Japanese Journal of Ophthalmology最新文献

Purpose: To investigate paracentral stereopsis in glaucoma patients with localized visual field (VF) defects using a novel assessment method.

Study design: A pilot study METHODS: Three glaucoma patients had an absolute scotoma (0 dB) in the superior visual field of one eye, with preserved inferior VF sensitivity bilaterally. Best-corrected visual acuity was ≥1.2 (≤-0.1 logMAR) and stereopsis was ≤120 arcseconds on a random dot stereograms (RDSs) test, without manifest strabismus. Paracentral stereopsis thresholds were measured using the Stereo Eccentricity Analysis (SEA) program implemented in the binocular open field imaging system imovifa^@. Seventeen test points within the central 15° VF locations, including the fovea, were tested with circular stereoscopic stimuli (200-3000 arcsec disparity) on a RDSs background for 500 ms, with size adjusted by eccentricity.

Results: The mean binocular sensitivity for the superior field with a 0 dB scotoma was comparable to the monocular sensitivity for the superior field of the normal eye. Despite the preserved binocular sensitivity, however, paracentral stereopsis could not be confirmed in the affected superior field. In the normal inferior fields of the two eyes, paracentral stereopsis was detected, and higher stereopsis thresholds were observed with increasing eccentricities. These results were observed in all three cases.

Conclusion: In glaucoma patients, paracentral stereopsis was absent in the corresponding area of the VF defect regardless of the preserved binocular sensitivity. Its assessment may contribute to providing insight into functional vision loss beyond central stereopsis.

Purpose: OQrimo^® is a robotic assistant system that supports vitreoretinal surgery by holding an intraocular endoscope or illumination device to assist the surgeon. In April 2023, Japan approved this system, and as the world's first clinical institution to implement OQrimo^®, we aimed to evaluate its safety and clinical utility.

Research design: Retrospective case series METHODS: The study analyzed all vitreoretinal surgery utilizing OQrimo^® at Kyushu University Hospital between December 1, 2023 and November 31, 2024. Data collection included patient demographics, preoperative diagnoses, surgical procedures, equipment used, surgical records, and perioperative complications. We analyzed OQrimo's safety profile and patterns of clinical use based on these data.

Results: Eight eyes from eight patients were included. Preoperative diagnoses included proliferative vitreoretinopathy, panuveitis, acute retinal necrosis, macular hole, and secondary glaucoma due to uveitis. The purpose of pars plana vitrectomy included silicone oil removal, vitreous biopsy, internal limiting membrane peeling, and Ahmed valve implantation via pars plana. OQrimo^® maintained stable endoscope positioning in all cases, enabling observation of the peripheral retina without scleral indentation. In seven cases, OQrimo's endoscopic visualization and a wide-viewing system were used simultaneously. No intraoperative or postoperative complications were observed in any case.

Conclusion: We confirmed the safety of OQrimo^® during its initial clinical application. The system facilitated the observation of the peripheral retina using an intraocular endoscope without scleral indentation.

Purpose: To investigate the association between vascular factors affecting optic nerve perfusion and glaucoma progression in a clinical setting with systematic monitoring of blood pressure and intraocular pressure (IOP).

Study design: Retrospective cohort study.

Methods: This retrospective study analyzed 428 primary open-angle glaucoma (POAG; n=295) and exfoliation glaucoma (EXG; n=133) patients from Shimane University Hospital. We employed a validated Bidirectional Encoder Representations from Transformers (BERT)-based natural language processing system to extract clinical data from electronic medical records of 36,561 visits, including blood pressure measurements, IOP, and medication details across 216 clinical parameters. Mixed-effects regression models were employed to identify factors associated with visual field mean deviation (MD) and the rate of MD decline.

Results: The cohort demonstrated consistent pressure management (median IOP: 13.0 mmHg; median systolic: 138.0 mmHg; median diastolic: 79.0 mmHg). Ocular perfusion pressure (OPP) showed no significant association with either visual field MD or the rate of MD decline. Significant predictors of worse visual field MD included age (coefficient: -0.28, 95% CI -0.33 to -0.23, p<0.001), history of filtration surgery (coefficient: -3.8, 95% CI -5.7 to -1.9, p<0.001), and number of glaucoma medications (coefficient: -0.19, 95% CI -0.35 to -0.030, p=0.020). Factors significantly associated with faster MD decline were age, initial MD severity, and medication burden.

Conclusions: In a clinical setting with systematic monitoring, OPP provided limited prognostic value for glaucoma progression, while traditional clinical factors were stronger predictors. Our BERT-based approach demonstrates how artificial intelligence (AI)-powered data extraction enables comprehensive analyses of clinical records, offering new insights for routine ophthalmological care.

Purpose: To evaluate the clinical performance of a hydrophobic acrylic toric intraocular lens (IOL) with double C-loop haptics in a Japanese population with cataracts.

Study design: Prospective METHODS: The PODEYE TORIC IOL (POD T 49P) was implanted in 58 eyes from 42 patients diagnosed with bilateral cataracts with corneal astigmatism. Thirty-one eyes received IOLs with cylinder powers of 1.50 to 6.00 D (group A), and 27 eyes received IOLs with 1.00 D cylinder (group B). Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and refractive cylinder were examined postoperatively. The primary endpoints, which were the non-inferiority of UDVA in group A and superiority of the refractive cylinder in group B, were examined and compared with relevant previous data.

Results: In group A, the mean preoperative corneal astigmatism was 1.87±1.01 D and postoperative logMAR UDVA and CDVA were -0.023±0.110 and -0.102±0.079, respectively. There were 23 eyes (74.2%) with UDVA of 0.0 logMAR or better, while the refractive cylinder was - 0.39±0.39 D. In group B, the preoperative corneal astigmatism of 0.73±0.22 D and postoperative logMAR UDVA and CDVA were -0.074±0.091 and -0.096±0.075, respectively; 23 eyes (85.2%) obtained a UDVA of 0.0 logMAR or better. The postoperative refractive cylinder was -0.16±0.23D. The non-inferiority of UDVA in group A and the superiority of the refractive cylinder in group B were verified with previous data.

Conclusion: The PODEYE TORIC IOL with 1.00-6.00 D cylinder powers and double C-loop haptics effectively corrected corneal astigmatism in Japanese patients after cataract surgery.

Trial registration number: NCT04699266 (Clinicaltrials.gov).

Purpose: To compare anterior segment parameters in healthy children of the same age with those in children with phenylketonuria (PKU).

Study design: Retrospective observational study METHODS: Data from 25 eyes of PKU patients (study group) and 60 eyes of age- and gender-matched children (control group) were analyzed. The records reviewed included results from a comprehensive ophthalmic evaluation that each participant had previously undergone. This evaluation included refraction evaluation (spherical equivalent), best corrected visual acuity (BCVA) testing, slit-lamp biomicroscopy, fundus examination, intraocular pressure (IOP) measurement, specular microscopy, and corneal topography measurement.

Result: Forty-five (52.9%) age- and sex-matched participants were girls and 40 (47.1%) were boys. The percentage of hexagonal cells (HEX) was 65.53±8.17 in the study group and 69.75±4.19 in the control group (p=0.021). Flat keratometry (K1) was 41.70±1.54 D in the study group and 43.16±1.52 D in the control group (p=0.002). Steep keratometry (K2) was 42.55±1.83 D in the study group and 43.91±1.73 D in the control group (p=0.013).

Conclusion: This study shows that patients with pediatric PKU have differences in the anterior segment parameters, including keratometric values and HEX, when compared with healthy controls.

Purpose: To determine whether a white cataract (WC) with elevated intralenticular pressure (EWC) can be distinguished from one with normal intralenticular pressure (NWC) using an optical biometer based on Swept-Source Optical Coherence Tomography (SS-OCT).

Study design: Retrospective observational study METHODS: Patients with a WC who had undergone phacoemulsification and intraocular lens (IOL) implantation at Iwate Medical University Hospital were enrolled. Using surgical videos, WCs with/without leakage of the liquefied cortex or bulging of the swollen cortex were classified as EWC and NWC, respectively. Both groups were compared in terms of age, sex, ocular comorbidities, various parameters, and the presence of characteristic appearances of the liquefied cortex on SS-OCT images. If the parameters were not measured appropriately, remeasurement using SS-OCT images were performed.

Results: Of the 48 patients with a WC, 26 eyes were classified as having an EWC, and 22 as NWC. There were significant differences in lens thickness (LT), anterior chamber depth (ACD), ΔLT, ΔACD (the differences in LT or ACD between the eyes with a WC and the fellow eyes, respectively), and age between an EWC and an NWC. ROC analysis showed that the AUC values of LT, ΔLT, and ΔACD were higher than 0.970. LT required remeasurement in approximately half of the WC, whereas ACD did not. Image evaluation for detecting an EWC had a sensitivity of 88.5% and a specificity of 90.9%.

Conclusions: An optical biometer based on SS-OCT may detect an EWC using LT, ΔLT, ΔACD, and SS-OCT images.

Purpose: This single-center retrospective study aimed to identify independent predictors of retinopathy of prematurity (ROP) treatment by integrating continuous pulse oximetry (SpO₂) data with comprehensive laboratory parameters.

Study design: Single-center retrospective cohort study.

Methods: We analyzed 244 neonates (gestational age < 34 weeks or birth weight < 1800 g) admitted between 2019 and 2023, excluding those with major genetic abnormalities. Logistic regression assessed associations between birth weight (BW), average SpO₂ at birth, hemoglobin (Hb), albumin (Alb), and selected inflammatory markers (e.g., neutrophil-to-lymphocyte ratio) with ROP treatment. Model discrimination was evaluated via receiver operating characteristic curves.

Results: Of the 244 infants, 16.8% required treatment (laser therapy or anti-VEGF injections). Lower BW and lower Hb were significantly associated with treatment (P <0.05). In the final multivariable model, BW and Hb emerged as key predictors (AUC = 0.884; accuracy = 88%), while Alb and inflammatory indices were not independently significant. Predicted treatment probabilities decreased markedly as BW and Hb increased.

Conclusion: BW and Hb were primary predictors of ROP treatment necessity in this cohort, whereas Alb and inflammatory markers did not show independent associations. Incorporating continuous SpO₂ monitoring provided valuable respiratory insights. Further prospective, multicenter studies are warranted to validate these findings and refine ROP risk stratification strategies.

Purpose: Using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), to evaluate vision-related quality of life outcomes in patients with bullous keratopathy after cultured corneal endothelial cell (CEC) transplant.

Study design: Single-center prospective clinical trial METHODS: In this prospective, single-center study, 11 consecutive patients with bullous keratopathy underwent cultured CEC transplant. The NEI VFQ-25 was administered through in-person interviews by trained interviewers at baseline and at 24 weeks postoperatively. The NEI VFQ-25 comprises 12 subscales that assess different aspects of vision-related quality of life. Changes in composite and subscale scores were analyzed.

Results: The patients comprised 5 men and 6 women, with a mean age of 64.4 years (range 49-82 years). All the patients had pseudophakic bullous keratopathy, with Fuchs endothelial corneal dystrophy being the predominant underlying cause of disease (7 eyes). The NEI VFQ-25 composite score improved significantly from 61.8 ± 11.9 to 79.5 ± 8.0 (P <.01). Significant improvements were observed in general vision, ocular pain, near vision, social function, mental health, role limitations, dependency, and peripheral vision subscales (P <.05). General health, distance vision, driving, and color vision subscales showed minimal improvement.

Conclusions: Cultured CEC transplant significantly improved vision-related quality of life in patients with bullous keratopathy. The comprehensive improvement across multiple NEI VFQ-25 domains suggests that this novel therapeutic approach may be a viable treatment option for corneal endothelial dysfunction.

Purpose: To examine the associations between work-family conflict, implicit gender bias, and turnover intention among hospital ophthalmologists.

Study design: Cross-sectional study.

Methods: We conducted a web-based questionnaire survey between January and February 2024. The participants were full-time ophthalmologists working in 37 hospitals in the Kanto region of Japan. We assessed the associations between work-family conflict, implicit gender bias, and turnover intention using multivariable regression analysis, with adjustments for job fit and position.

Results: We analyzed data from 74 ophthalmologists (mean age: 41.5 years, standard deviation: 10.8; 51.4% women). The median intention to leave score was 2.50 (interquartile range: 2.00-3.00). Work interference with family was significantly associated with turnover intention (adjusted difference: 0.30; 95% confidence interval: 0.075-0.53; p=0.010). However, family interference with work and implicit gender bias were not significantly associated with turnover intention.

Conclusions: This is the first study to examine the associations between work-family conflict, implicit gender bias, and turnover intention among Japanese hospital ophthalmologists. Work interference with family was associated with increased turnover intention but not with family interference with work or implicit gender bias.

Purpose: To identify predictors of the 2-year best-corrected visual acuity (BCVA) after subretinal tissue plasminogen activator (tPA) injection for massive submacular hemorrhage (SMH) complicating neovascular age-related macular degeneration (nAMD).

Study design: A prospective, observational study.

Methods: This study included consecutive eyes with massive SMH and nAMD that underwent vitrectomy with subretinal tPA injection and follow-up for 2 years. We analyzed the correlation between the 2-year BCVA and other parameters, including baseline BCVA, SMH height, SMH size, and SMH recurrence.

Results: This study analyzed 20 eyes of 20 patients (72.5 ± 7.2 years). Two years after surgery, the mean logarithm of the minimum angle of resolution (logMAR) BCVA changed from 0.72 (Snellen equivalent, 20/105) ± 0.40 at baseline to 0.80 (Snellen equivalent, 20/126) ± 0.92. The BCVA did not change significantly during the 2-year observation period (P = 0.39). Compared to baseline, the 2-year BCVA improved in 11 eyes (55%) and declined in 6 eyes (30%) by more than 0.30 logMAR, including all five eyes with recurrence. The 2-year BCVA was correlated only with recurrence (P < 0.001, β = 0.85).

Conclusions: This study suggests that recurrence was a robust determinant of poor 2-year BCVA after vitrectomy with subretinal tPA injection for SMH complicating nAMD and that subretinal tPA injection was effective in most cases, without recurrence. Our findings highlight the importance of establishing methods for preventing and controlling recurrence to maintain long-term BCVA.