctuations and promises to be a simple visual screening test that can be performed in a shorter time.

Abstract Osteoprotegerin (OPG) is a secreted cytokine that functions as a decoy receptor for receptor activator of nuclear factor kappa-B (RANK) ligand (RANKL). Anti-RANKL treatment for bone metastasis has been widely accepted for solid tumors. However, the mechanism of OPG-RANKL-RANK signaling in systemic colorectal cancer (CRC) metastasis remains unclear. In this study, we investigated the relevance and function of OPG expression in CRC liver metastasis. First, we performed in silico analysis using The Cancer Genome Atlas public database and found that lower OPG expression in CRC was associated with poor overall survival. Immunohistochemistry analyses using resected specimen from patients with CRC in our institute confirmed the result. Patient-matched primary CRC and liver metastases showed a significant downregulation of OPG expression in metastatic lesions. In CRC cell lines, OPG expression did not suppress cell proliferation and migration. However, OPG expression inhibited macrophage migration by suppressing the RANKL-RANK pathway. Moreover, in vivo mouse liver metastasis models showed that OPG expression in CRC cells suppressed liver metastases. In addition, treatment with an anti-RANKL neutralizing antibody also suppressed liver metastases. These results showed that downregulation of OPG expression in CRC cells promotes liver metastasis by activating tumor-associated macrophage, which can become a candidate for targeted therapy with anti-RANKL neutralizing antibody for CRC liver metastasis.

In horticultural greenhouses, the photosynthetic photon flux density (I) is inevitably lower than that outside because of interference from greenhouse superstructures (e.g., reflection and absorption of radiation by greenhouse coverings and superstructures). In addition, during hot seasons in many regions, I can be lowered by shade nets installed to reduce excessive radiation. These reductions in I can cause a decrease in the canopy photosynthetic rate (Ac), potentially leading to crop yield losses. This study investigated to what extent Ac is reduced inside a modern greenhouse and under a shade net in comparison with that outside. A simple Ac model (i.e., canopy-scale photosynthesis-light curves) was parameterized based on the measurements of Ac and I for paprika and tomato canopies using the open-chamber method. In addition, based on the measurements of I, linear regression models were derived that related outside I (Iout) with I inside arch-roofed, single-span greenhouses [enveloped with a diffuse ethylene tetrafluoroethylene (ETFE) film; Iin] and I under shade nets (composed of aluminum and polyester strips; Ish). An Ac simulation using these models indicated that on a typical sunny summer day in Japan, Ac inside the greenhouses and under the shade nets (Ac,in and Ac,sh, respectively) corresponded to 91% and 52% of Ac outside (Ac,out) for the paprika canopy (for the tomato canopy, Ac,in and Ac,sh corresponded to 90% and 48% of Ac,out, respectively). The simulated Ac loss was more serious on a cloudy day because of the linear Ac-I response under low I conditions (Ac,in/Ac,out and Ac,sh/Ac,out were 69% and 13%, respectively, for the paprika canopy). The loss of Ac,sh may be alleviated by limiting the shading period to only midday hours.

Hosta is a perennial ornamental herb, sometimes consumed as a vegetable in Japan. We evaluated the leaf mineral content of twelve hosta plant taxa, namely Hosta sieboldiana, H. alismifolia, H. sieboldii, H. longissima, H. tardiva, H. longipes var. gracillima, H. nakaiana, H. kikutii var. caput-avis, H. kikutii var. polyneuron, H. longipes var. caduca, H. kiyosumiensis, and H. montana. The leaf K content of 12 hosta plant taxa ranged from 2.85 to 4.05%; the P content from 0.13 to 0.34%; Ca from 0.02 to 1.15%; Mg from 540.00 to 794.12 ppm; Mn 26.93 to 133.77 ppm; Zn 115.39 to 334.52 ppm; Cu 1.78 to 5.95 ppm and Fe 26.43 to 251.95 ppm. Our results indicate that H. alismifolia is the best source of K; H. sieboldii the best sources of Ca and Fe; H. nakaiana of P, Mg and Zn; and H. longissima of Mg and Cu. The K content value for H. montana was statistically identical to that for H. alismifolia. The Cu content values for H. montana and H. nakaiana were statically identical to that for H. longissima. H. alismifolia, H. sieboldii, H. longissima, H. nakaiana, and H. montana were found to be richer in the minerals studied than the other species studied here.