Japanese Journal of Ophthalmology最新文献

Purpose: Retinal artery occlusion (RAO) is frequently associated with cerebrovascular and cardiovascular events, and guidelines highlight the need for secondary prevention. Since 2019, our hospital has implemented collaborative care between ophthalmologists and vascular neurologists for acute RAO, and here, we report the clinical outcomes before and after this approach.

Study design: Retrospective observational study.

Methods: Eighty-seven patients (mean age: 72.2 ± 13.4 years; 40 male) diagnosed with central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), or cilioretinal artery occlusion (CLRAO) at Kyushu University Hospital between March 2013 and May 2024 were retrospectively analyzed, and information on patient backgrounds, ocular and systemic examinations, and treatments was obtained.

Results: The disease types were CRAO in 58, BRAO in 24, and CLRAO in 5 patients. Systemic complications before and after collaborative care included hypertension (67% before vs 79% after), diabetes (28% vs 17%), dyslipidemia (41% vs 44%), cerebrovascular diseases (21% vs 10%), carotid artery diseases (18% vs 40%, P = 0.03), and cardiac diseases (3% vs 27%, P = 0.002). After initiation of collaborative care, the causes of RAO were identified as large-artery atherosclerosis (LAA) in 29%, cardioembolism (CE) in 23%, undetermined in 38%, other determined in 8%, and insufficient evaluation in 2% of the patients. Anticoagulants were commonly prescribed for patients with CE, whilst antiplatelet agents were prescribed for those with LAA or embolic stroke of undetermined source (ESUS).

Conclusion: Integrated collaborative care facilitates prompt detection of systemic vascular complications and initiation of secondary preventive treatments in patients with RAO.

Purpose: To compare choriocapillaris flow voids in pachychoroid spectrum disorders with an optical coherence tomography angiography (OCTA) image processing strategy excluding artifacts.

Study design: Retrospective case-control study.

Methods: This study included 22 eyes with pachychoroid pigment epitheliopathy (PPE), 25 with spontaneously resolved central serous chorioretinopathy (CSC), 20 with photodynamic therapy (PDT)-treated CSC, 21 with active CSC, 19 with pachychoroid neovasculopathy (PNV) and 24 healthy eyes. The number, average area, and maximum area of flow voids and the percentage of nonperfused choriocapillaris area (PNPCA) were evaluated on artifact-removed binarized OCTA images using a custom MATLAB-powered algorithm.

Results: The PNV group had the largest flow void maximum area, flow void average area, and PNPCA. After adjusting for covariates, PPE, active-CSC, and PNV were associated with increased PNPCA and with increases across all choriocapillaris flow-void parameters, whereas PDT-CSC was associated only with a larger maximum flow-void area. In pairwise comparisons, PNV showed a greater maximum flow-void area than other groups, and PNV had a higher average flow-void area than controls and spontaneously resolved CSC (p < 0.05). Pairwise comparisons showed no significant differences in the number of flow voids among the groups. The location of the maximum flow-void area was consistent with the location of pachyvessels (80%) and choroidal neovascularization (84.2%).

Conclusions: Flow void parameters have higher values in pachychoroid eyes than in healthy controls. These parameters are worst in eyes with PNV. The maximum area of the choriocapillaris flow void, especially, may be a marker of focal ischemia and the tendency to development of PNV.

Purpose: To characterize choroidal circulation in the vortex veins in central serous chorioretinopathy.

Study design: Single-center retrospective study.

Methods: The study included 22 eyes with central serous chorioretinopathy from 22 patients with serous retinal detachment at the macula (18 men and four women, mean age 47.3 years). Ultra-widefield indocyanine green angiography was performed using Optos^®California, and images were taken intermittently from the early to the late phase (> 20 min of contrast) to examine late images of the vortex veins. Findings in the affected and contralateral eyes were also compared.

Results: In 13 of the 22 eyes, the vortex veins were hypofluorescent in all quadrants and continuous with the vortex ampullae. In five eyes, only the asymmetric dilated vortex vein was hypofluorescent, and in four eyes, the vortex veins were not hypofluorescent. Of the 22 contralateral eyes examined, 20 eyes exhibited identical findings in the vortex veins to those observed in the affected eye. Of the four eyes that did not exhibit hypofluorescence of the vortex veins in the affected eye, two eyes had partial hypofluorescence of some vortex veins in the contralateral eye, showing different findings.

Conclusions: In the late phase, some eyes showed hypofluorescence due to the washout of indocyanine green dye in the vortex veins and others did not, suggesting that obstruction of the scleral passage in the choroidal venous outflow is not the main cause of the syndrome.

Purpose: Visual acuity (VA) assessment is crucial for evaluating visual function, but inter-clinic VA measurement variations were observed in patients with epiretinal membrane (ERM). Inter-clinic variations in acuity chart luminance exist because the International Organization for Standardization (ISO) recommends a range of 80-320 cd/m² for VA charts. We investigated the effects of luminance within this ISO range on the VA in patients with ERM.

Study design: Prospective observational study.

Methods: We analyzed data from 187 patients with ERM and a normal fellow eye with a decimal VA of ≥1.0 at 320 cd/m² OU. Baseline VA was measured at 320 cd/m², then reduced in 0.1-log unit steps using neutral density filters. Metamorphopsia was evaluated with the Amsler Grid Test. The luminance causing a two-line VA reduction from 320 cd/m² was measured before and after ERM removal.

Results: In normal fellow eyes, a two-line VA reduction occurred at approximately 40 cd/m², indicating stable VA within the normal ISO range, while in affected eyes, it happened at around 150 cd/m². The luminance difference causing a two-line VA reduction between eyes with and without metamorphopsia was not significant. For surgical patients, the luminance causing a two-line VA reduction decreased over time: from 153 cd/m² preoperatively to 36 cd/m² at 6 months postoperatively.

Conclusions: Considering the luminance is critical when measuring VA in patients with ERM.

Purpose: To identify predictors of ocular complications and to investigate treatment approaches in patients with facial paralysis (FP) in Taiwan.

Study design: Retrospective database study.

Methods: Patients with FP in the Chang Gung Research Database (2001-2022) were enrolled. Primary outcomes were ocular complications, including eyelid malposition (eg, lagophthalmos, ectropion) and ocular surface diseases (eg, recurrent corneal erosion, corneal ulcer). Predictors (demographics, comorbidities, and causes of FP) were assessed by use of the Cox proportional hazards model. A hazard ratio (HR) ≥1.50 or ≤0.67 was predefined as clinically significant. Secondary outcomes included treatment approaches.

Results: Among 36,382 patients with FP, 55.38% were diagnosed with Bell palsy; 4.95%, with new stroke; and 4.55%, with head and neck injury. Ocular complications developed in 9.22% of the patients. Factors associated with increased hazard included underlying chronic obstructive pulmonary disease (HR: 1.64; 95% CI: 1.46-1.85) and causes of FP due to head and neck injury (HR: 2.47; 95% CI: 2.19-2.79), brain tumors (HR: 2.26; 95% CI: 1.93-2.66), birth trauma (HR: 1.70; 95% CI: 1.42-2.04), surgery for brain tumors (HR: 1.59; 95% CI: 1.11-2.28), and head and neck tumors (HR: 1.56; 95% CI: 1.29-1.89). Among all the causes of FP, Bell palsy was associated with the lowest hazard of ocular complications (HR: 0.81; 95% CI: 0.75-0.88). Surgeries were required in 10.35% of patients, including 1.34% for dynamic reconstruction (muscle transfer and/or neurotization), 0.98% for static eyelid surgeries (eg, eyelid malposition correction, temporary tarsorrhaphy), and 0.05% for corneal transplant.

Conclusion: Bell palsy, the predominant cause of FP, showed the lowest hazard of ocular complications, whilst head and neck injuries showed the highest hazard.

Purpose: Although Japan has an established welfare system for individuals with visual impairments, medical-welfare coordination remains limited. To address this gap, the Low Vision Care Hub (LVCH) was established within a university hospital. We evaluated the impact of LVCH on visitor satisfaction before and after consultation STUDY DESIGN: A single-center, one-group pre-post study METHODS: Individuals with self-reported functional vision difficulties who visited LVCH between July 1 and December 20, 2024 were included. Consultation was provided based on seven domains of low vision care outlined by the Japan Society for Low-Vision Research and Rehabilitation. Satisfaction was measured on a custom 6-point ordinal scale (0-5) pre/post consultation. Changes in satisfaction scores were analyzed using the Wilcoxon signed-rank test. Multivariable logistic regression adjusted for potential confounders RESULTS: Ninety-three participants were included. Satisfaction scores significantly increased after consultation (p < .001) and improvements were consistent across sex, age groups, and visual impairment classification using the International Council of Ophthalmology (ICO) criteria (all p < .001). Notably, participants not meeting the ICO-defined low vision criteria also improved (p < .001). On multivariable logistic regression, only older age (≥ 60 years) remained significantly associated with a markedly improved satisfaction score (OR = 2.98, 95% CI 1.10-8.05, p = .03) CONCLUSION: Consultations provided at LVCH significantly improved visitor satisfaction, including those who did not meet the ICO low vision criteria. Consultation may be particularly effective in individuals aged over 60 years. Overall, early-stage intervention through structured consultation may benefit individuals with functional vision difficulties.

Purpose: To evaluate the biomechanical and tomographic characteristics of keratoconic corneas undergoing accelerated cross-linking (CXL) for over one year and to assess the impact of cone localization on postoperative biomechanical behavior.

Study design: Prospective-comparative.

Methods: This study included 68 eyes of 68 patients with progressive keratoconus. Based on cone location, the patients were divided into two groups: group 1 (central cone; 34 eyes) and group 2 (paracentral cone; 34 eyes). Scheimpflug imaging was used to assess the corneal thickness, anterior and posterior Kmean, Kmax, and astigmatism. The Ocular Response Analyzer (ORA) measures corneal compensated intraocular pressure (IOPcc), Goldmann-correlated pressure (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF). All the baseline measurements were repeated at 1, 6, and 12 months. Demarcation line (DL) depth was assessed at 1 month using anterior segment optical coherence tomography. Best corrected visual acuity was recorded at each visit.

Results: At 1year, anterior Kmean, posterior Kmean and Kmax showed significant reductions (p < 0.01). No significant differences in CH or CRF changes were found between the central and peripheral cones (p = 0.22, p = 0.33). Visual improvement and reduction in spherical equivalent were greater in the central cone group (p = 0.03, p = 0.03). DL depth correlated positively with CH and CRF at 1 month (p = 0.02, p = 0.008), but not at 1 year.

Conclusion: Accelerated CXL improves corneal shape, but may not produce detectable changes in ORA-derived biomechanics. Regional stiffening may not be captured by global indices, and the cone location appears to be more influential on visual recovery than biomechanical parameters.

Purpose: Fundus parameters can be used to quantify masculinity or femininity as a fundus sex index (FSI) ranging from 0 to 1. The purpose of this study was to investigate the association between smoking, hypertension, diabetes, and FSI in the Kumejima population study STUDY DESIGN: Prospective cross-sectional observational population study METHODS: Using color fundus photographs obtained from the Kumejima population study, 1653 healthy right eyes with reliable fundus parameter measurements were included. The tessellation fundus index R/(R + G + B), red-green-blue intensity in eight locations around the optic disc and foveal region, optic disc ovality ratio, papillomacular angle, and retinal vessel angles were quantified using ImageJ. The FSI was calculated using machine learning from the 42 fundus parameters, and the Mann-Whitney U-test was used to assess whether there were differences in the FSI depending on the presence or absence of smoking, hypertension, and diabetes RESULTS: The mean age of the 838 men and 815 women included in this study was 52.8 and 54.0 years, respectively. The FSI of the smoking group was lower than of the non-smoking group overall (P < 0.001). The FSI of the hypertension and diabetes groups was significantly higher than of the non-hypertension (P = 0.005) and non-diabetes (P = 0.017) groups only in women CONCLUSION: In the Kumejima population study of healthy eyes in individuals aged 40 years or older, the fundus tended to be more feminine in women with hypertension or diabetes than in those without these conditions.

Purpose: To compare the monocular uncorrected visual acuity (UCVA) and contrast sensitivity (CS) of three enhanced monofocal intraocular lenses (IOLs) under emmetropic and mild myopic refractive targets.

Study design: Single-center retrospective observational study.

Methods: Among 198 patients (244 eyes) who underwent uneventful cataract surgery with enhanced monofocal IOL implantation (Tecnis Eyhance [DIB00V, E group], Vivinex Impress [XY1-EM, I group], NIDEK NSP-3 [N group]) with emmetropia or mild myopia (-1.00D), refractive targets, monocular UCVA at six different distances (5, 1, 70, 50, 40, and 30 cm) and CS with and without glare were assessed 1 month postoperatively and compared using the Kruskal-Wallis test followed by the Steel-Dwass post-hoc test.

Results: In the emmetropic group, UCVA for all IOLs achieved ≤ 0.2 logMAR from 5 m to 50 cm, with significantly better UCVA at 5 m in the E than I group (p = 0.0300) and at 50 cm in the I than N group (p = 0.0242). For mild myopia, the N group achieved better UCVA at 5 m (p = 0.0066), the I group showed superior near-visual acuity at 30 cm than the E group (p = 0.0457), and UCVA for all IOLs achieved ≤ 0.2 logMAR from 1 m to 40 cm, with the highest CS at 6, 12, and 18 cycles per degree, with and without glare, in the E group. These findings suggest that combining enhanced monofocal IOLs with mild myopic targeting (-1.0 D) may optimize functional vision for everyday activities, particularly in older adults who rely on safe intermediate and near vision in daily life.

Conclusions: All IOLs showed good UCVA. The E, I, and N groups demonstrated balanced visual performance, with superior contrast sensitivity, superior near-to-intermediate vision, and superior distance vision, respectively.

Purpose: To explore the positional relationship between intraocular lens (IOL) and crystalline lens (CLL) by anterior segment optical coherence tomography (AS-OCT) in high myopia complicated with cataract eyes.

Study design: Retrospective and consecutive study.

Methods: Patients who had undergone phacoemulsification with IOL implantation were reviewed. Exclusion criteria were any ocular history that could have affected the zonules, poor pupil dilation and intra- or post- operative complications. The magnitude and direction of tilt and decentration of CLL and IOL, CLL thickness (LT), anterior chamber depth (ACD) and axial length (AL) were measured.

Results: Fifty eyes without high myopia (EM group) and 73 high myopia eyes (HM group) were recruited. The magnitude of tilt and decentration of CLL was significantly different between the HM and EM group (p_{tilt HM vs. EM} <0.01, p_{decentration HM vs. EM} <0.01). In terms of the decentration, the magnitude of IOL was significantly higher than of CLL in both the HM and EM groups (p _HM < 0.01; p _EM=0.043). Multivariate analysis showed that only the alignment of CLL was related with the position of IOL in both group (R² _{tilt EM}=0.237, p _{tilt EM} < 0.01, R² _{decentration EM}=0.097, p _{tilt EM}=0.042; R² _{tilt HM}=0.476, p _{tilt HM} < 0.01, R² _{decentration HM}=0.359, p _{tilt HM} < 0.01).

Conclusions: Alignment of CLL in high myopia eyes determines the position of the IOL. Moreover, the IOL in high myopia was more decentrated, while this discrepancy did not reach a level that would compromise visual quality, it needs to be taken into consideration.