Japanese Journal of Ophthalmology最新文献

Purpose: To characterize the in vivo morphologic and biometric changes in the lens during accommodation as a function of age by use of swept-source OCT technology STUDY DESIGN: Observational, prospective study METHODS: Complete optometric and ophthalmologic examinations were performed on all the patients to determine their eligibility for inclusion in the study. The examinations included anterior segment measurements obtained using swept-source OCT. Morphologic parameters of the lens were analysed under accommodative stimuli of 0, -1, -2, -3, and -6 D. A second measurement was taken 10 minutes after the first.

Results: Three hundred eyes of 300 patients were enrolled in the study. Structural changes in the lens were observed, specifically in the anterior and posterior radii, which decreased with accommodation, and the total thickness of the lens, which increased. In patients aged younger than 40 years, significant changes were found in the curvature radius and lens thickness during accommodation. In patients aged older than 40 years, these changes began to diminish. Significant differences between stimuli (P <.05) were observed in all the groups, demonstrating lens variation during accommodation and its dependence on age. Repeatability analysis showed an intraclass correlation coefficient of >0.700 for all the parameters.

Conclusions: During accommodation, the anterior and posterior curvatures of the lens decrease, while its thickness increases. Age-related differences remained significant, indicating persistent changes over time. Swept-source OCT demonstrated high repeatability, particularly for anterior curvature, thickness, and tilt, even under accommodation.

Purpose: To evaluate the long-term outcomes of primary filtering surgery, including trabeculectomy and combined trabeculotrabeculectomy (CTT), in secondary childhood glaucoma (SCG) patients.

Study design: Retrospective cohort study.

Methods: SCG patients, who underwent primary filtering surgery at two tertiary hospitals between 2008 and 2018, were reviewed. Surgical success was defined as an intraocular pressure (IOP) between 5 to 21 mmHg. Failure was defined as IOP outside those criteria for two consecutive visits, the need for additional surgery, or loss of light perception. Surgical success was evaluated using the Kaplan-Meier method.

Results: Sixty-four eyes (50 patients) were included. Glaucoma associated with non-acquired ocular anomalies (SCG-O) included 31 eyes from 23 patients. Median age and follow-up time were 63.6 and 18 months, respectively. Overall success probabilities were 57.8% at 1 year, 55.1% at 3 years, and 50.1% at 5 years. For trabeculectomy (55 eyes), the success probabilities were 59.5% at 1 and 3 years, and 52.0 % at 5 years. For CTT (9 eyes), the success probabilities were 44.4% at 1 year, decreasing to 33.3% at 3 and 5 years. There was no statistically significant difference between trabeculectomy and CTT. Hypotony was the most common early complication. Two eyes developed phthisis bulbi.

Conclusions: Primary filtering surgery in SCG patients showed a significant drop in the success rate to about 60% within the first year, followed by a slight decline thereafter, with a long-term success rate around 50%.

Purpose: To identify novel risk factors associated with the presence of fungal ocular lesions in patients with fungemia and to evaluate the validity and efficacy of routine screening.

Study design: Retrospective study METHODS: The medical records of 198 patients diagnosed with fungemia by blood culture at 3 medical centers in Japan between March 2017 and April 2022 were analyzed. Ocular lesions were categorized as possible, probable, or proven, according to previously established definitions. The primary outcome measure was prevalence of ocular lesions. Secondary outcomes included the classification of ocular lesions and mortality.

Results: Among the 198 patients with fungemia, 115 underwent fundus examination. Ocular lesions were observed in 40 patients (34.8%), with 16 classified as probable and 24 as possible. Among those with positive ocular lesions, 5 (12.5%) complained of ocular symptoms, whereas 21 (52.5%) had impaired consciousness. Impaired consciousness was associated with an increased prevalence of ocular lesions (odds ratio [OR], 2.70). Bedside ophthalmic consultations were associated with the classification of ocular lesions (OR, 0.0485). Positive ocular lesions and echinocandin administration were associated with mortality (ORs, 3.180 and 4.140, respectively).

Conclusion: Our study results demonstrate that impaired consciousness is an independent risk factor for ocular lesions. Moreover, the presence of ocular lesions was determined to be an independent factor associated with mortality, highlighting the importance of detecting these lesions in systemic management. Based on these findings, we recommend dilated fundus examination by ophthalmologists in patients with fungemia who do not complain of visual symptoms.

Purpose: We aimed to report the 5-year efficacy and safety data of suture trabeculotomy ab interno (SLOT ab interno) in patients with primary open-angle glaucoma and exfoliation glaucoma.

Study design: Single-centre, three-arm randomised trial.

Methods: Ninety-nine eyes of 99 patients were randomly assigned to one of three groups: the 360° (n = 34), upper-180° (n = 34), and lower-180° (n = 31) groups. We evaluated intraocular pressure (IOP), medication use, and visual field progression. Surgical success (with or without medication) was defined as IOP ≤21 mmHg with a ≥20% reduction (criterion A) or IOP ≤15 mmHg with a ≥ 20% reduction (criterion B). Visual field progression was assessed by MD values at fixed postoperative time points and by the MD slope (dB/year).

Results: Fifty-six of 99 eyes (56.5%) completed 5 years of follow-up. At 5 years, the mean IOP decreased from 18.8 ± 5.7 to 13.5 ± 3.1 mmHg (28% reduction, p<0.001), with medication use decreasing from 3.3 ± 1.1 to 2.0 ± 1.7 (p=0.005) and a mean MD slope of -0.2 dB/year. No significant differences in surgical success rates (criteria A and B), MD values, or MD slopes were observed among the groups.

Conclusion: The extent of Schlemm's canal incisions (360°, upper-180°, or lower-180°) during SLOT ab interno has no significant effect on IOP reduction or medication use over 5 years.

Purpose: Evaluation of scleral thickness with anterior segment optical coherence tomography (AS-OCT) in patients with obstructive sleep apnea syndrome (OSAS).

Study design: Cross-sectional study.

Methods: A total of 30 severe (Group 1), 30 moderate (Group 2) and 30 mild (Group 3) OSAS patients and 22 healthy volunteers (Group 4) were included in the study. Scleral thickness measurements were taken with AS-OCT, 6 mm, 4 mm and 2 mm posterior to the scleral spur, in four gaze positions. Data and findings were examined comparatively.

Results: At 6 mm posterior to the scleral spur, the mean thickness was found to be significantly higher in all quadrants in Group 1 (p<0.05 for all). Superior thickness was higher in Group 2 compared to Group 4 (p=0.034). At 4 mm posterior to the scleral spur; in Group 1, the mean thickness was found higher than Group 2 and 3 only in the inferior (p=0.01, p=0.021, respectively) and was found higher than Group 4 in the nasal and inferior (p<0.001, p=0.006, respectively). At 2 mm posterior to the scleral spur; significant difference was observed between Groups 1 and 2 only in the inferior (p=0.002), between Groups 1 and 3 in the nasal and inferior (p=0.029, p=0.002), and between Groups 1 and 4 the in nasal and inferior (p=0.002, p<0.001).

Conclusion: The scleral thickness measured from 6 mm posterior to the scleral spur was higher in all quadrants in patients with severe OSAS. It is possible that the increase in scleral thickness, especially in severe OSAS, is due to extracellular matrix accumulation in the scleral tissue.

Purpose: To investigate the efficacy and safety of loading phase treatment with 3 monthly intravitreal injections of aflibercept 8 mg for neovascular age-related macular degeneration (nAMD).

Study design: Retrospective, interventional case series.

Methods: We retrospectively analyzed 83 consecutive eyes of 80 patients with treatment-naïve nAMD who received 3 monthly injections of aflibercept 8 mg as a loading phase treatment. Best-corrected visual acuity (BCVA), foveal thickness, central choroidal thickness (CCT), and dry macula achievement were all assessed every 4 weeks. Moreover, polypoidal lesion regression was evaluated after the loading phase.

Results: Seventy eyes (84.3%) of 67 patients completed the 3 monthly injections of aflibercept 8 mg. In these cases, BCVA was 0.33±0.45 at baseline and showed significant improvement to 0.22±0.38 at week 12 (P<0.01). Foveal thickness was 313±135µm at baseline, decreasing significantly to 171±76µm at week 12 (P<0.01). CCT was 193±98µm at baseline, decreasing significantly to 160±85µm at week 12 (P<0.01). Dry macula had been achieved in 58 (82.9%) of 70 eyes at week 12. Indocyanine green angiography after the loading phase revealed complete polypoidal lesion regression in 16 of 22 eyes (72.7%) with polypoidal lesions. Among the 13 eyes (15.7%) not completing the loading phase treatment, 9 (10.8%) developed non-infectious intraocular inflammation (IOI) associated with retinal vasculitis and aflibercept 8 mg administration was thus discontinued.

Conclusions: Loading phase treatment with intravitreal aflibercept 8 mg appears to be effective for improving visual acuity and ameliorating exudative changes in eyes with nAMD. However, careful monitoring is required due to the potential development of IOI associated with retinal vasculitis.

Purpose: The speed of axial elongation typically slows during the growth phase; however, in some eyes, it accelerates, leading to myopia progression during school age. This study examined the association between ocular biometrics and the acceleration of axial elongation (AAE) in children.

Study design: Longitudinal, prospective, observational study METHODS: This cohort study included 67 right eyes of elementary school children, tracked over six years (from ages 8.5 to 14.5). Annual measurements were conducted for optical axial length, anterior chamber depth, and lens thickness. Yearly axial elongation was calculated for each time period, and AAE was estimated using regression analysis coefficients. Spearman's correlation was used to evaluate the association between AAE and ocular biometric parameters measured in the first year.

Results: The average axial length in the initial year was 23.37 ± 0.89 mm. By the sixth year, the mean axial elongation reached 1.50 ± 0.49 mm, while the average AAE was recorded as -0.015 ± 0.048. AAE was significantly correlated with first-year axial length (r = - 0.40, p < 0.001), anterior chamber depth (r = 0.33, p = 0.007), and lens thickness (r = - 0.42, p < 0.001).

Conclusion: Some eyes with hyperopic ocular biometry at 8.5 years of age exhibited accelerated axial elongation during school age. Future research on myopia should consider both acceleration and axial elongation.

Purpose: To evaluate the repeatability of the binocular Esterman visual field (bEVF) test and develop a corresponding reliability criterion based on repeatability-associated factors.

Study design: Prospective cross-sectional study.

Methods: Ninety-five glaucoma patients underwent two bEVF tests on the same day using a Humphrey field analyzer. The repeatability of the bEVF was assessed by the agreement rate for seen and unseen points over all test points between the first and second tests. Factors associated with the repeatability were analyzed with multivariate linear regression analysis. Receiver operating characteristic (ROC) curve analysis was performed for those associated factors to identify the reliability criterion.

Results: The mean agreement rate was 88.9% (95% confidence interval [CI]: 73.9%, 99.2%). A total of 44 patients (46.3%), 75 patients (78.9%), and 88 patients (92.6%) had agreement rates of more than 90%, 85%, and 80%, respectively. The false positive (FP) response rate of the bEVF test was negatively associated with the agreement rate (p<0.01). The best cutoff value according to the maximum Youden index for the FP response rate of the bEVF test was >7.1% (sensitivity = 71.0% and specificity = 88.0%), while the cutoff value based on a fixed 95% specificity was >12.1% (sensitivity = 28.6%).

Conclusion: An approximately 90% agreement rate existed for the bEVF test when applied to glaucoma patients. The FP response rate was associated with the repeatability of the bEVF test, and 8% or at least 13% may serve as a useful reference to ensure an agreement rate of 80% or higher.

Purpose: This study evaluated the anatomical and functional outcomes in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) who were switched from conventional anti-vascular endothelial growth factor (VEGF) agents to faricimab.

Study design: Retrospective observational study.

Methods: This study included 42 eyes from 42 patients treated at Hikichi Eye Clinic between April and August 2024. All patients had relapsed ME despite prior treatment with aflibercept and were switched to intravitreal faricimab (6.0 mg). The primary endpoints included best-corrected visual acuity (BCVA), central foveal thickness (CFT), and intravitreal injection intervals over six months.

Results: The mean (± standard error) CFT significantly decreased from 356 ± 23 μm to 214 ± 3 μm at one month (p < 0.01) and remained stable at the final visit (205 ± 4 μm). Logarithm of the minimum angle of resolution (logMAR) BCVA improved from 0.16 ± 0.03 to 0.04 ± 0.03 at one month (p < 0.01) and remained at 0.02 ± 0.02 at the final visit. The mean injection interval was significantly extended from 12.3 ± 0.4 weeks to 16.2 ± 0.5 weeks (p < 0.01).

Conclusion: Faricimab improved anatomical and functional outcomes while extending treatment intervals in ME secondary to RVO. Further large-scale, prospective, and long-term follow-up studies are needed to confirm these findings.