Japanese Journal of Ophthalmology最新文献

Purpose: To determine whether convolutional neural networks (CNN) can classify the severity of central vision loss using fundus autofluorescence (FAF) images and color fundus images of retinitis pigmentosa (RP), and to evaluate the utility of those images for severity classification.

Study design: Retrospective observational study.

Methods: Medical charts of patients with RP who visited Nagoya University Hospital were reviewed. Eyes with atypical RP or previous surgery were excluded. The mild group was comprised of patients with a mean deviation value of > - 10 decibels, and the severe group of < - 20 decibels, in the Humphrey field analyzer 10-2 program. CNN models were created by transfer learning of VGG16 pretrained with ImageNet to classify patients as either mild or severe, using FAF images or color fundus images.

Results: Overall, 165 patients were included in this study; 80 patients were classified into the severe and 85 into the mild group. The test data comprised 40 patients in each group, and the images of the remaining patients were used as training data, with data augmentation by rotation and flipping. The highest accuracies of the CNN models when using color fundus and FAF images were 63.75% and 87.50%, respectively.

Conclusion: Using FAF images may enable the accurate assessment of central vision function in RP. FAF images may include more parameters than color fundus images that can evaluate central visual function.

Purpose: To investigate the safety and aesthetic outcomes of silicone buckle #506 for anophthalmic socket reconstruction.

Study design: Retrospective cohort study.

Methods: Patients who underwent enucleation or evisceration at the Osaka University Hospital were retrospectively analyzed. Patients under 18 years old, with < 3 months follow-up, without a prosthesis, or with bilateral surgery were excluded. Aesthetic outcomes were assessed using standardized photographs taken 3 months postoperatively, scored by five independent ophthalmologists for upper eyelid sulcus deepening asymmetry. Scoring was categorized as 0: no noticeable side difference, 1: slight asymmetry, and 2: marked asymmetry characterized by upper eyelid sulcus deepening.

Results: Fifty-nine patients (60 sockets) were analyzed. Thirty-three received silicone buckle implants (1-4 buckles). Implant exposure occurred in two patients (6.1%). Aesthetic scores were assessed in 48 patients. Mean aesthetic scores were 0.97 (no implant), 0.78 (one buckle), 0.68 (two buckles), and 0.42 (three/four buckles) (p = 0.123).

Conclusions: Silicone buckle #506 appears to be a safe and feasible option for anophthalmic socket reconstruction. Further studies are needed to optimize aesthetic outcomes and determine the ideal number of buckles.

Purpose: This study aimed to translate the Adult Strabismus-20 (AS-20) questionnaire into Japanese, creating the JAS-20, to assess health-related quality of life (HRQOL) in Japanese strabismus patients for the first time. The HRQOL was compared between patients with strabismus and those with non-strabismus mild eye diseases to evaluate HRQOL changes pre- and post-strabismus surgery.

Study design: Prospective cohort study.

Methods: The AS-20 was translated into Japanese according to international standards by bilingual health professionals. Participants were recruited from an ophthalmology hospital near Tokyo between May 2022 and August 2023. They included adults over 18 years with strabismus (strabismus group) and those with mild eye diseases without strabismus (control group). Patients with strabismus undergoing surgery were reassessed using the JAS-20 two months after operation. Analyses included comparisons between strabismus and control groups, the presence of diplopia within the strabismus group, and pre- versus post-surgery evaluations.

Results: The study included 239 patients: 168 in the strabismus group (114 with diplopia and 54 without diplopia) and 71 in the control group. The strabismus group showed significantly lower JAS-20 scores than the control group, indicating a reduced HRQOL. The patients without diplopia scored lower on the psychosocial scale, whereas those with diplopia scored lower on the functional scale. Despite significant post-surgery HRQOL improvements, strabismus patient scores remained below the control group levels.

Conclusions: Strabismus affects HRQOL in Japanese patients; it affects functional aspects in patients with diplopia and psychosocial aspects in those without diplopia. Although surgical intervention significantly enhanced HRQOL, it did not equalize with the control group's HRQOL.

Purpose: To compare the efficac and safety of a dual-blade 20,000 cuts per minute (cpm) vitrectomy probe with a single-blade 10,000 cpm probe for primary rhegmatogenous retinal detachment (RRD).

Study design: Prospective, randomized controlled clinical trial.

Methods: Evaluations were conducted preoperatively, intraoperatively, and at three months postoperatively. The main outcome measure focused on the duration of core vitrectomy, with secondary outcomes including peripheral vitreous shaving duration, balanced salt solution (BSS) consumption, anatomical and functional outcomes, as well as the incidence of surgical procedure-related complications.

Results: Overall, 35 cases in the 20,000 cpm group and 37 cases in the 10,000 cpm group completed the trial without significant differences in baseline demographic characteristics. The 20,000 cpm group demonstrated significantly shorter core vitrectomy duration (161.6 ± 10.4 vs. 206.8 ± 10.1 s) (P = 0.003) and peripheral vitreous shaving time (446.3 ± 20.3 vs. 544.2 ± 22.2 s) (P = 0.002) compared to the 10,000 cpm group. BSS consumption was higher in the 20,000 cpm group but without statistical significance (P = 0.231). There were no significant differences in the need for scleral sutures and the incidence of iatrogenic retinal breaks (P = 0.331 and 0.523). At the 3-month follow-up, there were no statistically significant differences in primary success, final anatomical success, or mean visual acuity (P > 0.9, P = 0.326). Rates of complications, including ocular hypertension, epiretinal membrane formation, and endophthalmitis also showed no statistically significant differences (P > 0.6).

Conclusion: The utilization of the new-generation 27-gauge system with a 20,000 cpm probe may herald a new paradigm of high-flow, smaller-diameter instrumentation, thereby enhancing the efficiency of the small gauge technique.

Purpose: To compare the surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe segmental viscotrabeculotomy (VT) in primary open-angle glaucoma (POAG).

Study design: A prospective randomized controlled study.

Patients and methods: Patients presenting with POAG and operated upon in Mansoura Ophthalmic Center in Mansoura, Egypt between February 2017 and September 2021 were enrolled. Study eyes were randomized to either VCST or VT and follow up extended for 24 months. Success was defined as an intra ocular pressure (IOP)≤18 mmHg with a 40% reduction from baseline. Complications were noted.

Results: The study enrolled 166 (82 in the circumferential group) eyes of 107 patients. There were no statistically significant differences between both groups in any demographic or preoperative clinical characteristics. The IOP trend demonstrated marked initial reduction (from 32.3±2.4 and 31.8±2.6 mmHg preoperatively in VCST and VT groups respectively) followed by a slow gradual rise over subsequent follow-up settling at lower IOP values in the circumferential (12.4±1.2 mmHg) than in the segmental group (15.5±0.9 mmHg) (p<0.001), both settling at significantly lower levels than preoperative values. The survival curve demonstrates complete success rates at 12, 15, 18, and 24 months were 98.8%, 96.4%, 95.1%, and 85.4% in the circumferential group and 98.8%, 92.9%, 91.7%, 79.8% in the segmental group respectively. Minimal self-limiting hyphema was universal in all study eyes.

Conclusions: Angle procedures -segmental and circumferential- are effective in lowering the IOP for at least 2 years in eyes with POAG, with circumferential angle surgery providing a greater reduction of IOP and requiring fewer subsequent glaucoma procedures.

Purpose: Internal limiting membrane (ILM) is usually peeled simultaneously with epiretinal membrane (ERM), however, in eyes with glaucoma and ERM, ILM is preserved in order to prevent nerve fiber damage. The aim of this study was to evaluate if a new approach for ERM is effective to keep ILM during surgery.

Study design: Retrospective consecutive case series.

Methods: ERM was directly grasped with forceps at the site where the scale of submembrane space imaged in OCT was maximum. After the removal of ERM, ILM was stained with brilliant blue G and the area of remaining ILM was graded with 5 patterns. The relationship between ILM preservation and submembrane space was analyzed with ROC curve.

Results: Thirty-three eyes of 33 patients undergoing ERM surgery (14 women, mean age: 69.2 years) were enrolled. There were 3 eyes with stage 1, 11 eyes with stage 2, 18 eyes with stage 3, and 1 eye with stage 4. The mean maximum distance between ERM and ILM was 80.5 ± 36.0 μm before surgery. ILM was preserved after initial membrane peeling in 21 of 33 eyes (63.6%). ERM-ILM distance correlated with ILM grading (Spearman rank coefficient: P = 0.03). ROC curve analysis identified cutoff value of ERM-ILM distance for ILM preservation was 66 μm[AUC (95% CI):0.7143 (0.5192-0.9093)].

Conclusions: Eyes with larger ERM-ILM distance are likely to show preserved ILM during ERM surgery. ERM-ILM distance appears to be a biomarker of ILM preservation during ERM surgery, which would be useful to minimize neuroretinal damage in eyes with glaucoma and related diseases.

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.