Japanese Journal of Ophthalmology最新文献

Purpose: To investigate the presence and characteristics of mitochondria-associated membranes (MAMs) in Fuchs endothelial corneal dystrophy (FECD) and to assess the relationship between endoplasmic reticulum (ER) stress and MAM formation in corneal endothelial cells, given the established roles of mitochondrial dysfunction and ER stress in FECD pathogenesis.

Study design: Experimental laboratory investigation.

Methods: Corneal endothelial tissues from FECD patients and controls were examined by use of transmission electron microscopy to evaluate the ultrastructural features of mitochondria-ER contacts. An established FECD cell model was used for immunofluorescence colocalization analysis and protein expression profiling. Experimental models of protein misfolding (MG132) and direct ER stress induction (tunicamycin) were implemented to explore the relationship between ER stress and MAM formation.

Results: The FECD specimens exhibited extensive mitochondria-ER contacts with evident tethering complexes and distances reduced to <20 nm when compared with normal corneal endothelium. Quantitative analysis showed significantly increased mitochondria-ER colocalization in iFECD cells (P <0.01). The FECD cell model showed significant upregulation of MAM-associated proteins, including GRP75, Mfn1, Mfn2, Sigma1 receptor, VDAC, and IP3R. MG132 and tunicamycin treatments both increased MAM formation while activating all UPR pathways.

Conclusions: This study provides the first evidence of enhanced MAM formation in FECD and identifies ER stress as a key driver of this structural change. While these findings suggest a potential role for MAMs in linking ER stress and mitochondrial dysfunction in FECD pathogenesis, further investigation is needed to clarify whether such changes are protective adaptations or whether they contribute to disease progression.

Purpose: Neovascular age-related macular degeneration (nAMD) can cause vision loss and irreversible blindness. However, its treatment needs to be improved. This study aimed to evaluate the 1-year treatment outcomes in patients with nAMD after switching from 2 mg aflibercept to faricimab.

Study design: Retrospective observational study.

Methods: We included 83 eyes of 83 patients with nAMD who switched from 2 mg aflibercept to faricimab to extend the administration interval or eliminate exudative changes, with ≥ 1 year of follow-up. We retrospectively examined the 1-year treatment outcomes after switching, with the time of switching as the baseline.

Results: After switching, the mean log minimum angle of resolution best corrected visual acuity was significantly improved from 0.35 to 0.33 (p = 0.0498), and the mean central retinal thickness was significantly reduced from 302 μm to 237 μm (p < 0.0001). A significant reduction was observed in the incidence of subretinal fluid, intraretinal fluid, and subretinal pigment epithelial fluid (p < 0.05). The mean dosing interval was significantly extended from 5.58 weeks to 9.69 weeks (p < 0.0001). One year after switching, 66 eyes (80%) continued receiving faricimab, while 17 eyes (20%) were switched to other drugs owing to worsening exudation or other reasons.

Conclusion: One year after switching treatment for nAMD from 2 mg aflibercept to faricimab, visual acuity and macular morphology were improved, and the treatment interval was extended. The study's findings could help develop strategies for improving nAMD.

Purpose: To evaluate the therapeutic efficacy of limbal-rigid contact lens (CL) wear in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)-related ocular sequelae and to identify factors associated with visual acuity outcomes.

Study design: Retrospective interventional case series.

Methods: 20 patients (23 eyes) with stable SJS/TEN-related ocular surface disease underwent limbal-rigid CL therapy. Patients were stratified into two groups based on baseline best-corrected visual acuity (BCVA): Group 1 (logMAR >1.0, 16 eyes) and Group 2 (logMAR ≤1.0, 7 eyes). BCVA, subjective dryness scores, and objective ocular findings were assessed at baseline and at 1-, 3-, and 6-months post-initiation. Correlations between BCVA at 6 months and baseline ocular findings were analyzed. Bonferroni correction was applied for multiple comparisons.

Results: All patients completed six months of CL wear without serious complications. Group 1 exhibited significant improvement in BCVA, from 1.65±0.45 to 0.98±0.52 immediately after CL wear, with sustained gains throughout follow-up (P < 0.01). Group 2 showed stable BCVA with moderate early effect sizes that did not reach statistical significance. Significant improvements in subjective dryness were observed only in Group 1. A moderate correlation between BCVA at 6 months and upper tarsal scarring was noted, although it did not reach statistical significance after correction.

Conclusions: Limbal-rigid CL therapy appears safe and effective for visual rehabilitation in SJS/TEN-related ocular sequelae, particularly in severe cases. Upper eyelid scarring may influence visual outcomes and warrants further investigation.

Purpose: To investigate paracentral stereopsis in glaucoma patients with localized visual field (VF) defects using a novel assessment method.

Study design: A pilot study METHODS: Three glaucoma patients had an absolute scotoma (0 dB) in the superior visual field of one eye, with preserved inferior VF sensitivity bilaterally. Best-corrected visual acuity was ≥1.2 (≤-0.1 logMAR) and stereopsis was ≤120 arcseconds on a random dot stereograms (RDSs) test, without manifest strabismus. Paracentral stereopsis thresholds were measured using the Stereo Eccentricity Analysis (SEA) program implemented in the binocular open field imaging system imovifa^@. Seventeen test points within the central 15° VF locations, including the fovea, were tested with circular stereoscopic stimuli (200-3000 arcsec disparity) on a RDSs background for 500 ms, with size adjusted by eccentricity.

Results: The mean binocular sensitivity for the superior field with a 0 dB scotoma was comparable to the monocular sensitivity for the superior field of the normal eye. Despite the preserved binocular sensitivity, however, paracentral stereopsis could not be confirmed in the affected superior field. In the normal inferior fields of the two eyes, paracentral stereopsis was detected, and higher stereopsis thresholds were observed with increasing eccentricities. These results were observed in all three cases.

Conclusion: In glaucoma patients, paracentral stereopsis was absent in the corresponding area of the VF defect regardless of the preserved binocular sensitivity. Its assessment may contribute to providing insight into functional vision loss beyond central stereopsis.

Purpose: OQrimo^® is a robotic assistant system that supports vitreoretinal surgery by holding an intraocular endoscope or illumination device to assist the surgeon. In April 2023, Japan approved this system, and as the world's first clinical institution to implement OQrimo^®, we aimed to evaluate its safety and clinical utility.

Research design: Retrospective case series METHODS: The study analyzed all vitreoretinal surgery utilizing OQrimo^® at Kyushu University Hospital between December 1, 2023 and November 31, 2024. Data collection included patient demographics, preoperative diagnoses, surgical procedures, equipment used, surgical records, and perioperative complications. We analyzed OQrimo's safety profile and patterns of clinical use based on these data.

Results: Eight eyes from eight patients were included. Preoperative diagnoses included proliferative vitreoretinopathy, panuveitis, acute retinal necrosis, macular hole, and secondary glaucoma due to uveitis. The purpose of pars plana vitrectomy included silicone oil removal, vitreous biopsy, internal limiting membrane peeling, and Ahmed valve implantation via pars plana. OQrimo^® maintained stable endoscope positioning in all cases, enabling observation of the peripheral retina without scleral indentation. In seven cases, OQrimo's endoscopic visualization and a wide-viewing system were used simultaneously. No intraoperative or postoperative complications were observed in any case.

Conclusion: We confirmed the safety of OQrimo^® during its initial clinical application. The system facilitated the observation of the peripheral retina using an intraocular endoscope without scleral indentation.

Purpose: To investigate the association between vascular factors affecting optic nerve perfusion and glaucoma progression in a clinical setting with systematic monitoring of blood pressure and intraocular pressure (IOP).

Study design: Retrospective cohort study.

Methods: This retrospective study analyzed 428 primary open-angle glaucoma (POAG; n=295) and exfoliation glaucoma (EXG; n=133) patients from Shimane University Hospital. We employed a validated Bidirectional Encoder Representations from Transformers (BERT)-based natural language processing system to extract clinical data from electronic medical records of 36,561 visits, including blood pressure measurements, IOP, and medication details across 216 clinical parameters. Mixed-effects regression models were employed to identify factors associated with visual field mean deviation (MD) and the rate of MD decline.

Results: The cohort demonstrated consistent pressure management (median IOP: 13.0 mmHg; median systolic: 138.0 mmHg; median diastolic: 79.0 mmHg). Ocular perfusion pressure (OPP) showed no significant association with either visual field MD or the rate of MD decline. Significant predictors of worse visual field MD included age (coefficient: -0.28, 95% CI -0.33 to -0.23, p<0.001), history of filtration surgery (coefficient: -3.8, 95% CI -5.7 to -1.9, p<0.001), and number of glaucoma medications (coefficient: -0.19, 95% CI -0.35 to -0.030, p=0.020). Factors significantly associated with faster MD decline were age, initial MD severity, and medication burden.

Conclusions: In a clinical setting with systematic monitoring, OPP provided limited prognostic value for glaucoma progression, while traditional clinical factors were stronger predictors. Our BERT-based approach demonstrates how artificial intelligence (AI)-powered data extraction enables comprehensive analyses of clinical records, offering new insights for routine ophthalmological care.

Purpose: To evaluate the clinical performance of a hydrophobic acrylic toric intraocular lens (IOL) with double C-loop haptics in a Japanese population with cataracts.

Study design: Prospective METHODS: The PODEYE TORIC IOL (POD T 49P) was implanted in 58 eyes from 42 patients diagnosed with bilateral cataracts with corneal astigmatism. Thirty-one eyes received IOLs with cylinder powers of 1.50 to 6.00 D (group A), and 27 eyes received IOLs with 1.00 D cylinder (group B). Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and refractive cylinder were examined postoperatively. The primary endpoints, which were the non-inferiority of UDVA in group A and superiority of the refractive cylinder in group B, were examined and compared with relevant previous data.

Results: In group A, the mean preoperative corneal astigmatism was 1.87±1.01 D and postoperative logMAR UDVA and CDVA were -0.023±0.110 and -0.102±0.079, respectively. There were 23 eyes (74.2%) with UDVA of 0.0 logMAR or better, while the refractive cylinder was - 0.39±0.39 D. In group B, the preoperative corneal astigmatism of 0.73±0.22 D and postoperative logMAR UDVA and CDVA were -0.074±0.091 and -0.096±0.075, respectively; 23 eyes (85.2%) obtained a UDVA of 0.0 logMAR or better. The postoperative refractive cylinder was -0.16±0.23D. The non-inferiority of UDVA in group A and the superiority of the refractive cylinder in group B were verified with previous data.

Conclusion: The PODEYE TORIC IOL with 1.00-6.00 D cylinder powers and double C-loop haptics effectively corrected corneal astigmatism in Japanese patients after cataract surgery.

Trial registration number: NCT04699266 (Clinicaltrials.gov).

Purpose: To compare anterior segment parameters in healthy children of the same age with those in children with phenylketonuria (PKU).

Study design: Retrospective observational study METHODS: Data from 25 eyes of PKU patients (study group) and 60 eyes of age- and gender-matched children (control group) were analyzed. The records reviewed included results from a comprehensive ophthalmic evaluation that each participant had previously undergone. This evaluation included refraction evaluation (spherical equivalent), best corrected visual acuity (BCVA) testing, slit-lamp biomicroscopy, fundus examination, intraocular pressure (IOP) measurement, specular microscopy, and corneal topography measurement.

Result: Forty-five (52.9%) age- and sex-matched participants were girls and 40 (47.1%) were boys. The percentage of hexagonal cells (HEX) was 65.53±8.17 in the study group and 69.75±4.19 in the control group (p=0.021). Flat keratometry (K1) was 41.70±1.54 D in the study group and 43.16±1.52 D in the control group (p=0.002). Steep keratometry (K2) was 42.55±1.83 D in the study group and 43.91±1.73 D in the control group (p=0.013).

Conclusion: This study shows that patients with pediatric PKU have differences in the anterior segment parameters, including keratometric values and HEX, when compared with healthy controls.

Purpose: To determine whether a white cataract (WC) with elevated intralenticular pressure (EWC) can be distinguished from one with normal intralenticular pressure (NWC) using an optical biometer based on Swept-Source Optical Coherence Tomography (SS-OCT).

Study design: Retrospective observational study METHODS: Patients with a WC who had undergone phacoemulsification and intraocular lens (IOL) implantation at Iwate Medical University Hospital were enrolled. Using surgical videos, WCs with/without leakage of the liquefied cortex or bulging of the swollen cortex were classified as EWC and NWC, respectively. Both groups were compared in terms of age, sex, ocular comorbidities, various parameters, and the presence of characteristic appearances of the liquefied cortex on SS-OCT images. If the parameters were not measured appropriately, remeasurement using SS-OCT images were performed.

Results: Of the 48 patients with a WC, 26 eyes were classified as having an EWC, and 22 as NWC. There were significant differences in lens thickness (LT), anterior chamber depth (ACD), ΔLT, ΔACD (the differences in LT or ACD between the eyes with a WC and the fellow eyes, respectively), and age between an EWC and an NWC. ROC analysis showed that the AUC values of LT, ΔLT, and ΔACD were higher than 0.970. LT required remeasurement in approximately half of the WC, whereas ACD did not. Image evaluation for detecting an EWC had a sensitivity of 88.5% and a specificity of 90.9%.

Conclusions: An optical biometer based on SS-OCT may detect an EWC using LT, ΔLT, ΔACD, and SS-OCT images.

Purpose: This single-center retrospective study aimed to identify independent predictors of retinopathy of prematurity (ROP) treatment by integrating continuous pulse oximetry (SpO₂) data with comprehensive laboratory parameters.

Study design: Single-center retrospective cohort study.

Methods: We analyzed 244 neonates (gestational age < 34 weeks or birth weight < 1800 g) admitted between 2019 and 2023, excluding those with major genetic abnormalities. Logistic regression assessed associations between birth weight (BW), average SpO₂ at birth, hemoglobin (Hb), albumin (Alb), and selected inflammatory markers (e.g., neutrophil-to-lymphocyte ratio) with ROP treatment. Model discrimination was evaluated via receiver operating characteristic curves.

Results: Of the 244 infants, 16.8% required treatment (laser therapy or anti-VEGF injections). Lower BW and lower Hb were significantly associated with treatment (P <0.05). In the final multivariable model, BW and Hb emerged as key predictors (AUC = 0.884; accuracy = 88%), while Alb and inflammatory indices were not independently significant. Predicted treatment probabilities decreased markedly as BW and Hb increased.

Conclusion: BW and Hb were primary predictors of ROP treatment necessity in this cohort, whereas Alb and inflammatory markers did not show independent associations. Incorporating continuous SpO₂ monitoring provided valuable respiratory insights. Further prospective, multicenter studies are warranted to validate these findings and refine ROP risk stratification strategies.