Japanese Journal of Ophthalmology最新文献

Purpose: This study investigated aqueous humor (AH) levels of α-crystallins and vascular endothelial growth factor (VEGF) in patients with neovascular age-related macular degeneration (nAMD).

Study design: Prospective study.

Methods: AH samples were collected from treatment-naïve phakic nAMD patients before the first and third anti-VEGF injections and from cataract patients without retinal disease as controls. αB-crystallin, αA-crystallin, and VEGF levels were quantified using enzyme-linked immunosorbent assay. Patients were classified as good responders (achieved remission) or poor responders (persistent intraretinal or subretinal fluid) according to response after three consecutive monthly anti-VEGF injections.

Results: A total of 28 eyes from 24 nAMD patients and 27 eyes from 23 controls were analyzed. nAMD showed higher αB-crystallin and VEGF, but similar αA-crystallin levels versus controls (P < 0.001, P = 0.002, and P = 0.721, respectively). In nAMD eyes, after two anti-VEGF injections, αB-crystallin and αA-crystallin remained unchanged, whereas VEGF decreased (P = 0.057, P = 0.182, and P = 0.017, respectively). Among nAMD eyes, 20 eyes from 18 patients were good responders and 8 from 6 were poor responders. Good responders demonstrated reductions in αB-crystallin and VEGF (P = 0.016 and P = 0.002, respectively), whereas poor responders showed no significant changes (P = 0.249 and P = 0.075, respectively). In untreated nAMD eyes, αB-crystallin and VEGF levels showed a positive correlation (P = 0.010).

Conclusion: In nAMD, AH αB-crystallin levels were elevated compared with controls. Among good responders to anti-VEGF therapy, αB-crystallin levels decreased. Moreover, αB-crystallin levels showed a positive correlation with VEGF.

Purpose: To investigate 6-month outcomes in eyes with neovascular age-related macular degeneration (nAMD) switched from intravitreal aflibercept 2 mg to intravitreal aflibercept 8 mg.

Study design: Retrospective observational study.

Methods: We reviewed records of consecutive nAMD eyes switched from aflibercept 2 mg to 8 mg. In eyes continuing aflibercept 8 mg, best-corrected visual acuity (BCVA), treatment intervals, and anatomical/exudative parameters were evaluated at 6 months. In eyes that could not continue, reasons for discontinuation were examined.

Results: Forty-four eyes from 44 patients were included. At 6 months, 35 eyes (79.5%) continued and 9 (20.5%) discontinued aflibercept 8 mg. Discontinuing eyes had significantly shorter pre-switch treatment intervals and more frequent prior therapies than continuing eyes. In the continuation group, BCVA remained stable (median 0.05 to 0.00 logMAR, P = 0.351), while the treatment interval was significantly extended (median 7.0 to 9.0 weeks, P < 0.001). Central retinal thickness and pigment epithelial detachment height decreased significantly (P = 0.035 and P = 0.021, respectively). The proportion of eyes with subretinal fluid significantly decreased from 74.3 to 37.1% (P = 0.003). Of the discontinuations, 4 were due to worsening exudation and 5 to inability to extend to ≥8 weeks as required by labeling. No intraocular inflammation or serious adverse events occurred.

Conclusions: Switching to aflibercept 8 mg achieved anatomical improvements and longer treatment intervals in ~80% of nAMD cases, suggesting it may be a useful alternative to aflibercept 2 mg. However, continuation may be difficult in refractory cases requiring frequent injections before switching.

Purpose: To evaluate the efficacy of a self-supervised learning Vision Transformer (ViT) for classification of the nucleus, cortex, and posterior capsule cataract severity utilizing anterior segment optical coherence tomography (AS-OCT) images.

Study design: Artificial intelligence (AI) model training.

Methods: Overall, 1,693 eyes were imaged using AS-OCT, with 1,023 classified according to the Lens Opacities Classification System III for supervised training at the Department of Ophthalmology, University of Tsukuba Hospital, Japan. Five AI models were compared: ResNet18, ViT with/without ImageNet pre-training, and Self-Supervised ViT (SS-ViT) constructed using AS-OCT images from 670 eyes. These models were evaluated across five classification tasks: nuclear cataract 2-class (N1 vs. N2≥), 3-class (N1, N2-N3, N4≥), and 6-class classifications; and 2-class classifications for both cortical (C1 vs. C2≥) and posterior subcapsular cataracts (P1 vs. P2≥). Performance was measured using Area Under the Precision-Recall Curve (AUPRC).

Results: In the nuclear cataract 2-class classification, ResNet18, ViT, and SS-ViT, which were pre-trained on ImageNet, demonstrated the highest AUPRC of 0.999. For the nuclear cataract 3-class classification, SS-ViT exhibited the highest AUPRC of 0.939. In the 6-class classification of nuclear cataract, SS-ViT attained the highest value with an AUPRC of 0.788. In the 2-class classification of cortical cataract, SS-ViT demonstrated the highest performance with an AUPRC of 0.774, while in the 2-class classification of posterior subcapsular cataract, SS-ViT exhibited the most favorable performance with an AUPRC of 0.506.

Conclusion: Our findings demonstrate the effectiveness of a self-supervised ViT model for severity classification of nuclear, cortical, and posterior subcapsular cataracts on AS-OCT.

Purpose: This study investigated the relationship between watercleft localization in crystalline lenses and higher-order aberrations.

Study design: Single-center, retrospective, observational study METHODS: The study included 131 right eyes from 131 patients. The patients underwent complete ophthalmic examinations, swept-source anterior-segment optical coherence tomography (Tomey Corporation), and wavefront analysis with a wavefront analyzer (Topcon Corporation). Waterclefts were classified according to the Kanazawa Medical University Cataract Classification and Grading System. On the basis of their location, the central and peripheral watercleft types were further categorized as anterior waterclefts (AWC) or posterior cortical waterclefts (PWC).

Results: The total cross-sectional areas and volumes of the central waterclefts were 7.722 ± 5.926 mm² and 1.413 ± 1.357 mm³ for the C-AWC and 2.443 ± 2.422 mm² and 0.214 ± 0.286 mm³ for the C-PWC, respectively. The size (area and volume) of the C-AWC was significantly larger than that of the C-PWC. Both eyes exhibited significantly higher levels of higher-order aberrations and lower visual acuity than did the clear eye in both cases (P <.05).

Conclusion: Central-type waterclefts caused visual deterioration, with a significant correlation between size and visual function. For the same cross-sectional area and volume, the effects on higher-order aberrations and visual acuity were greater with C-PWC than with C-AWC.

Purpose: Recurrent retinal detachment (re-RD) after rhegmatogenous retinal detachment (RRD) surgery is associated with poor visual outcomes. This retrospective study evaluated the incidence and risk factors for re-RD following primary 25-gauge pars plana primary vitrectomy (25G-PPV).

Study design: Retrospective observational study METHODS: Consecutive patients who underwent initial 25G-PPV at Fujita Health University Hospital between January 2011 and March 2019 were included. After applying exclusion criteria, preoperative and surgical factors were obtained from medical records. Patients were categorized into re-RD and initial reattachment groups. Univariate analysis was used to identify factors associated with re-RD, followed by multivariate analysis of significant variables.

Results: Among 1399 eyes, the mean age was 56.5±11.0 years. The re-RD and reattachment groups included 89 and 1310 eyes, respectively. The initial reattachment rate was 93.2%. Significant differences were observed between macular detachment and inferior retinal break (RB). The odds ratios of macular detachment and inferior RB in the re-RD group were 1.70 (95% confidence interval [CI] 1.05-2.79) and 2.26 (1.40-3.61), respectively.

Conclusion: The initial reattachment rate with 25G-PPV was 93.2%. The re-RD group showed higher rates of macular detachment and a higher proportion of inferior RB, identified as risk factors for re-RD. RD due to inferior RB with macular detachment may require vitrectomy combined with buckling.

Purpose: To characterize the clinical and genetic features of REEP6-associated retinopathy in 8 Japanese patients from 7 families STUDY DESIGN: Retrospective, multicenter cohort study METHODS: Biallelic REEP6 variants were identified by use of whole-exome sequencing in patients with inherited retinal dystrophy (IRD). Comprehensive ophthalmic assessments were performed in all the patients.

Results: Among a nationwide cohort of 2011 patients with IRD, 8 patients from 7 families were found to carry biallelic REEP6 variants. Four distinct variants were identified: c.223G>A, p.Glu75Lys; c.268G>C, p.Val90Leu; c.280_281del, p.Leu94ValfsTer86 (novel frameshift), and c.598+1G>A. Five families (Families 1-5) carried the compound heterozygous p.Val90Leu and c.598+1G>A variants. The other two had either homozygous c.598+1G>A (Family 6) or compound heterozygous p.Glu75Lys/p.Leu94ValfsTer86 (Family 7). In Families 1-5, the patients exhibited relatively mild phenotypes with limited to peripheral retinal degeneration in the younger patients and gradual posterior pole involvement in the older patients. Optical coherence tomography revealed well-preserved outer retinal layers at the macula, and good visual acuity was maintained even in some of the older patients. In contrast, the 2 patients in Families 6 and 7 exhibited more severe phenotypes, including macular atrophy and visual acuity decline.

Conclusions: The combination of p.Val90Leu and c.598+1G>A variants was associated with a milder phenotype, supporting the hypothesis that p.Val90Leu is a hypomorphic variant. These findings expand the clinical and genetic spectra of REEP6-associated retinopathy, particularly among East Asian populations.

Purpose: To investigate the distribution of axial length (AL) and the prevalence of long axial length (LAL) in Japanese children and adolescents.

Study design: cross-sectional observational study METHODS: We analyzed AL data from 14,482 participants (7,457 boys and 7,025 girls) aged 4-19 in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan. AL was measured using a non-contact optical axis measurement device. We evaluated the distribution of AL in the participants with box plots for age. Segmented regression identified age-related trends and breakpoints. We calculated the age-specific proportions of participants with AL ≥ 24.5 mm and those with AL ≥ 26 mm, defined as LAL, which were considered indicative of suspected myopia.

Results: Mean AL increased with age, with a break point at 11.73 years. The slope before the break point was β = 0.27, while the slope after the break point decreased to β = 0.12. Boys showed earlier break point (9.87 years) than girls (15.91 years). Proportions with AL ≥ 24.5mm and ≥26mm began to increase approximately at 8 and 10 years of age respectively, with sex differences noted between ages 7 to 10 years and 10 to 11 years.

Conclusion: This was the first large-scale AL survey in Japan and revealed the age and sex related distribution of AL and the proportion with LAL among Japanese children and adolescents aged 4 to 19 years.

Purpose: To investigate the incidence and clinical characteristics of malignant glaucoma (MG) following Preserflo MicroShunt (PMS) implantation.

Study design: Retrospective multicenter cohort study METHODS: We investigated 957 consecutive eyes that underwent PMS implantation between August 2022 and May 2025. In all eyes, patient age, sex, glaucoma subtype, preoperative intraocular pressure (IOP), medication score, axial length (AL), and use of intraluminal suture stenting (ISS) were examined. We identified cases in which MG developed postoperatively and compared age, preoperative IOP, medication score, and AL between the MG and non-MG groups. The timing of MG onset and treatment outcomes were also evaluated. After Bonferroni correction, the adjusted significance level was set at P<0.0125 (0.05/4).

Results: MG occurred in 4 eyes (0.42%) of 2 men and 2 women, with a median age of 85.5 years (interquartile range [IQR], 84-90 years). All eyes were diagnosed with exfoliation glaucoma (XFG). Patients in whom MG developed were significantly older (P=0.006) and had a significantly higher preoperative IOP (P=0.006) than those without MG. No significant differences in AL or medication score were observed between the groups. MG developed on postoperative days 2, 3, and 4 in 3 eyes without ISS. In 1 case with ISS, MG occurred 3 days after ISS removal, but not during ISS placement. All MG cases were successfully treated with irido-zonulo-hyaloido-vitrectomy, with or without pars plana vitrectomy.

Conclusions: Although rare, MG can occur in the early postoperative period after PMS implantation, particularly in older patients with a high preoperative IOP.

Purpose: To assess the efficacy of trabecular micro-bypass stents (IS) versus ab interno trabeculotomy (LOT) performed alongside cataract surgery; and to ensure patient comparability across both surgical groups concerning age, intraocular pressure (IOP), medication score, and disease type.

Study design: Retrospective cohort METHODS: Overall, 194 eyes were assessed from 107 Japanese patients with open-angle glaucoma or exfoliation glaucoma who received IS plus cataract surgery at Saitama Red Cross Hospital between July 2017 and January 2022. Another 88 eyes were assessed from 58 patients who underwent combined LOT and cataract surgery at the same hospital between January 2018 and December 2019. Both cohorts were followed-up for ≥6 months. Propensity scoring facilitated between-group patient background matching. Overall, 62 eyes per group matched for preoperative characteristics were analyzed.

Results: Six-month postoperative IOP was 14.50 ± 2.26 and 14.08 ± 2.50 mmHg for IS and LOT, respectively, with medication scores of 1.50 ± 1.17 (IS) and 1.71 ± 1.60 (LOT), indicating no significant differences. The IOP reduction rate was 19.03 ± 13.34% (IS) and 18.94 ± 23.26% (LOT), showing no significant difference. Both groups exhibited similar medication score reductions (-1.11 ± 1.04 [IS], and -0.92 ± 1.47 [LOT]). Preoperative IOP significantly correlated with IOP reduction rate in both procedures. LOT patients experienced more hyphema postoperatively, versus IS patients.

Conclusion: In eyes with relatively well-controlled preoperative IOP-where either IS or LOT could be reasonably selected-either procedure offers similar surgical outcomes, with comparable postoperative performance and complication rates, except for postoperative hyphema.

Purpose: To investigate 10-year changes in risk factors associated with treatment required for retinopathy of prematurity (ROP) in extremely low birth weight infants.

Study design: Retrospective cohort study.

Methods: Data for extremely low birth weight infants born in 2011 (Group 1) and those born in 2020-2021 (Group 2) were extracted from the Neonatal Research Network of Japan, with a total of 564 cases. The frequency of ROP treatment-related risk factors and results of multivariate analyses were compared between the two groups. Missing data in covariates were handled using multiple imputation.

Results: Group 2 had a significantly lower birth weight (p=0.038), gestational age (p=0.037), and Apgar scores (p<0.001), than Group 1. The frequencies of resuscitation with intubation (p=0.030), oxygen therapy beyond 36 weeks' postmenstrual age (p<0.001), chronic lung disease (p=0.012), gastrointestinal perforation (p=0.030), and red blood cell transfusion (p=0.018) were higher in Group 2 than in Group 1. However, the incidence and treatment rate of ROP decreased over time. The multivariate analysis shows that mechanical ventilation for 60 days or more is a strong independent risk factor for ROP treatment in Group 1, but this effect disappeared in Group 2.

Conclusion: Birth weight and gestational age of extremely low birth weight infants born in Tokyo have decreased significantly compared with 10 years previously, and the severity of ROP has not increased. Advances in respiratory management may have contributed to reducing the risk of developing severe ROP.