Japanese Journal of Ophthalmology最新文献

Purpose: To investigate the one-year outcomes of pneumatic displacement for submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD). We compared cases of polypoidal choroidal vasculopathy (PCV) and non-PCV.

Study design: A retrospective observational study.

Methods: We reviewed the medical records of 76 eyes of 74 patients with SMH secondary to nAMD who underwent pneumatic displacement as initial treatment. The primary outcomes were best-corrected visual acuity (BCVA), complications, and additional treatment.

Results: We examined 54 eyes with PCV and 22 eyes with non- PCV. Approximately 0.5 mL of 100% sulfur hexafluoride (SF₆) gas was injected into the vitreous cavity. After pneumatic displacement, 19 eyes (25%) underwent vitrectomy for complications such as vitreous hemorrhage or retinal detachment. Additionally, 95% of eyes that underwent vitrectomy had hemorrhage extending beyond the arcade vessels at baseline. During the 12 months, the average number of anti-vascular endothelial growth factor (VEGF) injections was 7.0±3.6 in PCV cases and 7.0±3.3 in non-PCV cases (P=0.74). The mean BCVA at 12 months improved from 0.77±0.44 to 0.42±0.45 in PCV cases (P<0.01) and from 1.13±0.51 to 0.88±0.59 in non-PCV cases (P=0.01). The PCV group had better BCVA than the non-PCV group at both time points (P<0.01). In the previously treated group, 100% of non-PCV cases had worsened visual acuity compared to pre-onset SMH, while 62% of PCV cases maintained pre-onset visual acuity (P<0.01).

Conclusion: Pneumatic displacement resulted in superior visual outcomes in the PCV group compared to the non-PCV group for submacular hemorrhage secondary to nAMD. .

Purpose: To investigate the effect of preservative-containing and preservative-free latanoprost eyedrops on dry eye symptoms and matrix metalloproteinase 9 expression in untreated open-angle glaucoma patients.

Study design: Prospective METHODS: Treatment-naïve open-angle glaucoma patients were randomly assigned to either preservative-containing or preservative-free latanoprost groups. The ocular surface disease index score, Schirmer test, tear break up time, corneal staining score, and matrix metalloproteinase 9 expression in tears were prospectively compared before and at 1 and 3 months after drug instillation.

Results: Ocular surface disease index score, Schirmer's test, tear break up time, corneal staining score, and matrix metalloproteinase 9 expression levels did not significantly differ between the two groups before drug instillation. After 3 months, the preservative-free latanoprost group exhibited a significantly longer tear break up time and improved corneal staining score. The proportion of patients with positive matrix metalloproteinase 9 in tears was lower in the preservative-free group, although this difference was not statistically significant (75.0% vs. 62.5%, P = 0.118).

Conclusion: Compared with preservative-containing latanoprost, the preservative-free preparation led to improved tear break up time and a potential reduction in positive matrix metalloproteinase 9 expression after 3 months in untreated open-angle glaucoma patients.

Purpose: To investigate the role of the interleukin-23 (IL-23)/T helper type 17 (Th17) immune axis in conjunctival allergic inflammation using a murine model of experimental allergic conjunctivitis (EAC).

Study design: Experimental study.

Methods: BALB/c mice were assigned to four groups: control (untreated), allergy (EAC), IL-23 (EAC with IL-23 eyelid injection), and non-sensitized IL-23 (non-sensitized with IL-23 eyelid injection). Conjunctival tissue was analyzed histologically to quantify eosinophil and neutrophil infiltration. Gene expression of mRNA in conjunctival tissue was assessed using a PCR array and quantitative RT-PCR.

Results: Eosinophilic and neutrophilic infiltration in the subconjunctival tissue was more pronounced in the IL-23 group than in the allergy and control groups. PCR array and quantitative RT-PCR analyses revealed significantly elevated Ccl17/Tarc mRNA expression in the IL-23 group compared to the allergy group. IL-17A mRNA, undetectable in the allergy group, was expressed in the IL-23 group. Additionally, PCR array comparisons between the IL-23 and non-sensitized IL-23 groups showed a significant increase in Rorc and Il1r1 expression in the IL-23 group. At the same time, Mmp3, Ccl7, and Ccr2 were significantly upregulated in the non-sensitized IL-23 group. RT-PCR analysis also demonstrated higher IL-17A mRNA levels in the non-sensitized IL-23 group than in the IL-23 group.

Conclusion: IL-23 induces mixed eosinophilic-neutrophilic inflammation in conjunctival tissue, characterized by enhanced Th2 and weak Th17 responses in a murine model of EAC. These findings suggest a modulatory role of the IL-23/Th17 axis in influencing the severity and phenotype of allergic conjunctival inflammation.

Purpose: Acute acquired comitant esotropia (AACE) is an increasingly reported form of esotropia, possibly linked to the rising use of digital devices. Botulinum toxin type A (BTXA) has emerged as a minimally invasive treatment alternative to surgery, particularly for patients with diplopia. We aimed to investigate the efficacy and safety of BTXA injections in treating AACE while identifying factors contributing to successful treatment outcomes.

Study design: A retrospective, single-center study.

Methods: This study retrospectively evaluated 228 patients with AACE who received BTXA injections at a single center. Treatment outcomes, adverse events, and factors influencing success were analyzed. Successful outcomes were defined as either the absence of diplopia in the primary position or an angle of deviation of ≤10 prism diopters from orthotropia, both evaluated at more than 6 months after the last injection.

Results: The average patient age was 30.9 years, and 52% achieved successful outcomes. Transient adverse events, including blepharoptosis (24%) and hypertropia (16%), were observed. The study found that shorter duration from onset to treatment (P = 0.018) and post-treatment overcorrection (P = 0.0073) were associated with higher success rates. Although some patients required additional treatment or surgery due to recurrence, BTXA was an effective intervention for AACE, with a significant improvement in eye alignment and stereopsis.

Conclusion: Early intervention with BTXA is crucial for successful outcomes and offers a safe, less invasive alternative to traditional strabismus surgery.

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.