Japanese Journal of Ophthalmology最新文献

Purpose: To investigate the long-term efficacy of accelerated corneal cross-linking (CXL) with Belin ABCD progression display in pediatric keratoconus patients.

Study design: Retrospective observational cohort study.

Methods: This retrospective study included 40 eyes of 40 pediatric keratoconus patients who underwent accelerated CXL (10 min/9 mW/cm²) and were followed at least 60 months after CXL. Corrected distance visual acuity, keratometry (K), anterior elevation, posterior elevation, asphericity, corneal densitometry, Belin/Ambrósio enhanced ectasia display and ABCD progression display values ​were recorded at baseline and 12 and 60 months after CXL.

Results: Iimprovements in visual acuity, gauged by regression in anterior curvature, progression in posterior curvature and corneal thickness, were observed using the ABCD progression display at the end of the 60 months follow-up. Significant improvements in K1, K2, maximum keratometry, anterior elevation and anterior asphericity values and significant worsening in the posterior elevation values were observed with topographical parameters. Significant thinning in pachymetric indices was observed with Belin/Ambrósio enhanced ectasia display.

Conclusion: Accelerated CXL is efficient in pediatric keratoconus patients in halting the disease progression. Visual and keratometric stabilization continued over a long follow-up period of 60 months. Belin ectasia progression display may be very helpful in the longitudinal follow-up of pediatric keratoconus patients after CXL.

Purpose: Rapid diagnosis and initiation of treatment are essential to improve outcomes for optic neuritis. However, many patients suspected of having optic neuritis may have different underlying conditions. This study aimed to investigate the spectrum of diseases in patients referred with suspected optic neuritis and to identify clinical factors associated with confirmed optic neuritis.

Study design: Retrospective cohort study METHODS: This study retrospectively reviewed 255 cases referred to Kobe University Hospital with suspected optic neuritis between January 2016 and June 2024. Cases were excluded if patients had a history of optic neuritis, encephalitis, or myelitis, were referred from non-ophthalmology departments, or resided outside Hyogo Prefecture. Logistic regression analysis was conducted to identify factors significantly associated with confirmed optic neuritis.

Results: Of the 206 eligible cases, 89 (43.2%) were confirmed to have optic neuritis. Other major diagnoses included anterior ischemic optic neuropathy (18.4%), space-occupying lesions such as intracranial tumors (11.7%), and retinal diseases or uveitis (10.2%). Logistic regression analysis revealed significant associations between confirmed optic neuritis and younger age, the presence of central scotoma, eye pain, decreased visual acuity, reduced critical flicker fusion frequency, and a shorter interval between symptom onset and consultation.

Conclusion: Although 43.2% of suspected cases were confirmed as optic neuritis, a substantial proportion was attributed to other conditions requiring distinct diagnostic and therapeutic approaches. These findings emphasize the critical role of multidisciplinary collaboration and evidence-based protocols in managing patients with acute visual impairment.

Purpose: Cataract, a clouding of the intraocular lens leading to blindness, is the most common eye disease globally. While whether and how circRNAs function in cataract is not fully understood.

Study design: Experimental study METHODS: We carried out circRNA RNA and lncRNA sequencing in a ribosome removal-specific transcriptome library. We then analyzed differentially expressed genes and their coding capacity. The enrichment results were visualized by use of the R ggplot2 package. KEGG pathway enrichment analysis was performed by use of the DAVID online tool. Quantitative real-time polymerase chain reactions (RT-PCR) were performed to verify the RNA levels of the top differentially expressed genes. The target genes miRNAs of circRNAs were found in circAtlas, and the targeted lncRNAs of miRNAs were searched in ENOCRI.

Results: We identified 86 differentially expressed known circRNAs and 612 lncRNAs in cataract lenses by use of RNA-sequencing. Functional annotation revealed that differentially expressed circRNAs might function through the Wnt signaling pathway and that lncRNAs may be enriched in the metabolic pathways, Wnt signaling pathway, focal adhesion, and ECM-receptor interaction pathways. The RT-PCR verification results showed that 7 circRNAs and 7 lncRNAs were consistent with the RNA-seq data. Translation prediction showed high scores for has_circ_0026233 and has_circ_0006388. Finally, we found that the hsa_circ_0006388-AC008738.7-miR-378g network is probably the key regulator of cataract formation.

Conclusion: This study identified the hsa_circ_0006388-AC008738.7-miR-378g network as possibly functioning in cataract formation, providing new intervention targets.

Purpose: To investigate macular hole (MH) development after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) and identify epiretinal membrane (ERM)-related factors contributing to MH formation.

Study design: Retrospective case series.

Methods: A retrospective analysis was performed on patients who underwent vitrectomy for RRD between January 2008 and December 2022 and subsequently developed ERM or MH requiring secondary surgery. Patients were categorized into two groups: ERM with MH progression (MH group, n=15) and ERM only (ERM group, n=25). Medical records were reviewed to identify potential risk factors including patient demographics, preoperative clinical findings, central macular thickness (CMT), and ERM characteristics using optical coherence tomography (OCT).

Results: CMT measured after ERM occurrence was significantly lower in the MH group (299.23 ± 69.56 μm) compared to the ERM group (445.8 ± 118.34 μm, p < 0.01). The MH group predominantly showed flat foveal contour, whereas the ERM group exhibited significant loss of foveal depression (p < 0.01). Epiretinal proliferation was observed in all MH group cases (100%) versus 24% in the ERM group (p < 0.01). The foveal crack sign was present in 73.3% of MH group cases but absent in the ERM group (p < 0.001).

Conclusion: Following successful RRD surgery, the occurrence of MH is a possiblity associated with specific OCT biomarkers. Our findings suggest that centrifugal tangential traction, distinct from conventional centripetal ERM formation, contributes to MH development after RRD repair.

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.