Japanese Journal of Ophthalmology最新文献

Purpose: To evaluate the treatment outcomes of switching to intravitreal brolucizumab (IVBr) for neovascular age-related macular degeneration (nAMD) which did not achieve a dry macula even with 4- or 8-week intervals of intravitreal faricimab (IVF).

Study design: Retrospective, interventional case series.

Methods: We retrospectively studied 33 eyes of 33 consecutive patients with nAMD who switched to IVBr from IVF, assessing best corrected visual acuity (BCVA), foveal thickness (FT), central choroidal thickness (CCT), and exudative status at baseline and after the switch. For patients that switched 4 weeks after the last IVF (4-week interval group), treatment outcomes were evaluated 4 weeks after the switch. For patients that switched 8 weeks after the last IVF (8-week interval group), treatment outcomes were evaluated after the first 8-week interval following the switch.

Results: Thirty-one eyes had completed IVBr treatment up to the evaluation point after the switch. There were no significant changes in BCVA at baseline and after the switch in either group. FT and CCT significantly decreased after the switch compared with baseline in both groups. Moreover, in both groups, exudative changes disappeared or decreased in most cases after the switch. The dry macula rate after the switch was 37.5% and 34.8% in the 4-week and 8-week interval group, respectively. Although brolucizumab-related intraocular inflammation was observed in 3 eyes (9.1%) after the switch, it was ameliorated in response to steroid therapy.

Conclusion: Switching to IVBr for nAMD refractory to IVF was generally effective in improving exudative changes in the short term.

Purpose: Chemical chelation with ethylenediaminetetraacetic acid (EDTA) is an established treatment for calcific band keratopathy (CBK), whereas removal of calcium deposits from the subepithelial layer of the cornea may cause corneal irregularity. Using Fourier harmonic analysis, we analyzed the corneal topography in eyes with CBK treated by EDTA chelation.

Study design: Retrospective, single-center study.

Methods: This study included 42 eyes of 26 patients who underwent chemical chelation using EDTA for CBK at the Kyorin University Hospital. Clinical data included age, sex, refraction, visual acuity, operation records, and corneal topography. Corneal topography was evaluated by a TMS-5 Corneal Topographer, and 3.0- and 6.0-mm-diameter Fourier series harmonic analyses were performed. Refraction, visual acuity, and parameters of corneal topography were compared before surgery and at 1 and 4 weeks postoperatively.

Results: Visual acuity and refraction (spherical equivalent and astigmatism) did not significantly change at 4 weeks postoperatively. Fourier harmonic analysis revealed that there were no time serial changes in the spherical component and regular astigmatism in both 3.0- and 6.0-mm analyses. Asymmetry astigmatism, and high-order irregularity significantly increased at 1 week postoperatively but decreased at 4 weeks postoperatively, with no statistical differences compared with preoperative data.

Conclusion: The effects of EDTA treatment on the corneal shape and refraction are minimal, which is beneficial for maintaining visual function in patients with CBK.

Purpose: To identify a method for comparing preoperative axial length (AL) measurements with postoperative AL in submacular hemorrhage (SMH).

Study design: Retrospective.

Methods: This study included 30 patients who underwent vitrectomy for SMH (January 2016-January 2023) with preoperative and postoperative AL data. Preoperative AL was obtained using ultrasonography for the affected eye (aUS-AL) and compared to those measured using optical biometry (OB) for the affected and fellow eyes (aOB-AL and fOB-AL, respectively). Postoperative AL (aPost-AL) was defined as the AL of the affected eye by OB. The absolute differences between the preoperative AL (aUS-AL, aOB-AL, and fOB-AL) and aPost-AL were assessed.

Results: aUS-AL, aOB-AL, and fOB-AL values were 23.50 ± 1.41 mm, 23.32 ± 1.40 mm, and 23.66 ± 1.45 mm, respectively, correlating strongly with aPost-AL (23.54 ± 1.37 mm) (all R > 0.95). fOB-AL exceeded aPost-AL significantly (P = 0.02). In all 30 eyes, absolute differences between preoperative AL and aPost-AL were 0.19 ± 0.18 mm, 0.28 ± 0.32 mm, and 0.21 ± 0.22 mm, respectively, which were not significantly different from each other (all P > 0.05). In nine eyes with SMH height > 1000 μm or unmeasurable, the absolute difference between aOB-AL and aPost-AL (0.42 ± 0.33 mm) exceeded that of aUS-AL and aPost-AL (0.10 ± 0.09 mm) (P = 0.003).

Conclusion: Although aUS-AL, aOB-AL, and fOB-AL correlated well with postoperative AL in patients with SMH, fOB-AL may be measured longer and aOB-AL shorter in some cases. Therefore, aUS-AL may be considered primarily in determining IOL power of cataract surgery performed in combination with SMH displacement.

Purpose: To compare the postoperative outcomes of corticosteroid therapy following biopsy with those following debulking surgery in patients with immunoglobulin G4 (IgG4)-related ophthalmic disease (IgG4-ROD).

Study design: Retrospective comparative study.

Methods: Fifteen patients diagnosed with IgG4-ROD (5 unilateral, 10 bilateral) were retrospectively analyzed. IgG4-ROD was diagnosed based on imaging, histopathology, and blood test results. The biopsy group included patients who underwent resection of minimal tissue for diagnosis, whereas the debulking group included patients who underwent resection of a substantial portion of the mass to decrease the tumor size. Postoperative outcomes after steroid administration, recurrence rates, and changes in lacrimal gland function were compared between the groups.

Results: The biopsy and debulking groups included seven and eight patients, respectively. All patients in the biopsy group and 25% of patients in the debulking group required steroid treatment postoperatively (p = 0.0070). Relapse occurred in 71.4% and 12.5% (p = 0.041) and maintenance therapy was required in 57.1% and 12.5% (p = 0.12) patients in the biopsy and debulking groups, respectively. Twelve patients had extraorbital lesions, with one patient receiving corticosteroid treatment for sphenoid bone lesion. Schirmer I test values did not differ preoperatively and postoperatively in either group (biopsy: p = 0.47; debulking: p = 0.72). One patient from the biopsy group developed severe dry eyes, necessitating lacrimal canalicular excision.

Conclusions: Debulking surgery effectively reduced the requirement for postoperative steroid administration for recurrent lacrimal gland lesion in patients with IgG4-ROD, indicating its potential as an effective alternative to current standard treatment.

Purpose: To determine whether corneal biomechanical parameters can predict ectasia progression.

Study design: Retrospective observational study.

Methods: The baseline corneal biomechanical parameters of 64 eyes of 41 young patients (age, < 25 years at the first visit) who were diagnosed with keratoconus (KC) or suspected KC at Osaka University Hospital and followed up for more than two years were reviewed. Suspected KC was defined as borderline cases with no definitive clinical or topographical abnormalities in both eyes. The eyes were divided into progressed (P) and non-progressed (NP) groups using the ABCD grading system of Scheimpflug-based tomography. The Scheimpflug-based corneal biomechanical parameters evaluated included deformation amplitude ratio within 2 mm, integrated radius, Ambrósio relational thickness to the horizontal profile, stiffness parameter at the first applanation, stress-strain index, E-staging, and Corvis Biomechanical Index. The optimized tomographic/biomechanical index (TBIv2), Belin/Ambrósio Enhanced Ectasia Deviation (BAD-D), and inferior-superior axial steepening values from Scheimpflug-based tomography were also evaluated.

Results: Twenty-three and 41 eyes were categorized into the P and NP groups, respectively. Logistic regression analysis showed that age, BAD-D, and TBIv2 could predict ectasia progression. The specificity, sensitivity, and area under the receiver operating characteristic curve (AUROC) values for BAD-D combined with age were 0.82, 0.60, and 0.83, respectively, whereas those for TBIv2 combined with age were 0.65, 0.82, and 0.82, respectively.

Conclusions: Baseline TBIv2 is a potentially useful predictive marker for ectasia progression in young patients, whereas baseline BAD-D could be used for establishing a definitive diagnosis.

Purpose: To assess the efficacy and safety of PreserFlo MicroShunt (PMS) combined with mitomycin C in patients with medically treated primary open-angle glaucoma (POAG).

Study design: A retrospective observational study.

Methods: The study examined 83 eyes from 83 patients with medically treated glaucoma surgery naive POAG. Preoperative intraocular pressure (IOP) was stratified into three groups: IOP < 15 mmHg (group 1), 15 ≤ IOP < 21 mmHg (group 2), and IOP ≥ 21 mmHg (group 3). IOP levels at week 1, month 1, month 3, and month 6 were evaluated using a linear mixed model, and Kaplan-Meier survival analysis was employed to assess the complete success rate (30% IOP reduction without any medications or interventions) of IOP management. The postoperative complications and interventions were also evaluated.

Results: Overall, the mean IOP decreased from 19.2 ± 7.4 mmHg to 11.3 ± 3.1 mmHg, representing a 41% IOP reduction. Especially, in group 1 (mean IOP of 12.8 mmHg), IOP decreased to 10.3 mmHg, achieving a reduction rate of 20%. Overall, 51% (95% confidence interval [CI] 41-62%) of the patients maintained a ≥ 30% IOP reduction (complete success). Minor complications included hypotony (n = 10) and hyphema (n = 30). Needling was performed in 12 eyes, bleb revision in 2, tube re-insertion in 2, and insertion of a second tube in 1.

Conclusions: PMS demonstrated significant efficacy in reducing IOP in patients with POAG reagrdless of its preoperative IOP levels. No serious complications affecting the VA were observed.

Purpose: There is no established method for visualizing the three-dimensional (3D) structure of the aqueous humor outflow tract. This study attempted to visualize the 3D structures of porcine and human ocular tissues, particularly the aqueous humor outflow tract using a transparency reagent composed of 2, 2-thiodiethanol.

Study design: Clinical and experimental.

Methods: The porcine eyes were collected in Japan, and the human eyes were imported from the United States. The human eyes were obtained from a 64-year-old Caucasian woman, arriving 7 days after her death. The specimens were formalin-fixed upon arrival, fluorescently labeled, optically cleared using a transparency-enhancing reagent, and visualized using a confocal microscope.

Results: Both porcine and human eyes were visualized to the extent that the choroidal vessels were observed on gross examination. The aqueous humor outflow tract was clearly observed as a luminal structure in the porcine eye, mainly depicted by autofluorescence, and in the human eyes as a luminal structure continuing from the trabecular meshwork without fluorescence.

Conclusion: Observations using transparency-enhancing technology enabled us to obtain 3D images useful for visualizing ocular tissues, especially the aqueous humor outflow tract.

Purpose: To clarify the clinical and pathologic findings of 7 patients with inflamed juvenile conjunctival nevus (IJCN) treated with tacrolimus.

Study design: Retrospective study.

Subjects and methods: The medical records of 7 male patients diagnosed with IJCN between February 2007 and October 2022 at the Kansai Medical University Hospital and Ideta Eye Hospital were retrospectively reviewed. The patients' mean age was 11.3 (8-20) years, and the average follow-up period was 18 months. The patients underwent anterior segment optical coherence tomography (AS-OCT) and anterior segment optical coherence tomography angiography (AS-OCTA). All the patients were treated with steroids or immunosuppressant eye drops, or both. Histopathologic examinations were performed on specimens resected from 2 patients.

Results: The clinical characteristics of IJCN were as follows: (1) presence of cysts within a pigmented conjunctival mass, (2) tumor accompanied by feeder vessels, and (3) predominantly found in boys with allergic diseases. AS-OCT and AS-OCTA revealed the presence of a cystic structure with poor vascular signals within it and numerous vessels distributed on the sclera underlying the lesion. Immunosuppressant eye drops relieved the congestion, diminished the inflow vessels, and induced shrinkage of the cysts in all the patients. Histopathologic examinations revealed infiltration of inflammatory cells such as lymphocytes and macrophages and low proliferative activity of melanocytes with no division pattern.

Conclusions: This study clarified the clinical and histologic characteristics of IJCN. Noninvasive AS-OCT and AS-OCTA might be useful for diagnosing IJCN. The histopathologic findings of this study indicate that immunosuppressive and antiallergic agents can effectively bring about disease remission.

Purpose: To compare the clinical manifestations of and risk factors for choroidal detachment (CD) with or without hypotony after Ahmed valve implantation (AVI).

Study design: Retrospective, consecutive case series.

Methods: We enrolled patients with glaucoma who underwent AVI, and divided them into CD and non-CD groups. The patients with CD were divided into those with and without hypotony. Data collected from the chart review before and after AVI included patient demographics and ocular characteristics. We analyzed the risk factors for CD development. The relationship between hypotony and CD development was also analyzed.

Results: Among the 387 eyes, 63 developed CD. Among these 63 eyes, 42 had CD with hypotony and 21 had CD without hypotony. Multivariate regression analysis revealed that age (P < 0.001), lens status (P < 0.001), history of diabetes mellitus (DM) (P = 0.011), and history of hypertension (HTN) (P = 0.002) were significant predictors of CD development. Neovascular glaucoma (NVG) showed 42.9% of CD cases without hypotony. This rate was higher than primary open angle glaucoma (POAG) and exfoliative glaucoma (XFG). The rate of anterior chamber formation as treatment of CD was significantly higher in CD with hypotony than in CD without hypotony.

Conclusions: Older age, pseudophakic eyes, DM, and HTN are significantly associated with CD development after AVI. NVG has higher incidence rates of CD without hypotony compared with POAG and XFG. Therefore, clinicians should pay attention to CD development after AVI especially in NVG, even if a patient is not in a hypotonic state.

Purpose: To investigate the incidence of microbial keratitis among Japanese patients wearing orthokeratology (ortho-k) lenses STUDY DESIGN: Retrospective multicenter study METHOD: This study was conducted at 4 hospitals in Japan and involved 1438 patients who had been prescribed ortho-k lenses and had worn them for at least 3 months. Data on patient demographics, lens characteristics, lens care systems, and presence of microbial keratitis were extracted from the medical records. Duration of ortho-k lens wear was calculated from the original fitting date to the patient's last visit, with the total years of lens wear used as person-years of lens wear. The incidence of microbial keratitis was calculated by dividing the number of infected cases by the total person-years of lens wear for all enrolled participants.

Results: Among the 1438 patients, 753 were male and 685 were female, with a mean age of 12.7 ± 5.4 years. The mean duration of ortho-k lens wear was 5.2 ± 4.5 years, and the mean lens power was -3.52 ± 1.41 D. The total person-years of lens wear for all enrolled patients was 7415. Four cases of microbial keratitis were identified, resulting in an overall incidence of microbial keratitis of 5.4 (95% CI: 1.0-9.8) per 10,000 patient-years among ortho-k lens wearers.

Conclusion: This study represents the largest sample size to date for estimating the incidence of microbial keratitis associated with ortho-k lenses. The incidence was similar to or slightly lower than that of previous studies on ortho-k-related microbial keratitis and also comparable to that of daily wear soft contact lenses.