Japanese Journal of Ophthalmology最新文献

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.

Purpose: Using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25), to evaluate vision-related quality of life outcomes in patients with bullous keratopathy after cultured corneal endothelial cell (CEC) transplant.

Study design: Single-center prospective clinical trial METHODS: In this prospective, single-center study, 11 consecutive patients with bullous keratopathy underwent cultured CEC transplant. The NEI VFQ-25 was administered through in-person interviews by trained interviewers at baseline and at 24 weeks postoperatively. The NEI VFQ-25 comprises 12 subscales that assess different aspects of vision-related quality of life. Changes in composite and subscale scores were analyzed.

Results: The patients comprised 5 men and 6 women, with a mean age of 64.4 years (range 49-82 years). All the patients had pseudophakic bullous keratopathy, with Fuchs endothelial corneal dystrophy being the predominant underlying cause of disease (7 eyes). The NEI VFQ-25 composite score improved significantly from 61.8 ± 11.9 to 79.5 ± 8.0 (P <.01). Significant improvements were observed in general vision, ocular pain, near vision, social function, mental health, role limitations, dependency, and peripheral vision subscales (P <.05). General health, distance vision, driving, and color vision subscales showed minimal improvement.

Conclusions: Cultured CEC transplant significantly improved vision-related quality of life in patients with bullous keratopathy. The comprehensive improvement across multiple NEI VFQ-25 domains suggests that this novel therapeutic approach may be a viable treatment option for corneal endothelial dysfunction.

Purpose: To determine whether retro-mode scanning laser ophthalmoscopy (RMSLO) can detect optic disc abnormalities in highly myopic eyes.

Study design: A retrospective clinical study.

Methods: Patients with high myopia who had undergone RMSLO imaging and optic disc-centered optical coherence tomographic (OCT) examinations between July and September 2022 were studied. The existence and extent of the hyporeflective areas in the RMSLO images were determined. The OCT images were used to detect lamina cribrosa (LC) abnormalities, and the correspondence of the LC abnormalities to the location of the hyporeflective areas in the RMSLO images was determined.

Results: Thirty-eight eyes of 21 patients with high myopia were studied. The mean age of the patients was 58.6±12.3 years, and the mean axial length was 30.54±1.96 mm. Hyporeflective areas were detected on the optic nerve head in the RMSLO images in 37 eyes (97.4%). In these 37 eyes, OCT detected defects of the LC and enlarged LC pores corresponding to the hyporeflective areas. The maximum width of the LC abnormalities in the OCT images corresponded to the extent of the hyporeflective areas in the RMSLO images.

Conclusions: RMSLO can obtain images with hyporeflective areas on the optic disc in highly myopic eyes that correspond to areas of LC defects observed in the OCT images. RMSLO imaging can detect the enlarged LC pores as hyporeflective abnormalities. We conclude that RMSLO is helpful in detecting abnormalities of the LC of the optic disc.

Purpose: To examine the associations between work-family conflict, implicit gender bias, and turnover intention among hospital ophthalmologists.

Study design: Cross-sectional study.

Methods: We conducted a web-based questionnaire survey between January and February 2024. The participants were full-time ophthalmologists working in 37 hospitals in the Kanto region of Japan. We assessed the associations between work-family conflict, implicit gender bias, and turnover intention using multivariable regression analysis, with adjustments for job fit and position.

Results: We analyzed data from 74 ophthalmologists (mean age: 41.5 years, standard deviation: 10.8; 51.4% women). The median intention to leave score was 2.50 (interquartile range: 2.00-3.00). Work interference with family was significantly associated with turnover intention (adjusted difference: 0.30; 95% confidence interval: 0.075-0.53; p=0.010). However, family interference with work and implicit gender bias were not significantly associated with turnover intention.

Conclusions: This is the first study to examine the associations between work-family conflict, implicit gender bias, and turnover intention among Japanese hospital ophthalmologists. Work interference with family was associated with increased turnover intention but not with family interference with work or implicit gender bias.

Purpose: To identify predictors of the 2-year best-corrected visual acuity (BCVA) after subretinal tissue plasminogen activator (tPA) injection for massive submacular hemorrhage (SMH) complicating neovascular age-related macular degeneration (nAMD).

Study design: A prospective, observational study.

Methods: This study included consecutive eyes with massive SMH and nAMD that underwent vitrectomy with subretinal tPA injection and follow-up for 2 years. We analyzed the correlation between the 2-year BCVA and other parameters, including baseline BCVA, SMH height, SMH size, and SMH recurrence.

Results: This study analyzed 20 eyes of 20 patients (72.5 ± 7.2 years). Two years after surgery, the mean logarithm of the minimum angle of resolution (logMAR) BCVA changed from 0.72 (Snellen equivalent, 20/105) ± 0.40 at baseline to 0.80 (Snellen equivalent, 20/126) ± 0.92. The BCVA did not change significantly during the 2-year observation period (P = 0.39). Compared to baseline, the 2-year BCVA improved in 11 eyes (55%) and declined in 6 eyes (30%) by more than 0.30 logMAR, including all five eyes with recurrence. The 2-year BCVA was correlated only with recurrence (P < 0.001, β = 0.85).

Conclusions: This study suggests that recurrence was a robust determinant of poor 2-year BCVA after vitrectomy with subretinal tPA injection for SMH complicating nAMD and that subretinal tPA injection was effective in most cases, without recurrence. Our findings highlight the importance of establishing methods for preventing and controlling recurrence to maintain long-term BCVA.

Purpose: To evaluate the clinical outcomes of pneumatic retinopexy (PnR) for a recurrent rhegmatogenous retinal detachment (RRD) due to superior retinal breaks following initial vitrectomy for a RRD.

Study design: Clinical investigations.

Methods: A retrospective study of 82 eyes of 82 patients who underwent vitrectomy by a single surgeon between November 2021 and March 2023. PnR was performed on 4 (4.9%) of 11 eyes that developed a recurrent RD. The PnR procedure involved injecting sulfur hexafluoride gas into the vitreous cavity while the patient was in the lateral or in the supine position. The patient was placed in the prone position after the injection, and then laser photocoagulation was performed.

Results: A retinal reattachment was achieved in all four eyes that underwent rescue PnR. The gas infusion volume during the PnR was 4.3 to 5.6 ml for cases in which PnR was performed in the lateral position and 1.0 ml for a case in the supine position. The duration of the gas tamponade was 15 to 21 days for patients who had PnR in the lateral position and 11 days for patients who had PnR in the supine position. The best-corrected visual acuity after the treatment improved in all patients. No serious complications were associated with the PnR.

Conclusion: The results indicate that rescue PnR may be an effective treatment for a recurrent RRD due to superior retinal breaks after vitrectomy for a RRD to achieve retinal reattachment without reoperation or hospitalization.

Purpose: To evaluate the frequency, timing, and characteristics of intraocular pressure (IOP) spikes following standalone Gonioscopy-Assisted Transluminal Trabeculotomy (GATT), and to assess their predictors and management strategies.

Study design: A retrospective observational study.

Methods: A total of 210 eyes that underwent 360° GATT between September 2021 and January 2024 at our tertiary eye hospital were included. Demographics, best-corrected visual-acuity (BCVA), IOP, antiglaucoma medications, complications and interventions were recorded. IOP spikes were defined as >30 mmHg or >10 mmHg above baseline within two months postoperatively and classified as hyperacute (0-3 days), acute (4-9 days), or subacute (10-60 days). Surgical success was defined as IOP: 5-21 mmHg with ≥20% reduction from baseline. Primary outcomes included spike characteristics, associated factors, and success rates.

Results: Seventy-one eyes (33.8%) developed IOP spikes, with a mean IOP of 33.9±6.5 mmHg and duration of 2.0 ± 2.6 days. Hyperacute spikes had more fibrinoid reaction (p=0.026) and higher total success (p=0.049); acute spikes had higher maximal preoperative IOP and longer hyphema duration (p=0.02, p=0.006, respectively); and subacute spikes had prolonged topical corticosteroid use, longer axial length, and prior vitrectomy (p=0.003, p=0.04, p=0.004, respectively). Total surgical success was 91.9%, with higher rates in the non-spike group (99.3% vs. 77.5%, p<0.001). Fibrinoid reaction, prolonged topical corticosteroid use, and prior vitrectomy were associated with postoperative IOP spikes.

Conclusion: Postoperative IOP spikes are significantly correlated with surgical failure following GATT. Their timing might reflect differences in underlying mechanisms. Prompt management of complications associated with IOP spikes is essential to reduce failure.

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 investigate and analyze gender-related differences in myopia prevalence and factors associated with myopia progression in school-aged children.

Study design: Observational study.

Methods: This study involved 2,298 eyes (boys = 1194 eyes; girls=1104 eyes) of 1149 school children (597 boys; 552 girls) in two elementary/junior high schools in Kyoto Japan, examined from 2013 through 2022. Gender differences in all grades were evaluated in regard to subjective and objective refractive error (RE), axial length (AL), corneal keratometry, higher-order aberrations (HOAs), and a questionnaire regarding environmental factors of myopia progression.

Results: In the girls in all grades, corneal keratometry was steeper and AL was shorter (p<0.05), coma-like and total aberration (in 6mm) corneal HOAs, coma-like, spherical-like, and total aberration (in 6mm) ocular HOAs were larger (p<0.05), in addition, only spherical aberration (in 4mm) corneal HOAs were smaller. In all grades, no gender-related differences were found in myopia prevalence (Grade 1: boys = 6.1%; girls = 6.5%, Grade 9: boys = 60.4%; girls = 65.4%) as well as RE. The questionnaire findings revealed that in all grades the girls spent more time reading and less time playing mobile-phone-app games (p<0.001).

Conclusions: In Japanese school children, AL was shorter in the girls than in the boys, although, no gender-related differences were observed in myopia prevalence. The steeper cornea in girls might be associated with that discrepancy, and partially with gender differences of HOAs. Gender-specific differences of AL and HOAs should be considered in the analysis of myopia progression in school-aged children.