Japanese Journal of Ophthalmology最新文献

Purpose: To evaluate real-world adherence to anti-vascular endothelial growth factor (VEGF) therapy among Japanese patients with diabetic macular edema (DME) and identify demographic, clinical, and socioeconomic factors associated with treatment discontinuation.

Study design: Retrospective, observational cohort study.

Methods: This study included 380 treatment-naïve patients with center-involved DME. Patients were categorized into continuation (those who maintained therapy) and self-discontinuation (those who discontinued therapy after at least one follow-up visit) groups. All patients were treated under a treat-and-extend regimen with one of five anti-VEGF agents (ranibizumab, aflibercept, brolucizumab, faricimab, or ranibizumab biosimilar) between January 2017 and December 2023. Univariate and multivariate logistic regression analyses identified independent predictors of treatment discontinuation. Pre- and post-treatment visual acuity and anatomic outcomes were assessed.

Results: Among 380 patients, 55 (14.5%) self-discontinued therapy. Younger age and poorer baseline best-corrected visual acuity were significantly associated with treatment discontinuation in both univariate and multivariate analyses. Furthermore, faricimab use increased the risk of discontinuation, whereas aflibercept use was associated with better adherence.

Conclusion: The findings of this study underscore the importance of individualized patient management strategies to enhance long-term adherence to anti-VEGF therapy among patients with DME.

Refractory inflammatory ocular diseases-uveitic macular edema (UME), acute retinal necrosis (ARN), and vitreoretinal lymphoma (VRL)-pose significant diagnostic and therapeutic challenges due to their vision- or life-threatening nature and limited treatment options. UME, a leading cause of vision loss in intermediate, posterior, and panuveitis, affects approximately 40% of such cases, particularly in elderly patients and those with prolonged inflammation. Despite its prevalence, effective treatment is still being explored. ARN, caused by herpes viruses such as herpes simplex virus (HSV)-1, HSV-2, and varicella-zoster virus, ranks among the retinal diseases with the poorest visual prognosis; nearly half of patients experience a visual acuity (VA) of ≤ 0.1 within six months. However, a standardized treatment regimen has not yet been established. VRL, one of the ocular malignancies with the lowest overall survival rate, is frequently misdiagnosed as uveitis. Given the diagnostic delay and high frequency (60-85%) of central nervous system involvement-which is often directly life-threatening-early detection and comprehensive systemic management are essential. This review highlights recent advances in the diagnosis, clinical trials, and management of these three challenging ocular inflammatory diseases, emphasizing unmet needs and emerging therapeutic strategies.

Background:  Omidenepag isopropyl is a selective prostanoid prostaglandin E receptor2 agonist; its association with macular edema has mainly been identified in pseudophakic eyes. Herein, we report a case of diffuse bilateral macular edema caused by omidenepag isopropyl use in phakic eyes with a history of laser peripheral iridotomy.

Case presentation: A 63-year-old man diagnosed with primary angle closure glaucoma OU was prescribed omidenepag isopropyl. He had undergone laser iridotomy approximately 3 years prior to the omidenepag isopropyl prescription. After 4 months of using omidenepag isopropyl, he presented with blurred vision OU. Cirrus optical coherence tomography (OCT) revealed diffuse macular edema OU. Omidenepag isopropyl usage was discontinued, and bromfenac sodium hydrate was administered twice daily. After 2 months, the patient's visual discomfort improved, and a subsequent OCT examination confirmed a resolution of the macular edema.

Conclusions:  We report a case of diffuse bilateral macular edema development after omidenepag isopropyl use in a patient with glaucoma who had undergone bilateral laser peripheral iridotomy. This case demonstrates that macular edema can develop following the use of omidenepag isopropyl, even in phakic eyes. Notably, unlike most previous reports where the edema was typically cystoid in nature, this case showed diffuse retinal thickening with a preserved retinal contour. Given diffuse macular edema may affect the measurement of circumpapillary retinal nerve fiber layer (cpRNFL) thickness, caution is warranted whenever the use of omidenepag isopropyl in the management of glaucoma is considered.

Purpose: To investigate whether higher-order aberrations (HOAs) in the anterior and posterior corneal surfaces and the entire eye vary with age.

Study design: A prospective, cross-sectional study.

Methods: One hundred eyes from 100 participants, with 20 eyes per decade group (20s to 60s+), were assessed. Participants had no ocular diseases except refractive errors and mild cataracts, and no abnormalities on the anterior corneal surface, as assessed by Placido-based corneal topography. Corneal and ocular wavefront aberrations were measured with an integrated Scheimpflug tomographer/Hartmann-Shack wavefront aberrometer and analyzed over a 4-mm pupil. The root mean square values for total HOAs, spherical aberrations (SAs), and coma were calculated from the Zernike coefficients up to the 6th order. The total HOAs, SAs, and comas from the anterior corneal surface, posterior corneal surface, total cornea, and whole eye were compared across the age groups. The correlations between HOAs and age were also evaluated.

Results: Significant positive correlations with age were observed for the total HOAs and SAs in the anterior cornea (R=0.27, 0.29; P<0.01), total cornea (R=0.31, 0.34; P<0.01), and whole eye (R=0.48, 0.39; P<0.01). No significant correlations were found for coma in any region. Similarly, no significant correlations were observed for the total HOAs, SAs, or coma in the posterior cornea.

Conclusion: Total HOAs and SAs in the anterior cornea, total cornea, and whole eye were significantly positively correlated with age, whereas coma exhibited no age-related changes. These findings underscore the importance of considering age-related optical changes in clinical evaluations.

Purpose: To characterize the clinical features of open globe injury (OGI) in Vietnam and to identify risk factors associated with evisceration STUDY DESIGN: Prospective observational study METHODS: Ninety-two patients with OGI who presented to Cho Ray Hospital from August 2024 to May 2025 were prospectively enrolled. The demographic and clinical data were collected at presentation. Multivariable Firth logistic regression was used to identify independent predictors of evisceration.

Results: The majority of the patients were male, 78.3%, with a mean age of 39.5 years. Road traffic accidents were the most common cause of OGI. In those aged younger than 20 years, explosions were most frequent, whereas domestic incidents were more common in those aged older than 40 years. More than half of the eyes presented with no light perception. Evisceration was performed in 16.3% of the eyes. On multivariable analysis, zone III injury was associated with higher odds of evisceration (aOR 8.46, 95% CI 2.02-51.8), and increasing age was also associated with OGI (aOR per year 1.05, 95% CI 1.01-1.10). Trauma type, mechanism, and eyelid laceration were not associated with OGI.

Conclusion: OGIs in Vietnam predominantly affect working-age males and are often caused by high-energy trauma such as motorcycle crashes and workplace incidents. Whilst the injuries were often severe, most eyes were anatomically salvaged. Zone III injury and older age were associated with increased risk of evisceration. These findings support the need for targeted prevention efforts and improved access to specialized eye trauma care in similar settings.

Purpose: To investigate the effectiveness of preservative-free multi-dose eye drop technology in preventing contamination.

Study design: Prospective study METHODS: In this study, the caps, first and second drops of preservative-free multidose brimonidine (PF-MDB) and multidose brimonidine with purite preservative (P-MDB) used by 54 glaucoma patients were analysed on both chocolate and sheep blood agar. The patients used the drops at 3-week intervals. The contents of the eye droppers were examined for contamination by piercing the bottom of the eye dropper in accordance with aseptic techniques.

Results: The contamination levels detected using chocolate agar in the caps and the first drops of PF-MDBs were significantly higher than in P-MDBs (p=0.006 and p<0.001, respectively). The contamination levels detected using blood sheep agar in the caps and the first and second drops of PF-MDBs were significantly higher than in P-MDBs (p=0.001, ‹0.001, 0.006, respectively). No growth was found inside the eye dropper bottles of either PF-MDB or P-MDB drops. There was a significantly higher level of contamination in the first drops of PF-MDB compared to the second drops (p<0.001).

Conclusion: PF-MDB bottle technology effectively prevents microbial contamination in the bottle without preservatives. However, due to the lack of a preservative, there is increased bacterial and fungal growth associated with contamination on the cap, as well as in the first and second drops, compared to P-MDB.

Purpose: To investigate the clinical features of ocular inflammation caused by immune checkpoint inhibitors (ICIs) as immune-related adverse events (irAEs) in Japanese patients.

Study design: Retrospective observational case series.

Methods: We reviewed patients with ICI-associated ocular inflammation diagnosed at our institution in 2014-2024. Patient data-background characteristics, primary tumor, causative ICIs, time to onset, laterality, type of inflammation, irAE grade, treatment, visual outcomes, and complications-were analyzed. Stratified analyses were also performed according to the type of ICI.

Results: The cohort included 7 males and 9 females (mean age, 62.1 ± 14.3 years). The most common primary tumor was malignant melanoma (8 patients). The causative ICIs were pembrolizumab, nivolumab, and nivolumab plus ipilimumab (5, 6, and 5 patients, respectively). The median time of onset was 64 days (12-952) post-administration, with significantly earlier onset in patients receiving nivolumab plus ipilimumab. Ocular inflammation was bilateral in 13 patients. Panuveitis (10 patients) was the most common inflammation type, and 6 patients exhibited Vogt-Koyanagi-Harada (VKH) disease-like uveitis. Grade 3 irAEs were the most frequent (11 patients). ICIs were discontinued in 15 patients and 9 required systemic corticosteroids. At the final follow-up, visual acuity had generally improved; however, 4 patients had a best corrected visual acuity of 20/40 or worse due to complications.

Conclusion: In Japanese patients reviewed at our institution, ICI-associated ocular inflammation often presented as panuveitis, with VKH disease-like uveitis being relatively common. Visual impairment persisted in one-fourth of the patients, emphasizing the importance of careful management.

Purpose: The hypertensive phase (HP) following the implantation of a glaucoma drainage device (GDD) is a clinical challenge. We aimed to evaluate the risk factors, clinical features, and correlation of the HP with efficacy in a cohort of glaucoma patients who received a Paul glaucoma implant (PGI).

Study design: This was a single-center retrospective cohort study (Hospital Clínic of Barcelona).

Methods: Eighty-three eyes from 71 patients who underwent implantation of a PGI were included, with follow-up extending for up to 2 years. Intraocular pressure (IOP) was measured preoperatively, and at 1 day; 1 week; and 1, 3, 6, 12, and 24 months, postoperatively. Four different success criteria were established: criterion A: IOP <21 mm Hg; criterion B: <18 mm Hg; criterion C: <15 mm Hg; criterion D: <12 mm Hg. The numbers of postoperative IOP-lowering drops, complications, characteristics related to the presence or absence of an HP, and timing of prolene stent removal, among others, were recorded.

Results: We observed a total of 23 cases (27.7% with an HP). On multivariate analysis we identified younger age (P = .028) and elevated IOP 1 month after surgery (P = .001) as independent risk factors. IOPs were significantly higher (P <.05) in the HP group at 1 week and at 1, 3, and 6 months postoperatively. After 12 months of follow-up, no differences were found between the 2 groups.

Conclusion: The occurrence of an HP with a PGI does not seem to impact surgical success beyond 12 months postoperatively. However, further research is needed to better understand the underlying mechanisms of HP development and its clinical impact.

Purpose: To investigate the association between best-corrected visual acuity (BCVA) and sarcopenia in older adults, while the relationship between low visual acuity and age-related muscle decline remains unclear.

Study design: Cross-sectional study.

Methods: This cross-sectional study included 874 participants in the Kyotango Longevity Cohort Study from August 2017 to June 2022. We analyzed the association between best-corrected visual acuity (BCVA) and the presence of sarcopenia, grip strength, gait speed, and skeletal muscle index (SMI) in older adults. Logistic regression analyses were performed with sarcopenia as the dependent variable and visual acuity as the independent variable, adjusted for age, sex, body mass index (BMI), HbA1c, smoking, exercise, and alcohol consumption. Decimal BCVA was converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analyses.

Results: This cross-sectional study comprised 356 men and 518 women, with a median age of 72.0 years (range: 65-98 years). The prevalence of sarcopenia was 6.7% (24 cases) in the men and 5.2% (27 cases) in the women. Multivariate logistic regression analysis revealed a significant association between low visual acuity and sarcopenia for both sexes [odds ratio: 1.86, 95% confidence interval (CI): 1.23-2.81, p = 0.002 for men, and odds ratio: 1.45, 95% CI: 1.01-2.02, p = 0.038 for women).

Conclusions: This study demonstrates a significant relationship between lower visual acuity and sarcopenia. These findings support maintaining visual acuity to prevent age-related decline of physical functions.

Dupilumab-associated ocular surface disease (DAOSD) is one of the most common adverse events associated with dupilumab (an anti-interleukin-4-receptor-alpha monoclonal antibody) during the treatment of patients with atopic dermatitis (AD). However, it rarely occurs in patients with bronchial asthma or chronic rhinosinusitis with nasal polyps. Adequate understanding of DAOSD is important for proper diagnosis and appropriate ophthalmic intervention. The aim of this review was to summarize and discuss the clinical characteristics and management of DAOSD in Japan. The pathogenesis of DAOSD can be explained by the dry eye disease, upregulated T helper 17 and 22 cells, and Demodex theories. The main symptoms of DAOSD are irritation/pain, redness, pruritus, discharge, and light sensitivity. Patients with AD and DAOSD as an adverse event develop various types of ocular surface disease, including blepharitis, blepharoconjunctivitis, conjunctivitis, keratoconjunctivitis, and keratitis. In ophthalmologic practice, to diagnose and treat DAOSD, physicians must understand the condition of the patient, make a differential diagnosis of conjunctivitis, determine concurrent dry eye, and assess DAOSD severity. Red flags for ophthalmologic intervention have been reported by organizations and institutions in various countries, which have highlighted the need for appropriate ophthalmologic intervention. Treatment of DAOSD involves topical treatments with artificial tears, antiallergic drugs, corticosteroids, and immunosuppressive drugs. In conclusion, patients with severe DAOSD require ophthalmologic intervention, and clinical collaboration between ophthalmologists and dermatologists is crucial for patients with AD during dupilumab treatment. This review can assist ophthalmologists in their daily practice and in their management of patients with DAOSD.