Japanese Journal of Ophthalmology最新文献

Purpose: To evaluate the neuroprotective effect of ripasudil, a rho-kinase inhibitor that is a commercially available glaucoma medication that lowers intraocular pressure. We explored the effects of ripasudil on retinal damage via oxidative stress (OS) in primary rat retinal ganglion cell (RGC) cultures and NMDA-induced retinal damage in mice.

Study design: Experimental investigation METHODS: Primary rat RGCs were isolated via a 2-step immunopanning method and cultured under normal cultivation conditions for 72 h and for a further 24 h in antioxidant-free medium for OS. We measured the number of living RGCs by use of calcein-AM and calpain activity via calpain immunoreactivity assays. Furthermore, we evaluated the effects of ripasudil via RGC counting in retinal flat-mounts from Thy1-CFP mice, retinal thickness via optical coherence tomography, and reduced glutathione levels via GSSG/GSH assays in NMDA-induced retinal damage.

Results: The living RGC counts of normal, OS, 0.1, 1, 10, and 100 uM ripasudil under OS were 236.0 ± 21.6, 155.0 ± 13.2, 155.9 ± 17.1, 158.9 ± 12.0, 184.8 ± 26.9, and 201.1 ± 24.8 cells, respectively. 10 or 100 uM ripasudil significantly inhibited the OS-induced RGC reduction (P < 0.05 or 0.01). Furthermore, the enhanced calpain activity induced by OS was suppressed by 100 uM ripasudil (P < 0.05). In an in vivo study, the RGC counts in the NMDA-treated group were lower than those of the non-NMDA-treated group. NMDA-induced RGC loss was significantly suppressed by ripasudil (P < 0.01). Retinal thinning after 3 weeks of NMDA injection was also inhibited by ripasudil (P < 0.01 or 0.05). Furthermore, NMDA increased the glutathione level, whereas ripasudil suppressed it (P < 0.05).

Conclusions: Ripasudil may have neuroprotective effects via an antioxidative mechanism, which could be useful as an intraocular pressure-independent additive.

Purpose: To investigate the usage status and evaluate the efficacy of intravenous immunoglobulin (IVIG) for the acute treatment of optic neuritis (ON) in Japan.

Study design: Multicenter retrospective case series.

Methods: The study subjects were patients with steroid-resistant acute ON in whom IVIG had been initiated between January 2020 and August 2022 at 30 facilities in Japan. The clinical characteristics, visual acuity, and adverse events following IVIG were compared among anti-aquaporin 4 antibody positive ON (AQP4-ON), anti-myelin oligodendrocyte glycoprotein antibody positive ON (MOG-ON), and idiopathic ON (ION).

Results: The study included sixty-five patients (76 eyes); the main clinical department administering IVIG was ophthalmology (50 cases, 77.0 %). 43 cases had their first ON attack and 22 cases had recurrent ON. Plasmapheresis (PP) was combined in 21 cases. The efficacy endpoint, changes in logarithm of the minimum angle of resolution (logMAR) after IVIG compared with preIVIG, showed statistically significant improvement in the AQP4-ON group at one week, 4 weeks, and 12 weeks after IVIG (p=0.015, p<0.001, p<0.001, respectively). In the MOG-ON group, excluding cases with combined PP, logMAR post IVIG did not improve significantly compared with preIVIG. Among the ION group, compared with preIVIG, logMAR at 4weeks and 12 weeks post IVIG were statistically significant improved (p=0.019, p=0.023, respectively). Adverse events occurred in 7 patients with IVIG. 4 of the 7 patients continued the IVIG treatment, and 3 patients discontinued it within 5 days.

Conclusion: This study demonstrates that IVIG may be an effective new option for acute treatment of steroid-resistant ON as an add-on to conventional therapy.

Purpose: This study aimed to assess the real-world outcomes, including intraocular inflammation (IOI), following administration of intravitreal brolucizumab (Beovu 6.0 mg/0.05 mL; Novartis) injections (IVBr) for diabetic macular edema (DME).

Study design: Retrospective study.

Methods: A total of 56 eyes of 47 patients with DME were treated with IVBr for a minimum follow-up of at least 6 months between May 2022 and November 2023. A "non-strict pro re nata" dosing protocol for IVBr was used. The best corrected visual acuity (BCVA), central macular thickness (CMT), at baseline, 6 months, 1 year, and the latest visit date and IVBr frequency were assessed to evaluate the treatment efficacy. IOI incidence, baseline characteristics of patients with IOI, and treatment course were investigated.

Results: BCVA significantly improved at 6 months and at the latest visit compared to baseline (P = 0.008 and 0.006, respectively). CMT was significantly thinner at 6 months, 1 year, and the latest visit compared to baseline (all, P < 0.001). In 46 eyes followed for more than 1 year, the number of IVBr from baseline to 1 year was 3.8 ± 1.9. Four eyes (7.1%) of four patients (8.5%) developed IOI during the observation period. All patients were women, with an average age of 70.8 ± 9.0 years (59-81 years). Upon IOI diagnosis, all patients received posterior sub-Tenon's triamcinolone acetonide and topical betamethasone sodium phosphate, resulting in rapid resolution.

Conclusion: IOI developed in four of 56 (7.1%) eyes and responded well to prompt steroid therapy after 1.5 years of IVBr use for DME. BCVA and CMT improved at all evaluation time points. With an average of 3.8 IVBr injections per year, IVBr showed long-term efficacy for DME in the real-world setting, although the occurrence of IOI should be monitored.

Purpose: To investigate changes in the choroidal area (CA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), and choroidal thickness (CT) before and after vitrectomy in eyes with macular hole retinal detachment (MHRD).

Study design: Retrospective observational study.

Methods: We measured the best-corrected visual acuity (BCVA), intraocular pressure (IOP), CA, LA, SA, CVI, and CT preoperatively and 1, 3, and 6 months postoperatively in 10 eyes with MHRD. CA was measured within a 3-mm-wide area around the fovea in the horizontal and vertical images. LA and SA were quantified using the Niblack method, and CVI was calculated as the ratio of LA to CA. CT was measured at the subfovea and at 1 and 3 mm vertically and horizontally away from the fovea.

Results: BCVA improved significantly at 1 and 3 months postoperatively (P = 0.036 and 0.016). IOP remained stable. CA and LA decreased significantly 6 months postoperatively in both the horizontal (P = 0.002 and 0.014) and vertical sections (P = 0.006 and 0.002). SA remained stable. CVI reduced significantly at 1 month horizontally and at 3 months vertically (both P = 0.027). CT decreased significantly in the subfovea at 3 and 6 months postoperatively (P = 0.027 and 0.020, respectively). Significant reductions were also observed at 1 mm nasal, temporal, and superior regions (P = 0.014, 0.014, and 0.004) and at 2 mm temporal and superior regions 1 month postoperatively (P = 0.020 and 0.014).

Conclusion: Choroidal thinning was observed after vitrectomy in eyes with MHRD, driven by a reduction in the luminal area.

Purpose: To compare the refractive prediction accuracy of seven no-history intraocular lens (IOL) power calculation formulas in post-myopic laser vision correction (M-LVC) eyes in Japanese patients.

Study design: Multicenter retrospective case series.

Methods: This study included patients with previous M-LVC who underwent cataract surgery between 2016 and 2023. IOL power calculation formulas were assessed using measurements from a swept-source optical coherence biometer. Refractive prediction errors were calculated for the Emmetropia Verifying Optical 2.0 (EVO 2.0), Post Myopic LASIK/PRK Hoffer QST (Hoffer QST), and Post-M-LVC PEARL-DGS (PEARL-DGS) formulas. These results were compared with those obtained from the Barrett True-K No History (BTKNH), Haigis-L, Shammas, and ASCRS average formulas. Heteroscedastic testing for root mean square absolute error (RMSAE) was used to evaluate formula performance.

Results: The study comprised 125 post-LASIK eyes from 89 patients. Only the BTKNH had mean numerical errors not significantly different from zero. The formulas were ranked by absolute prediction error (MAE): ASCRS average (0.42 D), BTKNH (0.43 D), Hoffer QST (0.46 D), Pearl-DGS and Shammas (0.46 D), EVO 2.0 (0.48 D), and Haigis-L (0.51 D). The BTKNH and ASCRS average demonstrated smaller RMSAE compared to Shammas (P < .0001). The Hoffer QST had a smaller RMSAE than Pearl-DGS (P = 0.02).

Conclusion: The BTKNH, ASCRS average, and Hoffer QST formulas are precise and reliable for improving postoperative refractive outcomes in Japanese patients with a history of M-LVC.

Purpose: This study evaluated the effectiveness and safety of the biosimilar infliximab CT-P13 in treating refractory uveitis associated with Behçet's disease.

Study design: Retrospective study.

Methods: A retrospective analysis of medical records from seven patients was conducted, categorizing them into two groups: those initially treated with CT-P13 (Group 1) and those switched from other tumor necrosis factor inhibitors (Group 2). Data on demographics, treatment duration, ocular inflammatory attacks, visual acuity changes, relapse rates, and adverse events were collected.

Results: Seven patients (mean age: 32.0 ± 17.7 years) with refractory uveitis associated with Behçet's disease were included. Four patients in Group 1 received CT-P13 as their first-line biologic therapy, of whom two (50%) achieved remission. All patients exhibited a significant reduction in relapses in the 6 months before and after CT-P13 treatment (Wilcoxon test, p = 0.031). Three patients in Group 2, switched from original infliximab, maintained remission for an average of 11.0 ± 2.0 months. Overall, 71.4% of patients achieved remission. No significant changes in visual acuity were observed in either group. One adverse event occurred, but no adverse drug reactions were reported.

Conclusion: The biosimilar infliximab CT-P13 appears to be an effective and cost-efficient option for managing refractory uveitis in Behçet's disease. This finding highlights its potential in managing this challenging condition and warrants further investigation in larger patient cohorts.

Purpose: To evaluate the effects of prophylactic sequential argon- Nd:YAG laser peripheral iridotomy (pLPI_sequential) on the corneal endothelial cell density (CECD) over 5 years in Japanese eyes with narrow angles (NA-eyes).

Study design: Prospective observational study METHODS: The CECD of NA-eyes before and after pLPI_sequential and of untreated NA-eyes were assessed annually over 5 years with non-contact specular microscopy. Routine ophthalmic examinations and measurements using anterior-segment imaging devices were performed at baseline. The time courses of the CECD were analyzed using a multivariable linear mixed-effect model and factors obtained at baseline.

Results: Sixty-nine pLPI_sequential-treated NA-eyes (69 subjects; mean age, 68.9 years) and 67 pLPI_sequential-untreated NA-eyes (67 subjects; mean age, 64.4 years) were enrolled. In the pLPI_sequential-untreated NA-eyes, no baseline factors were correlated significantly with the time course of the CECD, and its decline rate - 4.7 (95% Confidence interval (I: - 13.3 to 4.0) cells/mm² was not significant (p = 0.267). In the pLPI_sequential-treated NA-eyes, the CECD declined with marginal significance - 12.2 (- 24.7 to 0.3) cells/mm²/year (p = 0.0513) over 5 years. Higher laser energy used, thicker iris, and shallower central anterior chamber depth (cACD) at baseline were significantly negatively correlated with the post-laser CECD (p = 0.0092, 0.0119, and 0.0158). No significant difference was seen in the baseline factors-adjusted CECD decline rate (p = 0.262) between both the groups.

Conclusion: Prophylactic sequential argon-Nd:YAG pLPI_sequential had no clinically significant effects on the time course of the CECD over 5 years in Japanese NA eyes. However, higher laser energy used, thicker iris, and shallower cACD significantly negatively affected the post-laser CECD.

Purpose: This study quantifies hyperreflective foci (HRFs) in neovascular age-related macular degeneration (nAMD) before and after anti-VEGF therapy in the initial loading phase using en-face ultra-high-resolution spectral domain OCT (UHR-SD-OCT), investigating their correlation with clinical findings.

Study design: Retrospective observational study METHODS: This retrospective study included 30 eyes from 30 patients with treatment-naïve nAMD. The patients received monthly intravitreal injections of anti-VEGF therapy for three months as the initial loading phase. At each visit, comprehensive ophthalmic examinations were conducted. HRFs were quantified using our custom-developed software from an en-face UHR-SD-OCT. The number of HRFs was compared before and after the loading phase and investigated the relationship with best-corrected visual acuity (BCVA), greatest linear dimension (GLD), macular neovascularization (MNV) size and incidence of macular atrophy (MA).

Results: This evaluation system showed a significant reduction in the number of HRFs after anti-VEGF therapy compared to before the loading phase (p < 0.0001). The number of pre-treatment HRFs significantly correlated with pre-treatment BCVA, GLD, and MNV size. The number of post-treatment HRFs significantly correlated with pre-treatment GLD and pre-treatment MNV size. Additionally, patients who developed MA two years after treatment initiation exhibited significantly higher counts of pre-treatment HRFs compared to those without the MA development (465.7 ± 187.0 vs. 212.9 ± 93.8, p < 0.05).

Conclusions: Quantification of HRF using en-face UHR-SD-OCT may be a useful clinical biomarker during anti-VEGF therapy in nAMD.

Purpose: To evaluate corneal anterior and posterior irregularities due to limbal stem cell deficiency (LSCD) based on staging using Fourier harmonic analysis with anterior segment optical coherence tomography (AS-OCT).

Study design: Retrospective observational study.

Methods: Patients with LSCD and those without anterior segment disease (controls), examined using AS-OCT, were retrospectively included. Based on Fourier harmonic analysis of the central 3 mm, spherical components, regular astigmatism, asymmetry components, and higher-order irregularities of the anterior, posterior, and total corneas were compared between the groups.

Results: We analyzed 72 eyes of 72 patients-25 eyes of 25 patients (63.0 ± 15.8 years) with LSCD and 47 eyes of 47 patients (66.8 ± 9.5 years) in the control group. Regular astigmatism, asymmetry components, and higher-order irregularities of the anterior, posterior, and total corneas were higher in LSCD than in the control group (all P < 0.001). Based on LSCD staging, asymmetry components of the total cornea were higher in LSCD stages I, II, and III than in the controls (P = 0.034, P < 0.001, and P < 0.001, respectively). Additionally, higher-order irregularity was larger in stages II and III of LSCD than in the controls (all P < 0.001). The higher-order irregularity in LSCD significantly correlated with best-corrected visual acuity (P = 0.034).

Conclusion: Corneal irregularities in the anterior and posterior corneas increased in patients with LSCD and contributed to best-corrected visual acuity. Even in patients at stage I, where the lesion spared the central 5 mm, an increase in asymmetric astigmatism within the central 3 mm was observed.

Purpose: To identify predictors for visual outcomes of eyes with submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD).

Study design: Retrospective observational study.

Methods: Clinical data from patients diagnosed with SMH secondary to nAMD and treated with pneumatic displacement were collected. SMH thickness was measured by optical coherence tomography (OCT) at baseline and 1 week. Possible factors associated with best-corrected visual acuity (BCVA) gain at 3 months were analyzed.

Results: Fifty-six eyes of 56 patients (18 female/38 male; mean age, 77.8 ± 10.1 years) were analyzed; 34 were treatment-naïve and 22 were previously treated with anti-vascular endothelial growth factor agents. Multivariable analysis showed that greater BCVA gain more than 0.3 logMAR at 3 months post-treatment was associated with being treatment-naïve (odds ratio [OR], 34.30; 95% confidence interval [CI], 1.38-851.91; P = 0.031), thinner SMH thickness at 1 week after pneumatic displacement (OR, 0.38 per 50-unit increase; CI, 0.18-0.80; P = 0.011), and worse baseline BCVA (OR, 2.58 per 0.1-unit increase; CI, 1.31-5.07; P = 0.006), but not associated with age (OR, 0.50; 95% CI, 0.24-1.06), the time from onset to pneumatic displacement (OR, 1.04; 95%CI, 0.87-1.23), SMH thickness at baseline (OR, 0.92; 95%CI, 0.63-1.36), and the presence of subfoveal hemorrhagic PED (OR, 0.72; 95%CI, 0.08-6.84).

Conclusion: This study identifies novel factors predictive of visual outcomes for pneumatic displacement for SMH due to nAMD. The presence of residual SMH at 1 week following unsuccessful pneumatic displacement may warrant further intervention.