Japanese Journal of Ophthalmology最新文献

Purpose: This study aimed to evaluate the efficacy of endoluminal lacrimal duct recanalization (ELDR) with intubation using dacryoendoscopy for secondary acquired lacrimal duct obstruction (SALDO) following epidemic keratoconjunctivitis (EKC) in children.

Study design: Prospective observational study.

Methods: We included 27 pediatric patients with EKC-derived SALDO between 2013 and 2023. All patients underwent ELDR with intubation for lacrimal pathway obstruction after EKC.

Results: We included 14 boys and 13 girls with unilateral obstructions (20 right and 7 left). The mean age at EKC onset and treatment was 23.4 ± 24.1 and 58.9 ± 42.4 months, respectively, and the mean interval from onset to treatment was 35.9 ± 29.0 months. Nineteen cases had a single blockage (common canalicular obstruction [CCO], sac-duct junction [SDJ], punctal obstruction, and canalicular obstruction in 7, 10, 1, and 1 case, respectively); five had two blockages (CCO and SDJ in 4 cases and SDJ and the lower end of the duct in 1 case), and three had diffuse blockages (2 with diffuse proximal nasolacrimal duct obstruction [NLDO] and 1 with CCO and diffuse proximal NLDO). All patients had tube stents, with a mean intubation period of 64.0 ± 26.3 days. Outcomes were classified as good, fair, and poor in 25 patients, 2 patients, and none, respectively.

Conclusion: CCO and SDJ were the primary lacrimal pathway obstruction sites following EKC in children. ELDR combined with intubation using dacryoendoscopy demonstrated favorable outcomes, supporting its role as an effective treatment option for secondary EKC-derived SALDO in children.

Purpose: To propose an implementation model for pneumatic retinopexy (PnR) in a region where PnR is performed infrequently, and to assess its impact on treatment of rhegmatogenous retinal detachment (RRD).

Study design: Retrospective case series.

Methods: We reviewed 222 consecutive eyes with primary RRD treated from July 2017 to September 2023 at a tertiary care center in Japan. The treatment methods utilized included pars plana vitrectomy (PPV), scleral buckling (SB) and PnR. The surgeon learned PnR through social media. Primary anatomic reattachment rate (PARR) and visual acuity outcomes were compared between the pre-PnR (prior to the implementation; 110 eyes) and post-PnR (after the implementation; 112 eyes) periods, as well as between PnR and PPV in the post-PnR period. PARR for PnR was also evaluated based on RRD characteristics and gas injection frequency.

Results: In the post-PnR period PnR was performed in 53.6% (60/112)of cases. The PARR was similar in the pre-PnR (97.3%) and post-PnR (93.8%) periods (P=.33). Visual outcomes were similar both across periods and between PnR and PPV at 3, 6 and 12 month post-operatively. The PARR for PnR was 88.3% overall, 90.5% in eyes meeting the Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) criteria, 93.3% in eyes with a single break and 100% in eyes with a single break meeting PIVOT criteria. Eyes with a single gas injection had higher PARR than eyes requiring an additional gas injection (93.5% vs. 71.4%).

Conclusion: Remote-learning utilizing social media effectively enabled PnR implementation with favorable anatomic and functional outcomes in a real-world setting in Japan.

Purpose: To analyze differences in demographics, etiology, and clinical characteristics between pure and impure orbital fractures (with or without orbital rim involvement) STUDY DESIGN: Retrospective observational study.

Methods: A total of 1104 cases of orbital fractures were reviewed. Fractures were classified as pure (881 cases) or impure orbital fractures (223 cases). Impure fractures were further subdivided into frontal bone (14 cases), zygomaticomaxillary complex (ZMC, 187 cases), and multiple (22 cases) fractures. Data on demographics, fracture types, injury mechanisms, field of binocular single vision (BSV), and associated ocular injuries were analyzed across the groups.

Results: Patients with ZMC fractures were older than those with orbital or frontal bone fractures (P <.001 and P = .007). Bilateral fractures were more frequent in the multiple-fractures group (P <.001). Falls were the leading cause of injury (39%), particularly in ZMC fractures (52%). Motor vehicle accidents accounted for 50% of multiple fractures. The overall rate of ocular injuries was 7.3%, with all globe ruptures (5 cases) occurring in the pure fracture group. Multiple fractures had higher incidences of optic canal fractures and orbital compartment syndrome (P <.001). Frontal bone fractures demonstrated better BSV outcomes, whilst multiple fractures had the worst.

Conclusion: This large-scale study highlights the significant influence of age and injury mechanisms on orbital fracture patterns. Frontal bone fractures were associated with more favorable visual function, whilst pure fractures posed greater risk of globe rupture. These findings underscore the importance of tailoring management strategies to specific fracture types and patient demographics.

Purpose: To characterize the progression of capillary nonperfusion in diabetic macular ischemia (DMI) using optical coherence tomography angiography (OCTA) images.

Study design: A single-center, prospective case series study.

Methods: We acquired 3 × 3 mm swept-source OCTA images and created en face images within a central 2.5 mm circle in 100 eyes of 100 patients with diabetic retinopathy (DR). The circle was divided into 15 × 15-pixel squares; squares without retinal vessels were defined as nonperfusion squares (NPSs). Vessel density (VD) and vessel length density (VLD) were also quantified as perfusion metrics. We compared these metrics at baseline and at the 3-year follow-up visit.

Results: Both VD and VLD decreased, and NPS increased at 3 years in both superficial and deep layers. The baseline superficial and deep non profusion squares' (NPS) counts correlated with the count at 3 years but not with its changes. Multivariate analyses demonstrated that logMAR (β = 0.785, P < 0.001) and PDR (β = 0.206, P = 0.002) at baseline predicted poorer VA at 3 years. PDR (β = 0.275, P = 0.007) and NPS counts in the inferior sector of the superficial layer (β = -0.223, P = 0.027) at baseline were mildly associated with VA deterioration. Age was the only baseline parameter correlated with changes in superficial NPS counts (β = 0.242, P = 0.015). Changes in deep NPS counts were associated with systemic hypertension (β = -0.262, P = 0.005), logMAR (β = 0.307, P = 0.001), and prior vitrectomy (β = -0.209, P = 0.024).

Conclusions: We demonstrated changes in the nonperfusion metrics on OCTA images over 3 years and identified baseline factors associated with the progression of nonperfusion areas.

Purpose: This study aimed to investigate the characteristics of magnetic resonance imaging (MRI) of lesions in Lebers hereditary optic neuropathy (LHON).

Study design: Retrospective study.

Methods: We examined the clinical characteristics and MRI scans of lesion locations in 34 LHON cases (68 eyes) with m.11778G>A mutation, examined within six months of onset who had detailed MRI imaging records available.

Results: The median age was 36.5 (range: 10-75) years, with 26 male cases. MRI lesions were observed in 15 cases, with the following distribution: isolated intraorbital lesions in 7 cases, intraorbital + optic canal lesions in 1 case, intraorbital + optic canal + intracranial lesions in 1 case, optic canal + intracranial lesions in 1 case, optic canal + intracranial + chiasmal lesions in 1 case, intracranial + chiasmal lesions in 3 cases, and chiasmal + optic tract lesions in 1 case. There were no significant differences in clinical characteristics between patients with and without MRI lesions. Cases with chiasmal lesions tended to be younger (chiasmal lesion group [n=5] vs. non-chiasmal lesion group [n=29]: median age 25 [range: 11-30] years vs. 44 [range: 10-75] years, p=0.02, Mann-Whitney U test), although there were no significant differences in sex or time to MRI imaging.

Conclusion: MRI lesions can extend from the intraorbital optic nerve to the chiasm and tract. Consistent with previous reports, chiasmal involvement was frequently observed and was more prevalent in younger patients. Recognition of these characteristic MRI and clinical findings is crucial in the differential diagnosis of subacute progressive optic neuropathy.

Purpose: To evaluate structural outcomes, including subretinal fluid (SRF) and fibrovascular pigment epithelial detachment (fvPED) volume changes, after switching from aflibercept 2 mg to faricimab in Japanese patients with neovascular age-related macular degeneration (nAMD).

Study design: Retrospective, observational study.

Methods: Patients with nAMD who were switched from aflibercept 2 mg to faricimab were enrolled. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and the volumes of SRF and fvPED were analyzed using three-dimensional spectral-domain optical coherence tomography data.

Results: A total of 46 eyes from 46 patients were included. All had been maintained on fixed dosing due to difficulty in extending the injection interval. Patients had received a mean of 25.6 aflibercept 2 mg injections, with a mean interval of 7.5 weeks for the last three injections. Subsequently, three faricimab injections were given at similar intervals (7.6 weeks). BCVA remained unchanged (p = 0.066), while CMT, SRF, and fvPED volumes significantly decreased (p < 0.01). A significant correlation was found between the reductions in SRF and fvPED volumes (p < 0.05).

Conclusions: Switching to faricimab led to favorable structural outcomes in nAMD patients previously treated with aflibercept 2 mg, particularly by reducing SRF and fvPED.

Purpose: To evaluate the 1-year efficacy and safety of aflibercept 8 mg compared with aflibercept 2 mg in a pre-specified analysis of patients from Japan with neovascular age-related macular degeneration (nAMD) included in PULSAR.

Study design: PULSAR (NCT04423718) was a global, phase 3, randomized, double-masked, non-inferiority study of adults with nAMD. Patients were randomized 1:1:1 to receive aflibercept 8 mg every 12 weeks (8q12), or every 16 weeks (8q16), or aflibercept 2 mg every 8 weeks (2q8), following three initial monthly doses in all groups.

Methods: This subgroup analysis of Japan and non-Japan cohorts from PULSAR evaluated changes from baseline in best-corrected visual acuity (BCVA), central subfield retinal thickness, durability and safety outcomes.

Results: In the Japan subgroup, least squares (LS) mean (95% CI) changes from baseline in BCVA at week 48 were +6.5 (+0.7, +12.3), +7.9 (+5.1, +10.6), and +4.7 (-0.5, +9.9) letters for patients in the 8q12 (n = 31), 8q16 (n = 33), and 2q8 (n = 33) groups, respectively. The majority of patients in the 8q12 (82.1%) and 8q16 (93.8%) groups maintained their randomized dosing intervals through Week 48. Ocular treatment-emergent adverse events were reported in 35.5%, 30.3%, and 39.4% of patients in the Japan subgroup in 8q12, 8q16, and 2q8 groups, respectively. Similar efficacy and safety results were observed in the non-Japan subgroup.

Conclusion: Aflibercept 8 mg has similar efficacy and safety to aflibercept 2 mg when administered at extended dosing intervals in both the Japan and non-Japan subgroups, consistent with the overall PULSAR results.

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.

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 investigate the relationship between visual function, optical coherence tomography (OCT) parameters, and optic nerve bending before and after tumor resection in adult patients with craniopharyngioma.

Study design: Retrospective observational study.

Methods: We retrospectively evaluated 22 eyes of 11 adult patients with craniopharyngioma who underwent tumor resection surgery. We assessed the preoperative and 1-month postoperative best-corrected visual acuity (BCVA), simple visual field impairment score (SVFIS) for visual field evaluation, 6-segmented macular ganglion cell layer (GCL) + inner plexiform layer (IPL) and 4-segmented circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and optic nerve-canal bending angle (ONCBA).

Results: Bilateral hemianopia was observed in 10 patients (91%), whilst homonymous hemianopia was observed in 1 patient (9%). The BCVA and SVFIS scores improved significantly postoperatively (both P <.001), and eyes with optic nerve bending had significantly worse preoperative BCVA and SVFIS (both P <.001), and the ONCBA was significantly correlated with preoperative BCVA, SVFIS, and GCL+IPL thickness in all areas. OCT detected superior nasal GCL+IPL thinning in 10 eyes (45%) and superior cpRNFL thinning in 2 eyes (9%).

Conclusion: In adult patients with craniopharyngioma, GCL+IPL and cpRNFL thicknesses were associated with postoperative visual function recovery. The ONCBA was associated with preoperative visual dysfunction. ONCBA, GCL+IPL, and RNFL thicknesses may be useful for monitoring visual function in adult craniopharyngiomas preoperatively and postoperatively.