During the 1-year follow-up, the combination of OK and atropine 0.01% ophthalmic solution was more effective in slowing axial elongation than OK monotherapy in children with myopia.

Eighty Japanese children, aged 8-12 years, with a spherical equivalent refraction (SER) of − 1.00 to − 6.00 dioptres (D) were randomly allocated into two groups to receive either a combination of orthokeratology (OK) and 0.01% atropine solution (combination group) or monotherapy with OK (monotherapy group). Seventy-three subjects completed the 2-year study. Over the 2 years, axial length increased by 0.29 ± 0.20 mm (n = 38) and 0.40 ± 0.23 mm (n = 35) in the combination and monotherapy groups, respectively (P = 0.03). Interactions between combination treatment and age or SER did not reach significance level (age, P = 0.18; SER, P = 0.06). In the subgroup of subjects with an initial SER of − 1.00 to − 3.00 D, axial length increased by 0.30 ± 0.22 mm (n = 27) and 0.48 ± 0.22 mm (n = 23) in the combination and monotherapy groups, respectively (P = 0.005). In the − 3.01 to − 6.00 D subgroup, axial length increased by 0.27 ± 0.15 mm (n = 11) and 0.25 ± 0.17 mm (n = 12) in the combination and monotherapy groups, respectively (P = 0.74). The combination therapy may be effective for slowing axial elongation, especially in children with low initial myopia. The prevalence of myopia is increasing worldwide 1-3 and younger generations are affected more than others 4-6. Myopia progression in children is strongly associated with axial elongation 7. Retinal changes caused by axial elongation of high myopia increase the risks of myopic maculopathy, retinal detachment, glaucoma, and resulting blindness 4,8,9. Although controlling axial elongation is vital for reducing the risk of these complications, no treatment has yet been established to halt axial elongation. Recent studies, however, have provided evidence of effective methods to slow the progression of myopia. The Atropine for the Treatment of Myopia (ATOM) 1 study demonstrated that treatment with 1% atropine ophthalmic solution significantly suppressed the progression of myopia by about 80% compared to placebo over a 2-year period 10. However, 1% atropine produced secondary unwanted effects such as pupil dilation and loss of accommodation 11 , and rebound effect after cessation of treatment 12. Thus, in the ATOM2 study, 0.5%, 0.1%, and 0.01% atropine ophthalmic solutions were examined, leading to reduced myopia progression by about 75%, 70%, and 60%, respectively, compared to placebo in the ATOM1 study over a 2-year period 13-15. Because the secondary unwanted effects and rebound effect were scarcely seen in the 0.01% atropine group compared to the higher concentrations of atropine, 0.01% atropine was the most recommended. However, axial elongation was not suppressed significantly in the ATOM2 study. Recently, the low-concentration atropine for myopia progression (LAMP) study compared the efficacy of 0.05%, 0.025%, and 0.01% atropine ophthalmic solutions and placebo for suppressing myopia progression and axial elongation 16,17. The results showed that 0.05% atropine was the most effective for suppressing of myopia progression and axial elongation with tolerable secondary un...

Complete PVD is a strong negative risk factor for DR. The PVD status in patients with diabetes should be evaluated.

We evaluated ranirestat, an aldose reductase inhibitor, in diabetic cataract and neuropathy (DN) in spontaneously diabetic Torii (SDT) rats compared with epalrestat, the positive control. Animals were divided into groups and treated once daily with oral ranirestat (0.1, 1.0, 10 mg/kg) or epalrestat (100 mg/kg) for 40 weeks, normal Sprague-Dawley rats, and untreated SDT rats. Lens opacification was scored from 0 (normal) to 3 (mature cataract). The combined scores (0–6) from both lenses represented the total for each animal. DN was assessed by measuring the motor nerve conduction velocity (MNCV) in the sciatic nerve. Sorbitol and fructose levels were measured in the lens and sciatic nerve 40 weeks after diabetes onset. Cataracts developed more in untreated rats than normal rats (P < 0.01). Ranirestat significantly (P < 0.01) inhibited rapid cataract development; epalrestat did not. Ranirestat significantly reversed the MNCV decrease (40.7 ± 0.6 m/s) in SDT rats dose-dependently (P < 0.01). Epalrestat also reversed the prevented MNCV decrease (P < 0.05). Sorbitol levels in the sciatic nerve increased significantly in SDT rats (2.05 ± 0.10 nmol/g), which ranirestat significantly suppressed dose-dependently, (P < 0.05, <0.01, and <0.01); epalrestat did not. Ranirestat prevents DN and cataract; epalrestat prevents DN only.

PurposeTo determine risk factors and clinical signs for severe Acanthamoeba keratitis (AK) by comparing severe cases with mild cases with good prognosis.Patients and methodsWe reviewed medical records of ten cases of AK (five males and five females) referred to our hospital and classified cases into two groups. One eye that required therapeutic keratoplasty and three eyes with a poor visual acuity (<0.2) on last visit were included in the severe group. Six eyes that had good prognosis with a visual acuity of 1.2 on last visit were classified as mild group. We compared patients’ age, the time required for diagnosis, visual acuity on first visit, the history of steroid eye drops use, and other clinical findings.ResultsThe average age of the severe group was older than the mild group (P=0.04). The duration between onset and diagnosis of AK and visual acuity on first visit was not statistically different. A history of steroid eye drop use was found in four eyes of the severe group (100%) and four eyes of the mild group (67%). Keratoprecipitates were found in all severe group eyes and one mild group eye during follow-up (P=0.01). One case in the severe group was diagnosed with diabetes mellitus at initial examination. We detected Staphylococcus epidermis by palpebral conjunctival culture in one case of the severe group.ConclusionAging may be a possible risk factor for severe AK. The presence of keratoprecipitates is a possible sign of severe AK. Attention is also required in patients with comorbidities such as diabetes mellitus and bacterial infection.