Japanese Journal of Ophthalmology最新文献

Purpose: To compare the improvements in all-distance visual acuity (VA) and contrast sensitivity early after cataract surgery among eyes implanted with multifocal and monofocal intraocular lenses (IOLs).

Study design: Nonrandomized comparative study.

Methods: Forty-two eyes with a trifocal IOL (Alcon, PanOptix^®), 42 eyes with a combined bifocal and extended-depth-of-focus (EDF) IOL (Johnson & Johnson, Synergy^®), and 84 eyes with a monofocal IOL were recruited. Uncorrected or corrected VA at various distances, and photopia and mesopic contrast VA were examined at 1 day and 3 months postoperatively. Improvements in these VAs were compared between time points and among groups.

Results: Mean uncorrected as well as corrected VA improved significantly between 1 day and 3 months postoperatively at almost all distances in the trifocal and combined bifocal + EDF groups (P ≤ 0.018), and at the intermediate distance of 1.0 m and far distances in the monofocal group (P ≤ 0.031). Mean improvements in near uncorrected VA at 0.3 m, intermediate VA at 0.5 m, and far VA at 2.0, 3.0, and 5.0 m were significantly greater in the multifocal groups than in the monofocal group (P ≤ 0.032). Improvements in photopic and mesopic contrast VA at most contrasts were significantly better in the multifocal groups (P ≤ 0.021).

Conclusion: Mean uncorrected or corrected VA at almost all distances and contrast sensitivity at most contrasts improved significantly early after surgery in eyes implanted with multifocal IOLs, and the improvements in VA at most distances and in contrast sensitivity were better with multifocal IOLs than with monofocal IOLs.

Purpose: To review hospitalized patients with Acute Retinal Necrosis (ARN) and investigate factors associated with subsequent retinal detachment (RD).

Study design: Retrospective.

Methods: The study included 40 patients (42 eyes), categorized into non-RD (23 eyes) and RD (19 eyes) groups. Patient demographics, ocular findings, treatment history, and visual outcomes were analyzed.

Results: The RD group had higher diabetes prevalence and worse initial and final visual acuity (VA) than the non-RD group (p = 0.035, p = 0.001, p = 0.000). The extent of retinal involvement was greater in the RD group (p = 0.000). The total steroid dose up to RD was significantly lower in the RD group (p = 0.023). Worse initial VA (p = 0.035) and greater retinal involvement (p = 0.036) increased the risk of RD. In the RD group, the time from initial symptoms to RD positively correlated with the duration of oral antivirals, the number of intravitreal antiviral injections, and the duration of oral steroids and immunosuppressants (p = 0.000, p = 0.023, p = 0.018, p = 0.001). The use of oral antivirals, steroids, and immunosuppressants was associated with longer median survival times compared to non-use (p = 0.000, p = 0.000, p = 0.048). The group receiving 9-11 intravitreal antiviral injections had a longer median survival time than the 0-4 and 5-8 injection groups (p = 0.009, p = 0.032).

Conclusions: In ARN, reduced steroid use due to diabetes may be associated with RD through inflammatory changes. The worse the initial VA and the greater the extent of retinal lesions, the higher the risk of RD. Oral antivirals, intravitreal antiviral injections, oral steroids, and oral immunosuppressants may be effective in delaying RD.

Purpose: To compare the amplitudes and implicit times of the oscillatory (OPs) of the full-field electroretinograms (ERGs) to those of the 30 Hz flicker ERGs in differentiating eyes with diabetic retinopathy (DR) from normal eyes.

Study design: Single-center observational study.

Methods: Full-field ERGs were recorded in 55 patients with Type 2 diabetes mellitus (DM) and 20 normal control subjects. The amplitudes and implicit times of the OPs and of the 30 Hz flicker ERGs were measured. Optical coherence tomography angiography (OCTA) was used to record 3×3 mm enface images of the retina from which the vascular density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were obtained. The receiver operating characteristic (ROC) curves were used to determine the ability of each ERG parameter to discriminate diseased eyes from normal eyes. The significance of the correlations between each ERG parameter and the VD of the SCP and DCP was determined.

Results: The area under the ROC curves (AUCs) was significantly larger for the implicit times than for the amplitudes of each ERG component (P<0.005). There were no significant differences in the AUCs between the OPs and 30 Hz flicker ERGs in differentiating eyes with DM or DR from normal eyes. The implicit time of the 30 Hz flicker ERG had the highest significant correlation coefficient with the VD of the DCP (r = - 0.31, P <0.001).

Conclusions: The OPs and 30 Hz flicker ERGs have equal ability in differentiating eyes with DR from normal eyes but with better ability for the implicit times than the amplitudes. The implicit time of the 30 Hz flicker ERG is the most sensitive parameter that is correlated with the reduction of VD among the full-field ERG components.

Purpose: This study aimed to investigate the choroidal thickness (ChT) distribution in adult myopic eyes, focusing on the macular, nasal midperiphery, and temporal midperiphery regions, and to explore its relationship with axial length (AL) and refractive error.

Study design: A cross-sectional, observational study.

Methods: Twenty-nine eyes of 29 adult volunteers were examined. ChT was measured using high-speed swept-source optical coherence tomography covering an area of 50 degrees in three different regions: centered at macular, nasal side at 33 degrees, and temporal side at 33 degrees. Statistical analyses were performed to assess differences in ChT between regions and correlations with AL and spherical equivalent (SE).

Results: ChT was found to be thickest in the macular region, followed by the nasal and temporal midperiphery regions. Significant correlations were observed between AL/SE and ChT in the macular and temporal regions, but not in the nasal region. The temporal midperiphery showed the strongest correlation with AL and SE.

Conclusion: This study revealed a nasal-temporal asymmetry in ChT distribution in myopic eyes, with the temporal midperiphery showing the thinnest ChT. The strong correlations between ChT in the temporal midperiphery and AL/SE suggest a role for the temporal choroid in axial elongation and myopia progression. These findings highlight the importance of considering peripheral ChT in understanding ocular growth and myopia management.

Purpose: This study aimed to report the incidence, characteristics, and prognosis of corneal perforation in patients with leprosy.

Study design: Retrospective observational study.

Methods: Patients who presented with leprosy and visited a specialised ophthalmology hospital (Miyata Eye Hospital, Miyazaki, Japan) between 1980 and 2020 were included. Their medical charts were retrospectively reviewed, and the incidence of lagophthalmos and corneal perforation was examined. Additionally, the presentation, treatment, and prognosis of patients with corneal perforations were assessed.

Results: In total, the records of 472 eyes of 236 patients (128 men and 108 women; mean age, 81.2 ± 7.5 years) diagnosed with leprosy were reviewed. Forty-one patients were diagnosed with lagophthalmos, and two of these patients (4.8%) showed signs of corneal perforation. Patients with lagophthalmos presented significantly more frequently with cicatricial contraction of eyelids (p < 0.001), superficial punctate keratopathy (p < 0.001), epithelial defect (p = 0.039), and corneal ulcer (p < 0.001) compared with patients without lagophthalmos. Patients with corneal perforation had uveitis more frequently compared with those without corneal perforation (p = 0.01).

Conclusion: Patients with leprosy frequently develop lagophthalmos. Patients with uveitis associated with leprosy are especially at risk of corneal perforation.

Purpose: To report the 3-year outcomes of surgical bleb revision (SBR) with mitomycin C (MMC) for early scarring bleb after trabeculectomy (TLE).

Study design: Retrospective observational study.

Methods: We included glaucoma patients aged ≧ 18 who underwent SBR with MMC within 6 months of their first TLE at Kobe University Hospital and were followed for at least 6 months. The primary outcome measure was the three-year success rate of SBR. We defined surgical success as: intraocular pressure (IOP) reduction ≧ 20% from baseline and 5 ≦ IOP ≦ 18 mmHg. Failure was defined when the IOP deviated from the criteria, when the eye required additional glaucoma surgery, and when the eye lost light perception. Complete success (CS) was success without glaucoma medications and qualified success (QS) was success with glaucoma medications. The secondary outcome measures included IOP, the number of glaucoma medications, mean deviation (MD), best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), and surgical complications.

Results: Sixty-eight eyes of 68 patients were analyzed. The median interval between initial TLE and SBR was 2 months. Overall success rate at three-year after SBR were 45.1% and 9.6% for QS and CS, respectively. A greater number of medications used before TLE was a contributing factor to failure (P = 0.02). 22 eyes (32.4%) underwent additional glaucoma surgery, and 41 eyes (60.3%) were spared from additional glaucoma surgery within 3 years after SBR. The median IOP decreased form 24.0 mmHg to 11.0 mmHg 3 years after SBR, and the number of medications decreased from 4 to 2 (P < 0.01). MD remained unchanged, but BCVA and ECD decreased at 3years postoperatively. There were no serious complications of SBR.

Conclusion: SBR may be an effective treatment option for early scarring blebs after TLE but is unsuccessful in eyes that have used many glaucoma medications prior to TLE.

Purpose: To investigate the usage status of biologics for the chronic treatment of optic neuritis including neuromyelitis optica spectrum disorders in Japan.

Design: Multicenter retrospective case series.

Methods: Patients diagnosed with anti-aquaporin 4 antibody (AQP4-Ab) positive optic neuritis and had been initiated on biologics (satralizumab, eculizumab, and inebilizumab) between January 2020 and August 2022 were identified at 30 facilities in Japan. These patients were investigated regarding changes in oral steroid doses, optic neuritis relapse, and adverse events after initiation of biologics.

Results: Eighty-eight patients with AQP4-Ab positive optic neuritis initiated on biologics were included. Satralizumab was the most common biologic used (79 patients), followed by eculizumab (6 patients) and inebilizumab (3 patients). In the satralizumab group, during the observation period (10.0±7.0 months) until February 2023, the oral steroid dose was reduced significantly from 13.8 ± 8.6 mg/day at the time of initiation to 5.3 ± 4.8 mg/day (p < 0.001). No relapse of optic neuritis was observed in 76 of 79 patients (96.2%) after initiation of satralizumab. Furthermore, in 15 patients who succeeded in discontinuing steroids during 8.5 ± 5.8 months after initiation of satralizumab, no relapse of optic neuritis was observed throughout the observation period. Adverse events occurred in 7 patients with satralizumab and 2 patients with eculizumab, but no serious infections were observed.

Conclusions: Satralizumab was the most commonly used biologic for AQP4-Ab positive optic neuritis in Japan. This study demonstrates the efficacy and safety of satralizumab in preventing the relapse of optic neuritis.

Purpose: To investigate the visual prognosis of metamorphopsia in patients undergoing surgery for stage 3 idiopathic epiretinal membrane (ERM) by Govetto classification using preoperative optical coherence tomography (OCT) parameters.

Study design: Retrospective clinical study.

Method: This study included 45 eyes of 45 patients with a minimum follow-up period of 3 months. The best-corrected visual acuity (BCVA) and metamorphopsia score using the M-CHARTS were recorded. Central foveal thickness (CFT), inner nuclear layer thickness (INL), ectopic inner retinal layer thickness (EIFL), outer retinal layer thickness, disruption of the ellipsoid zone, cotton ball sign, and intraretinal cystoid changes were measured based on spectral domain OCT. Preoperative and postoperative values and conditions were compared, and correlations between the preoperative values or conditions and postoperative metamorphopsia scores or BCVA were analyzed.

Results: After surgery, the horizontal, vertical, and mean metamorphopsia scores, as well as BCVA, CFT, INL, and EIFL significantly improved (p < 0.001). Using multivariate analysis, only preoperative CFT was a significant explanatory parameter for both the postoperative horizontal metamorphopsia scores and mean values of the postoperative horizontal and vertical metamorphopsia scores (p = 0.019 and p = 0.011, respectively). Age (p = 0.011) and preoperative CFT (p = 0.026) were significant explanatory parameters of postoperative BCVA.

Conclusion: Preoperative CFT significantly correlated with postoperative metamorphopsia in patients undergoing surgery for stage 3 idiopathic ERM. This finding might help surgeons predict postoperative visual outcomes and make timely surgical decisions.

Purpose: To clarify the clinical features including multimodal imaging of primary choroidal lymphoma.

Study design: Retrospective, observational case series METHODS: Six consecutive patients with primary choroidal lymphoma diagnosed at Tokyo Medical University Hospital were studied. Demographic profile, clinical features and multimodal imaging were reviewed retrospectively.

Results: The patients comprised 3 men and 3 women with average age of 68.2 ± 12.4 years. Clinical diagnosis before referring to our hospital included Vogt-Koyanagi-Harada disease, posterior scleritis, and choroidal hemangioma, and no patients had been diagnosed with choroidal lymphoma. Average duration from onset of ocular symptoms to establishing a diagnosis was 14.2 months. Ocular fundus examination revealed yellowish orange nummular infiltration in all six cases, and granular pigment deposits at the posterior pole in four cases. Optical coherence tomography showed increased choroidal thickness and waving of the retinal pigment epithelium in all cases. Ultrasonography depicted choroidal thickening and extraocular nodular lesions adjacent to the posterior sclera in all cases. None of the cases showed elevated interleukin-10 in the aqueous humor. Ocular fundus manifestations and visual acuity improved after external beam radiation therapy, except one case with bullous retinal detachment from the initial visit.

Conclusions: Characteristic ocular fundus manifestation together with multimodal imaging findings are useful for the clinical diagnosis of primary choroidal lymphoma.