Japanese Journal of Ophthalmology最新文献

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.

Purpose: To evaluate 5-year temporal changes in baseline clinical characteristics-age, axial length, and best-corrected visual acuity-among treatment-naïve eyes with neovascular Age-Related Macular Degenaration (nAMD), comparing pachychoroid neovasculopathy (PNV) with drusen-driven (non-PNV) nAMD at a Japanese tertiary center.

Study design: Retrospective observational study.

Methods: Registry data from Kyoto University Hospital were analyzed for patients newly diagnosed with nAMD in 2013/2014 and in 2018/2019. Patients were classified as PNV or non-PNV based on findings derived from multimodal imaging-including optical coherence tomography, indocyanine-green angiography, and color fundus photography. Demographic data, axial length, best-corrected visual acuity (BCVA) at baseline and 1 year posttreatment, and the proportion of eyes achieving ≥0.20 logMAR improvement were compared over time.

Results: A total of 118 patients were included. In the non-PNV group, mean age rose from 74.35 ± 8.42 years to 77.39 ± 7.90 years (p = 0.021), whereas the PNV group showed a smaller, non-significant change from 68.88 ± 7.25 to 70.41 ± 9.19 years (p = 0.48). Among non-PNV cases, both mean age (p=0.021) and axial length (p=0.017) increased significantly over time. In contrast, PNV cases showed no significant changes in age or axial length. BCVA outcomes and the proportion of patients achieving ≥0.20 logMAR improvement were similar across time points within each subtype. Multivariable logistic regression analysis revealed no significant associations between visual improvement and year, subtype, age, or axial length.

Conclusions: This study revealed an aging trend and axial elongation among non-PNV cases over time, underscoring a subtype-specific divergence in clinical trajectory.

Purpose: We previously reported 1-year outcomes of half-fluence photodynamic therapy (HFPDT) combined with intravitreal aflibercept (IVA) in treatment-naïve pachychoroid neovasculopathy (PNV). In this study, we evaluated the 2-year outcomes of HFPDT combined with IVA in treatment-naïve PNV without polypoidal lesions.

Study design: Retrospective, interventional case series METHODS: We retrospectively studied 61 eyes with treatment-naïve PNV that received HFPDT combined with IVA and were followed for at least 2 years. Additional treatments were given if a dry macula was not achieved or if exudation recurred. We evaluated the best-corrected visual acuity (BCVA), foveal thickness (FT), central choroidal thickness (CCT), and macular neovascularization thickness (MNVT). Factors associated with additional treatment were also analyzed.

Results: BCVA was significantly improved at 1 year (P <.05), but not at 2 years (P = .07). FT, CCT, and MNVT significantly decreased throughout the study period (all P <.01). A dry macula without further treatment was maintained in 44% of the eyes. These eyes were significantly younger (P <.01), with lower MNVT (P <.01) and greater CCT (P <.05) at baseline. Logistic regression identified age and MNVT as significant factors for additional treatment. PDT-induced acute exudative maculopathy (PAEM) was observed in 26.5% of the eyes requiring additional treatment, but not in those without retreatment.

Conclusion: HFPDT combined with IVA for treatment-naïve PNV maintained a dry macula for 2 years with initial treatment alone in 44% of the cases. Age, MNVT, and PAEM were associated with the need for additional treatment.

Purpose: To prospectively evaluate bilateral visual function in Japanese patients implanted with nondiffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs).

Study design: Multisite prospective observational study.

Patients and methods: This study included 48 eyes of 24 Japanese patients with cataracts (mean age: 68.7 ± 9.2 years) who underwent bilateral implantation of nondiffractive EDoF IOLs CNAET0 (Clareon Vivity, Alcon), made of high-water-content hydrophobic acrylic material. Three months postoperatively, binocular uncorrected and distance-corrected visual acuities (BUCVA and BDCVA) were assessed at far, 66 cm, and 40 cm. Binocular photopic contrast sensitivity (CSV-1000), binocular defocus curves, spectacle independence, and photic phenomena (glare, halo, starburst, and waxy vision) were also assessed.

Results: The mean logMAR BUCVA/BDCVA was -0.11/-0.15 at far, 0.05/0.08 at 66 cm, and 0.18/0.22 at 40 cm. Binocular contrast sensitivity was within the normal range for individuals aged 60-69 years across all spatial frequencies. The mean defocus curve demonstrated 0.1 logMAR or better between -2.0 and +1.0 D addition, with better performance of 0.0 logMAR or better between -1.5 and +0.5 D addition. All patients were spectacle-independent for distance and intermediate vision, whereas nine of the 24 patients (37.5%) required spectacles for near vision. None of the patients reported severe photic phenomena; 17 patients (70.8%) did not experience glare or starburst, and 20 patients (83.3%) did not report halo or waxy vision.

Conclusion: Bilateral implantation of nondiffractive EDoF IOLs provided good binocular functional vision from far to near, although some patients may require spectacles for near vision. The photic phenomenon was minimal.

Purpose: To examine the long-term real-world outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) and corticosteroid injections in patients with diabetic macular edema (DME).

Study design: Single-center, retrospective study.

Methods: We reviewed the medical records of patients diagnosed with DME between January 2010 and December 2023. The number of anti-VEGF and corticosteroid injections, along with best-corrected visual acuity (BCVA) and central macular thickness (CMT), were collected and analyzed throughout the follow-up period.

Results: A total of 574 patients (774 eyes) were included, with a mean follow-up of 5.1 ± 4.7 years. The mean anti-VEGF injections was 3.6 ± 2.3 times in the first year, significantly decreasing to 1.6 ± 2.0 in the second year (p < 0.001) and 0.29 ± 1.1 by the tenth year. In contrast, corticosteroid injections remained low and stable over ten years (0.16 ± 0.49 in the first year; 0.16 ± 0.68 in the tenth year). Baseline BCVA was 0.43 ± 0.36 logMAR, significantly improving to 0.27 ± 0.29 at year 1 (p < 0.001) and remained stable at 0.32 ± 0.31 by year 10. Mean CMT decreased from 423.1 ± 121.3 μm at baseline to 333.4 ± 93.8 μm in year 1 (p < 0.001), and continued to decline over 10 years, reaching 279.3 ± 71.2 μm.

Conclusion: This 10-year real-world study confirms the effectiveness of anti-VEGF and corticosteroid injections in achieving functional and anatomical improvements in DME, although the outcomes were less favorable than those reported in clinical trials, primarily due to undertreatment and patient heterogeneity.

Purpose: To assess the effect of increased injection volume on intraocular pressure (IOP) following intravitreal injections of aflibercept 8 mg (70 µl) compared to conventional anti-vascular endothelial growth factor drugs.

Study design: Retrospective observational study METHODS: This retrospective observational study included eyes treated with 50 µl of either aflibercept 2 mg or faricimab 6 mg, followed by a switch to 70 µl of aflibercept 8 mg. IOP was measured before and 30 minutes after intravitreal injections. IOP changes in treated and fellow eyes were analyzed, with potential associations examined between IOP changes and clinical parameters.

Results: A total of 88 eyes from 85 patients were switched to aflibercept 8 mg during the study period. Due to incomplete data, 17 eyes from 15 patients were excluded, leaving 71 eyes from 70 patients for the analysis. IOP significantly increased from 13.2 ± 2.9 mmHg to 19.1± 5.4 mmHg (P< 0.001) with 50 µl injections and from 13.3 ± 2.9 mmHg to 19.8 ± 4.8 mmHg (P<0.001) with 70 µl injections. The IOP increases were 6.0 ± 5.0 mmHg with 50 µl injections and 6.5 ± 4.3 mmHg with 70 µl injections, with no statistically significant difference (P = 0.20). An IOP exceeding 26 mmHg was observed in 6 eyes treated with 50 µl injections and 10 eyes with 70 µl injections, with no significant difference in IOP distribution between the volumes (P = 0.20).

Conclusion: There was no additional increase in IOP 30 minutes after intravitreal injections when switching from 50 µl to 70 µl volumes.

Purpose: To investigate the efficacy and safety of 2% ganciclovir (GCV) eye drops for the treatment of primary cytomegalovirus anterior uveitis (CMV-AU) STUDY DESIGN: Retrospective cohort study METHODS: This study included 12 patients diagnosed with CMV-AU who were treated with 2% GCV eye drops. The patients' demographics, clinical presentations, treatment regimens, and outcomes were analyzed.

Results: The cohort consisted predominantly of men (11:1 ratio), with a mean age of 63.4 years and all presenting with unilateral disease. Common presenting symptoms were blurred vision and elevated intraocular pressure (IOP). After the initiation of 2% GCV eye drops, all the patients demonstrated positive responses, with improvement in BCVA, decreased IOP, and resolution of keratic precipitates including coin-shaped lesions. Recurrence of uveitis occurred in 66.7% of the patients and was managed with intensified topical corticosteroids, antiglaucoma medications, and/or short-term oral GCV. IOP significantly decreased after treatment (P <.05), whilst BCVA and corneal endothelial cell counts remained stable. No patients developed bullous keratopathy or required intravenous GCV. One patient underwent trabeculectomy for uncontrolled IOP.

Conclusion: This study's findings suggest that 2% GCV eye drops are a safe and effective treatment option for primary CMV-AU, offering improvements in IOP and uveitis control. All the patients completed the treatment without serious adverse events, supporting the favorable safety profile of 2% GCV eye drops.

Purpose: To analyze the rate of new cerebral lesions' appearance within 6-12 months in Japanese optic neuritis patients who at onset had no cerebral lesions suggestive of multiple sclerosis (MS) and were negative for aquaporin-4 (AQP4) antibodies.

Study design: Retrospective study.

Methods: Medical records of 66 adult patients with optic neuritis were reviewed. Patients positive for AQP4, myelin oligodendrocyte glycoprotein, or antinuclear antibodies were excluded. Those without cerebral lesions on initial magnetic resonance imaging (MRI) underwent follow-up MRI within 6-12 months. Clinical characteristics and subsequent neurological diagnoses were analyzed.

Results: Forty-seven patients met the inclusion criteria (mean age, 41.9±16.7 years; 13 men, 34 women). Forty-two cases were unilateral, five bilateral; 19 had disc swelling, and 28 did not. The mean worst logMAR was 1.13±0.96. Two patients experienced recurrence within 1 year. Of the 27 patients without initial cerebral lesions, 20 underwent follow-up MRI; 3 (15%) developed new lesions. These three were later diagnosed as two MS and one suspected MS cases.

Conclusion: Follow-up MRI within 6-12 months revealed new cerebral lesions in 15% of patients, with 10% diagnosed with MS. This highlights the importance of follow-up imaging even in AQP4 antibody-negative optic neuritis patients without initial cerebral lesions, especially in the absence of other diseases like neuromyelitis optica spectrum disorders.

Abtract: PURPOSE: To evaluate the correlation between corneal backscatter and visual function in patients with Fuchs endothelial corneal dystrophy (FECD).

Study design: Prospective case series.

Methods: This study included 53 eyes from 38 patients with FECD. Corneal backscatter was quantified using light scattering (LS) via Scheimpflug imaging, and signal intensity (SI) via anterior segment optical coherence tomography. We measured corrected distance visual acuity (CDVA) using the Landolt-C and Early Treatment Diabetic Retinopathy Study (ETDRS) charts and contrast sensitivity function with sine wave grading chart by the area under the log contrast sensitivity function (AULCSF) and letter contrast sensitivity (LCS).

Results: Significant correlations were observed between LS and SI, particularly in the posterior 60 μm of the central 0-2-mm cornea. LS in the central 6-mm cornea was significantly correlated with CDVA (Landolt-C and ETDRS) or contrast sensitivity (AULCSF and LCS) in most layers or diameters. In the central 0-2-mm cornea, LCS and posterior LS had the strongest correlation (ρ = -0.58, P < 0.01), followed by AULCSF and posterior LS (ρ = -0.55, P < 0.01). In the central 0.5-2-mm cornea, anterior or posterior SI demonstrated significant correlations with CDVA (Landolt-C and ETDRS) and contrast sensitivity (AULCSF and LCS). AULCSF and posterior SI had the strongest correlation (ρ = -0.58, P < 0.01), followed by LCS and posterior SI (ρ = -0.56, P < 0.01).

Conclusion: The corneal backscatter of the anterior and posterior central cornea of FECD is significantly correlated with visual function across both imaging modalities.

Purpose: This study evaluated the clinical outcomes and aqueous humor cytokine levels in eyes with neovascular age-related macular degeneration (nAMD) switched from intravitreal aflibercept to ranibizumab biosimilar (BS).

Study design: Prospective observational study.

Methods: Thirty-eight eyes of 38 patients with nAMD who received aflibercept under a treat-and-extend (TAE) regimen were prospectively switched to ranibizumab BS. Eight eyes with cataracts undergoing surgery served as controls for aqueous humor cytokine analysis. Best-corrected visual acuity (BCVA) and anatomical outcomes were assessed over one year. The aqueous humor levels of vascular endothelial growth factor (VEGF)-A, angiopoietin-2 (Ang-2), and placental growth factor (PlGF) were measured before and after switching in eyes with nAMD and at surgery in controls.

Results: Disease activity remained controlled in 94.3% of patients with nAMD for over one year. No significant changes were observed in the BCVA (P=0.65) after one year. Ang-2 levels remained unchanged (P=0.66) and were not significantly different between eyes with nAMD and controls both before (P=0.64) and after switching (P=0.30). PlGF levels also remained stable (P=0.12) but were significantly higher in eyes with nAMD than in controls both before (P<0.01) and after switching (P=0.03). VEGF-A levels significantly increased after switching (P<0.01) but remained lower than in the controls both before (P<0.01) and after switching (P=0.02).

Conclusion: Switching from aflibercept to ranibizumab BS effectively maintained disease stability and cytokine balance in eyes with nAMD. These findings support ranibizumab BS as a viable and cost-effective alternative for long-term treatment.