Jpn. J. Ophthalmol. [JOURNAL]
Sun
200 papers
Intravitreal aflibercept 8 mg in patients from Japan with neovascular age-related macular degeneration: 48-week subgroup analysis of the PULSAR trial.
Koizumi H, Honda S, Yasukawa T … +17 more , Kishino G, Sekiryu T, Schulze A, Yamashita T, Schmidt-Ott U, Zhao M, Zhang X, Berliner AJ, Chu KW, Reed K, Cheng Y, Bhore R, Vitti R, Fujita I, Leal S, Iida T, PULSAR investigators
Jpn J Ophthalmol · 2026 Jan · PMID 41452565 · Full text
PURPOSE: To evaluate the 1-year efficacy and safety of aflibercept 8 mg compared with aflibercept 2 mg in a pre-specified analysis of patients from Japan with neovascular age-related macular degeneration (nAMD) included...
PURPOSE: To evaluate the 1-year efficacy and safety of aflibercept 8 mg compared with aflibercept 2 mg in a pre-specified analysis of patients from Japan with neovascular age-related macular degeneration (nAMD) included in PULSAR. STUDY DESIGN: PULSAR (NCT04423718) was a global, phase 3, randomized, double-masked, non-inferiority study of adults with nAMD. Patients were randomized 1:1:1 to receive aflibercept 8 mg every 12 weeks (8q12), or every 16 weeks (8q16), or aflibercept 2 mg every 8 weeks (2q8), following three initial monthly doses in all groups. METHODS: This subgroup analysis of Japan and non-Japan cohorts from PULSAR evaluated changes from baseline in best-corrected visual acuity (BCVA), central subfield retinal thickness, durability and safety outcomes. RESULTS: In the Japan subgroup, least squares (LS) mean (95% CI) changes from baseline in BCVA at week 48 were +6.5 (+0.7, +12.3), +7.9 (+5.1, +10.6), and +4.7 (-0.5, +9.9) letters for patients in the 8q12 (n = 31), 8q16 (n = 33), and 2q8 (n = 33) groups, respectively. The majority of patients in the 8q12 (82.1%) and 8q16 (93.8%) groups maintained their randomized dosing intervals through Week 48. Ocular treatment-emergent adverse events were reported in 35.5%, 30.3%, and 39.4% of patients in the Japan subgroup in 8q12, 8q16, and 2q8 groups, respectively. Similar efficacy and safety results were observed in the non-Japan subgroup. CONCLUSION: Aflibercept 8 mg has similar efficacy and safety to aflibercept 2 mg when administered at extended dosing intervals in both the Japan and non-Japan subgroups, consistent with the overall PULSAR results.
Choroidal fibrosis in secondary focal choroidal excavation detected by polarization-sensitive OCT: a report of two cases.
Sonoda S, Okamura K, Terasaki H … +3 more , Yamanari M, Totani K, Sakamoto T
Jpn J Ophthalmol · 2026 May · PMID 41442100 · Publisher ↗
BACKGROUND: Focal choroidal excavation (FCE) is a rare chorioretinal abnormality with unclear pathophysiology. Identifying structural alterations in the choroid may provide insights into disease progression and potential...
BACKGROUND: Focal choroidal excavation (FCE) is a rare chorioretinal abnormality with unclear pathophysiology. Identifying structural alterations in the choroid may provide insights into disease progression and potential therapeutic approaches. In this study, we aimed to evaluate fibrotic tissue within secondary FCE using polarization-sensitive optical coherence tomography (PS-OCT). CASES: Two men (aged 73 and 74 years) with secondary FCE associated with macular neovascularization (MNV) and pachychoroid spectrum disease were included. OBSERVATIONS: PS-OCT revealed distinct birefringence within the excavation area and adjacent choroid. The fibrous components showed multidirectional orientation, and in both cases fibrotic tissue was consistently observed at the excavation margins. A characteristic pattern of vertically aligned fibrous elements was identified, suggesting that fibrous tissue deposition plays a role in the structural remodeling process of secondary FCE. CONCLUSIONS: PS-OCT enables detection of fibrotic remodeling in secondary FCE, offering new insights into its pathogenesis and clinical significance. Further studies are needed to clarify the clinical implications of these findings and their potential role in disease management.
Use of brolucizumab in refractory neovascular age-related macular degeneration: characteristics and biomarkers of intraocular inflammation from an Asian real-world study.
Chang CP, Hwang YS, Chou HD … +13 more , Yeung L, Kang EY, Wu WC, Lai CC, Liu L, Wu JS, Chen KJ, Chao AN, Lin JY, Chen YT, Tsai TH, Ho MC, Chen YH
Jpn J Ophthalmol · 2026 May · PMID 41372725 · Publisher ↗
PURPOSE: To investigate the clinical features and biomarkers associated with intraocular inflammation (IOI) following brolucizumab treatment in Asian switched neovascular age-related macular degeneration (nAMD) patients....
PURPOSE: To investigate the clinical features and biomarkers associated with intraocular inflammation (IOI) following brolucizumab treatment in Asian switched neovascular age-related macular degeneration (nAMD) patients. STUDY DESIGN: Multi-center, retrospective cohort study. METHODS: This study included 109 eyes from 93 nAMD patients switched from other anti-vascular endothelial growth factor (VEGF) agents to brolucizumab (Beovu) without loading. Baseline characteristics, IOI timing, initial symptoms, and risk factors were assessed. RESULTS: IOI was observed in 17 eyes from 14 patients, including anterior uveitis (AU, n = 7), intermediate uveitis (IU, n = 5), and panuveitis with or without retinal vasculitis (RV, n = 5). Two eyes were asymptomatic. The median duration for IOI onset was 26 days, with 11 of 17 eyes (82.4%) developing IOI before the third brolucizumab injection. Firth-penalized multivariate Cox regression analysis depicted that the total number of anti-VEGF injections within one year prior to brolucizumab initiation (HR = 1.4, p = 0.009) and retinal angiomatous proliferation (RAP) (HR = 10.9, p = 0.009), may be associated with IOI development. In contrast, baseline macular neovascularization (MNV) size and the presence of retinal pigment epithelial and outer retinal atrophy were not associated with IOI occurrence. CONCLUSION: Vigilant examination after the initial brolucizumab injections is critical. Patients with identified risk factors may need meticulous monitor following brolucizumab injections.
Recent advances in the diagnosis and treatment of refractory ocular inflammatory diseases: focus on uveitic macular edema, acute retinal necrosis, and vitreoretinal lymphoma.
Takeda A, Yawata N, Sonoda KH
Jpn J Ophthalmol · 2026 Jan · PMID 41366138 · Full text
Refractory inflammatory ocular diseases-uveitic macular edema (UME), acute retinal necrosis (ARN), and vitreoretinal lymphoma (VRL)-pose significant diagnostic and therapeutic challenges due to their vision- or life-thre...
Refractory inflammatory ocular diseases-uveitic macular edema (UME), acute retinal necrosis (ARN), and vitreoretinal lymphoma (VRL)-pose significant diagnostic and therapeutic challenges due to their vision- or life-threatening nature and limited treatment options. UME, a leading cause of vision loss in intermediate, posterior, and panuveitis, affects approximately 40% of such cases, particularly in elderly patients and those with prolonged inflammation. Despite its prevalence, effective treatment is still being explored. ARN, caused by herpes viruses such as herpes simplex virus (HSV)-1, HSV-2, and varicella-zoster virus, ranks among the retinal diseases with the poorest visual prognosis; nearly half of patients experience a visual acuity (VA) of ≤ 0.1 within six months. However, a standardized treatment regimen has not yet been established. VRL, one of the ocular malignancies with the lowest overall survival rate, is frequently misdiagnosed as uveitis. Given the diagnostic delay and high frequency (60-85%) of central nervous system involvement-which is often directly life-threatening-early detection and comprehensive systemic management are essential. This review highlights recent advances in the diagnosis, clinical trials, and management of these three challenging ocular inflammatory diseases, emphasizing unmet needs and emerging therapeutic strategies.
Factors associated with patient-initiated discontinuation of anti-vascular endothelial growth factor therapy for diabetic macular edema: a real-world study in Japan.
Hasegawa T, Yagi R, Hirato M … +7 more , Fujita H, Sato T, Hiranuma Y, Tanaka Y, Kaburaki T, Kakehashi A, Nakagawa S
Jpn J Ophthalmol · 2026 May · PMID 41366137 · Publisher ↗
PURPOSE: To evaluate real-world adherence to anti-vascular endothelial growth factor (VEGF) therapy among Japanese patients with diabetic macular edema (DME) and identify demographic, clinical, and socioeconomic factors...
PURPOSE: To evaluate real-world adherence to anti-vascular endothelial growth factor (VEGF) therapy among Japanese patients with diabetic macular edema (DME) and identify demographic, clinical, and socioeconomic factors associated with treatment discontinuation. STUDY DESIGN: Retrospective, observational cohort study. METHODS: This study included 380 treatment-naïve patients with center-involved DME. Patients were categorized into continuation (those who maintained therapy) and self-discontinuation (those who discontinued therapy after at least one follow-up visit) groups. All patients were treated under a treat-and-extend regimen with one of five anti-VEGF agents (ranibizumab, aflibercept, brolucizumab, faricimab, or ranibizumab biosimilar) between January 2017 and December 2023. Univariate and multivariate logistic regression analyses identified independent predictors of treatment discontinuation. Pre- and post-treatment visual acuity and anatomic outcomes were assessed. RESULTS: Among 380 patients, 55 (14.5%) self-discontinued therapy. Younger age and poorer baseline best-corrected visual acuity were significantly associated with treatment discontinuation in both univariate and multivariate analyses. Furthermore, faricimab use increased the risk of discontinuation, whereas aflibercept use was associated with better adherence. CONCLUSION: The findings of this study underscore the importance of individualized patient management strategies to enhance long-term adherence to anti-VEGF therapy among patients with DME.
Comparison of surgical outcomes between iStent and iStent inject W with ≥2 years of follow-up: a propensity score matching analysis.
Kasai H, Ooka T, Kuleshov C … +4 more , Hasebe Y, Matsubara M, Kitamura K, Kashiwagi K
Jpn J Ophthalmol · 2026 May · PMID 41366136 · Publisher ↗
PURPOSE: To compare real-world outcomes between first-generation iStent (G1) and iStent inject W (G2) combined with cataract surgery. STUDY DESIGN: Retrospective, propensity score-matched clinical investigation. METHODS:...
PURPOSE: To compare real-world outcomes between first-generation iStent (G1) and iStent inject W (G2) combined with cataract surgery. STUDY DESIGN: Retrospective, propensity score-matched clinical investigation. METHODS: Consecutive eyes treated with phaco-iStent (G1) or phaco-iStent inject W (G2) were matched 1:1 (n=115 per group) for age, preoperative intraocular pressure (IOP), medication score, axial length, and glaucoma subtype. Longitudinal changes in IOP and medication score were analyzed using linear mixed models. Surgical success was evaluated by Kaplan-Meier analysis under three prespecified criteria (A/B/C), and Cox models were used to estimate hazard ratios (HRs). Corneal endothelial cell density (ECD) and perioperative complications were recorded. RESULTS: The baseline characteristics were balanced after matching. IOP decreased significantly from baseline at all visits in both groups except G1 at 24 months; the time-averaged IOP during follow-up was lower in G2 than in G1 (Δ=0.46 mmHg; p=0.018). The medication scores decreased postoperatively in both groups. Kaplan-Meier survival did not differ between devices (log-rank p=0.59, 0.996, and 0.509 for criteria A, B, and C, respectively). Lower preoperative IOP was consistently associated with higher failure risk according to Cox models. The generation effect was not significant, although a nonsignificant trend toward greater G2 benefit at lower IOP was observed under criterion A. The perioperative complication rates were similar. CONCLUSION: Both devices provided moderate reductions in IOP and medication burden with favorable safety. G2 achieved a statistically significant but small reduction in mean IOP over time, while the time-to-failure outcomes were comparable. Baseline IOP strongly influences success, underscoring the importance of patient selection.
Diffuse bilateral macular edema associated with omidenepag isopropyl in phakic eyes after laser iridotomy: a case report.
Kim DY, Kim JH
Jpn J Ophthalmol · 2026 May · PMID 41366135 · Publisher ↗
BACKGROUND: Omidenepag isopropyl is a selective prostanoid prostaglandin E receptor2 agonist; its association with macular edema has mainly been identified in pseudophakic eyes. Herein, we report a case of diffuse bilat...
BACKGROUND: Omidenepag isopropyl is a selective prostanoid prostaglandin E receptor2 agonist; its association with macular edema has mainly been identified in pseudophakic eyes. Herein, we report a case of diffuse bilateral macular edema caused by omidenepag isopropyl use in phakic eyes with a history of laser peripheral iridotomy. CASE PRESENTATION: A 63-year-old man diagnosed with primary angle closure glaucoma OU was prescribed omidenepag isopropyl. He had undergone laser iridotomy approximately 3 years prior to the omidenepag isopropyl prescription. After 4 months of using omidenepag isopropyl, he presented with blurred vision OU. Cirrus optical coherence tomography (OCT) revealed diffuse macular edema OU. Omidenepag isopropyl usage was discontinued, and bromfenac sodium hydrate was administered twice daily. After 2 months, the patient's visual discomfort improved, and a subsequent OCT examination confirmed a resolution of the macular edema. CONCLUSIONS: We report a case of diffuse bilateral macular edema development after omidenepag isopropyl use in a patient with glaucoma who had undergone bilateral laser peripheral iridotomy. This case demonstrates that macular edema can develop following the use of omidenepag isopropyl, even in phakic eyes. Notably, unlike most previous reports where the edema was typically cystoid in nature, this case showed diffuse retinal thickening with a preserved retinal contour. Given diffuse macular edema may affect the measurement of circumpapillary retinal nerve fiber layer (cpRNFL) thickness, caution is warranted whenever the use of omidenepag isopropyl in the management of glaucoma is considered.
Age-related optical changes: stability of coma and increased spherical aberrations in the cornea and whole eye.
Iwamoto Y, Koh S, Matsuo R … +3 more , Inoue R, Asonuma S, Nishida K
Jpn J Ophthalmol · 2026 May · PMID 41329389 · Publisher ↗
PURPOSE: To investigate whether higher-order aberrations (HOAs) in the anterior and posterior corneal surfaces and the entire eye vary with age. STUDY DESIGN: A prospective, cross-sectional study. METHODS: One hundred ey...
PURPOSE: To investigate whether higher-order aberrations (HOAs) in the anterior and posterior corneal surfaces and the entire eye vary with age. STUDY DESIGN: A prospective, cross-sectional study. METHODS: One hundred eyes from 100 participants, with 20 eyes per decade group (20s to 60s+), were assessed. Participants had no ocular diseases except refractive errors and mild cataracts, and no abnormalities on the anterior corneal surface, as assessed by Placido-based corneal topography. Corneal and ocular wavefront aberrations were measured with an integrated Scheimpflug tomographer/Hartmann-Shack wavefront aberrometer and analyzed over a 4-mm pupil. The root mean square values for total HOAs, spherical aberrations (SAs), and coma were calculated from the Zernike coefficients up to the 6th order. The total HOAs, SAs, and comas from the anterior corneal surface, posterior corneal surface, total cornea, and whole eye were compared across the age groups. The correlations between HOAs and age were also evaluated. RESULTS: Significant positive correlations with age were observed for the total HOAs and SAs in the anterior cornea (R=0.27, 0.29; P<0.01), total cornea (R=0.31, 0.34; P<0.01), and whole eye (R=0.48, 0.39; P<0.01). No significant correlations were found for coma in any region. Similarly, no significant correlations were observed for the total HOAs, SAs, or coma in the posterior cornea. CONCLUSION: Total HOAs and SAs in the anterior cornea, total cornea, and whole eye were significantly positively correlated with age, whereas coma exhibited no age-related changes. These findings underscore the importance of considering age-related optical changes in clinical evaluations.
Open globe injuries: clinical features and risk factors at a tertiary hospital in Vietnam.
Hoang PN, Xuan TH, Van HN … +4 more , Tuan SV, Minh TL, Bao CTN, Le HT
Jpn J Ophthalmol · 2026 May · PMID 41324843 · Publisher ↗
PURPOSE: To characterize the clinical features of open globe injury (OGI) in Vietnam and to identify risk factors associated with evisceration STUDY DESIGN: Prospective observational study METHODS: Ninety-two patients wi...
PURPOSE: To characterize the clinical features of open globe injury (OGI) in Vietnam and to identify risk factors associated with evisceration STUDY DESIGN: Prospective observational study METHODS: Ninety-two patients with OGI who presented to Cho Ray Hospital from August 2024 to May 2025 were prospectively enrolled. The demographic and clinical data were collected at presentation. Multivariable Firth logistic regression was used to identify independent predictors of evisceration. RESULTS: The majority of the patients were male, 78.3%, with a mean age of 39.5 years. Road traffic accidents were the most common cause of OGI. In those aged younger than 20 years, explosions were most frequent, whereas domestic incidents were more common in those aged older than 40 years. More than half of the eyes presented with no light perception. Evisceration was performed in 16.3% of the eyes. On multivariable analysis, zone III injury was associated with higher odds of evisceration (aOR 8.46, 95% CI 2.02-51.8), and increasing age was also associated with OGI (aOR per year 1.05, 95% CI 1.01-1.10). Trauma type, mechanism, and eyelid laceration were not associated with OGI. CONCLUSION: OGIs in Vietnam predominantly affect working-age males and are often caused by high-energy trauma such as motorcycle crashes and workplace incidents. Whilst the injuries were often severe, most eyes were anatomically salvaged. Zone III injury and older age were associated with increased risk of evisceration. These findings support the need for targeted prevention efforts and improved access to specialized eye trauma care in similar settings.
Evaluation of contamination in preservative-free multi-dose Brimonidine eye drops: a comparative study.
Karaca S, Sarmis A, Yilmaz OF … +4 more , Mutlu MA, Sahin ZB, Kaya SP, Oguz H
Jpn J Ophthalmol · 2026 May · PMID 41296207 · Publisher ↗
PURPOSE: To investigate the effectiveness of preservative-free multi-dose eye drop technology in preventing contamination. STUDY DESIGN: Prospective study METHODS: In this study, the caps, first and second drops of prese...
PURPOSE: To investigate the effectiveness of preservative-free multi-dose eye drop technology in preventing contamination. STUDY DESIGN: Prospective study METHODS: In this study, the caps, first and second drops of preservative-free multidose brimonidine (PF-MDB) and multidose brimonidine with purite preservative (P-MDB) used by 54 glaucoma patients were analysed on both chocolate and sheep blood agar. The patients used the drops at 3-week intervals. The contents of the eye droppers were examined for contamination by piercing the bottom of the eye dropper in accordance with aseptic techniques. RESULTS: The contamination levels detected using chocolate agar in the caps and the first drops of PF-MDBs were significantly higher than in P-MDBs (p=0.006 and p<0.001, respectively). The contamination levels detected using blood sheep agar in the caps and the first and second drops of PF-MDBs were significantly higher than in P-MDBs (p=0.001, ‹0.001, 0.006, respectively). No growth was found inside the eye dropper bottles of either PF-MDB or P-MDB drops. There was a significantly higher level of contamination in the first drops of PF-MDB compared to the second drops (p<0.001). CONCLUSION: PF-MDB bottle technology effectively prevents microbial contamination in the bottle without preservatives. However, due to the lack of a preservative, there is increased bacterial and fungal growth associated with contamination on the cap, as well as in the first and second drops, compared to P-MDB.
Clinical features and prognosis of immune checkpoint inhibitor-associated ocular inflammation in Japanese patients: a case series.
Yamae T, Aoyama Y, Izawa H … +4 more , Shen D, Nemoto H, Takase H, Tanaka R
Jpn J Ophthalmol · 2026 May · PMID 41273658 · Full text
PURPOSE: To investigate the clinical features of ocular inflammation caused by immune checkpoint inhibitors (ICIs) as immune-related adverse events (irAEs) in Japanese patients. STUDY DESIGN: Retrospective observational...
PURPOSE: To investigate the clinical features of ocular inflammation caused by immune checkpoint inhibitors (ICIs) as immune-related adverse events (irAEs) in Japanese patients. STUDY DESIGN: Retrospective observational case series. METHODS: We reviewed patients with ICI-associated ocular inflammation diagnosed at our institution in 2014-2024. Patient data-background characteristics, primary tumor, causative ICIs, time to onset, laterality, type of inflammation, irAE grade, treatment, visual outcomes, and complications-were analyzed. Stratified analyses were also performed according to the type of ICI. RESULTS: The cohort included 7 males and 9 females (mean age, 62.1 ± 14.3 years). The most common primary tumor was malignant melanoma (8 patients). The causative ICIs were pembrolizumab, nivolumab, and nivolumab plus ipilimumab (5, 6, and 5 patients, respectively). The median time of onset was 64 days (12-952) post-administration, with significantly earlier onset in patients receiving nivolumab plus ipilimumab. Ocular inflammation was bilateral in 13 patients. Panuveitis (10 patients) was the most common inflammation type, and 6 patients exhibited Vogt-Koyanagi-Harada (VKH) disease-like uveitis. Grade 3 irAEs were the most frequent (11 patients). ICIs were discontinued in 15 patients and 9 required systemic corticosteroids. At the final follow-up, visual acuity had generally improved; however, 4 patients had a best corrected visual acuity of 20/40 or worse due to complications. CONCLUSION: In Japanese patients reviewed at our institution, ICI-associated ocular inflammation often presented as panuveitis, with VKH disease-like uveitis being relatively common. Visual impairment persisted in one-fourth of the patients, emphasizing the importance of careful management.
Hypertensive phase after a novel small-lumen non-valved drainage device: predictive factors and two-year outcomes.
Franquesa-Garcia F, Labay-Tejado S, Ventura-Abreu N … +3 more , Izquierdo-Serra J, Opazo-Toro V, Milla E
Jpn J Ophthalmol · 2026 May · PMID 41269447 · Publisher ↗
PURPOSE: The hypertensive phase (HP) following the implantation of a glaucoma drainage device (GDD) is a clinical challenge. We aimed to evaluate the risk factors, clinical features, and correlation of the HP with effica...
PURPOSE: The hypertensive phase (HP) following the implantation of a glaucoma drainage device (GDD) is a clinical challenge. We aimed to evaluate the risk factors, clinical features, and correlation of the HP with efficacy in a cohort of glaucoma patients who received a Paul glaucoma implant (PGI). STUDY DESIGN: This was a single-center retrospective cohort study (Hospital Clínic of Barcelona). METHODS: Eighty-three eyes from 71 patients who underwent implantation of a PGI were included, with follow-up extending for up to 2 years. Intraocular pressure (IOP) was measured preoperatively, and at 1 day; 1 week; and 1, 3, 6, 12, and 24 months, postoperatively. Four different success criteria were established: criterion A: IOP <21 mm Hg; criterion B: <18 mm Hg; criterion C: <15 mm Hg; criterion D: <12 mm Hg. The numbers of postoperative IOP-lowering drops, complications, characteristics related to the presence or absence of an HP, and timing of prolene stent removal, among others, were recorded. RESULTS: We observed a total of 23 cases (27.7% with an HP). On multivariate analysis we identified younger age (P = .028) and elevated IOP 1 month after surgery (P = .001) as independent risk factors. IOPs were significantly higher (P <.05) in the HP group at 1 week and at 1, 3, and 6 months postoperatively. After 12 months of follow-up, no differences were found between the 2 groups. CONCLUSION: The occurrence of an HP with a PGI does not seem to impact surgical success beyond 12 months postoperatively. However, further research is needed to better understand the underlying mechanisms of HP development and its clinical impact.
Clinical characteristics and management of dupilumab-associated ocular surface disease in Japan.
Shoji J, Ebihara N
Jpn J Ophthalmol · 2026 Jan · PMID 41269446 · Full text
Dupilumab-associated ocular surface disease (DAOSD) is one of the most common adverse events associated with dupilumab (an anti-interleukin-4-receptor-alpha monoclonal antibody) during the treatment of patients with atop...
Dupilumab-associated ocular surface disease (DAOSD) is one of the most common adverse events associated with dupilumab (an anti-interleukin-4-receptor-alpha monoclonal antibody) during the treatment of patients with atopic dermatitis (AD). However, it rarely occurs in patients with bronchial asthma or chronic rhinosinusitis with nasal polyps. Adequate understanding of DAOSD is important for proper diagnosis and appropriate ophthalmic intervention. The aim of this review was to summarize and discuss the clinical characteristics and management of DAOSD in Japan. The pathogenesis of DAOSD can be explained by the dry eye disease, upregulated T helper 17 and 22 cells, and Demodex theories. The main symptoms of DAOSD are irritation/pain, redness, pruritus, discharge, and light sensitivity. Patients with AD and DAOSD as an adverse event develop various types of ocular surface disease, including blepharitis, blepharoconjunctivitis, conjunctivitis, keratoconjunctivitis, and keratitis. In ophthalmologic practice, to diagnose and treat DAOSD, physicians must understand the condition of the patient, make a differential diagnosis of conjunctivitis, determine concurrent dry eye, and assess DAOSD severity. Red flags for ophthalmologic intervention have been reported by organizations and institutions in various countries, which have highlighted the need for appropriate ophthalmologic intervention. Treatment of DAOSD involves topical treatments with artificial tears, antiallergic drugs, corticosteroids, and immunosuppressive drugs. In conclusion, patients with severe DAOSD require ophthalmologic intervention, and clinical collaboration between ophthalmologists and dermatologists is crucial for patients with AD during dupilumab treatment. This review can assist ophthalmologists in their daily practice and in their management of patients with DAOSD.
Involvement of best-corrected visual acuity in sarcopenia: findings from baseline analysis of the Kyotango longevity cohort study.
Yamashita Y, Kitazawa K, Okada H … +10 more , Ushigome E, Fukuoka H, Yoshii K, Yamanaka R, Iwamoto Y, Takahara S, Fukui M, Kinoshita S, Sotozono C, Matoba S
Jpn J Ophthalmol · 2026 May · PMID 41269445 · Publisher ↗
PURPOSE: To investigate the association between best-corrected visual acuity (BCVA) and sarcopenia in older adults, while the relationship between low visual acuity and age-related muscle decline remains unclear. STUDY D...
PURPOSE: To investigate the association between best-corrected visual acuity (BCVA) and sarcopenia in older adults, while the relationship between low visual acuity and age-related muscle decline remains unclear. STUDY DESIGN: Cross-sectional study. METHODS: This cross-sectional study included 874 participants in the Kyotango Longevity Cohort Study from August 2017 to June 2022. We analyzed the association between best-corrected visual acuity (BCVA) and the presence of sarcopenia, grip strength, gait speed, and skeletal muscle index (SMI) in older adults. Logistic regression analyses were performed with sarcopenia as the dependent variable and visual acuity as the independent variable, adjusted for age, sex, body mass index (BMI), HbA1c, smoking, exercise, and alcohol consumption. Decimal BCVA was converted to the logarithm of the minimum angle of resolution (logMAR) for statistical analyses. RESULTS: This cross-sectional study comprised 356 men and 518 women, with a median age of 72.0 years (range: 65-98 years). The prevalence of sarcopenia was 6.7% (24 cases) in the men and 5.2% (27 cases) in the women. Multivariate logistic regression analysis revealed a significant association between low visual acuity and sarcopenia for both sexes [odds ratio: 1.86, 95% confidence interval (CI): 1.23-2.81, p = 0.002 for men, and odds ratio: 1.45, 95% CI: 1.01-2.02, p = 0.038 for women). CONCLUSIONS: This study demonstrates a significant relationship between lower visual acuity and sarcopenia. These findings support maintaining visual acuity to prevent age-related decline of physical functions.
Subtype-specific shifts in age, axial length, and clinical profile of neovascular age-related macular degeneration: a five-year study in Japan.
Akada M, Hata M, Ideyama M … +5 more , Kido A, Miyata M, Tamura H, Ooto S, Tsujikawa A
Jpn J Ophthalmol · 2026 May · PMID 41217603 · Full text
PURPOSE: To evaluate 5-year temporal changes in baseline clinical characteristics-age, axial length, and best-corrected visual acuity-among treatment-naïve eyes with neovascular Age-Related Macular Degenaration (nAMD), c...
PURPOSE: To evaluate 5-year temporal changes in baseline clinical characteristics-age, axial length, and best-corrected visual acuity-among treatment-naïve eyes with neovascular Age-Related Macular Degenaration (nAMD), comparing pachychoroid neovasculopathy (PNV) with drusen-driven (non-PNV) nAMD at a Japanese tertiary center. STUDY DESIGN: Retrospective observational study. METHODS: Registry data from Kyoto University Hospital were analyzed for patients newly diagnosed with nAMD in 2013/2014 and in 2018/2019. Patients were classified as PNV or non-PNV based on findings derived from multimodal imaging-including optical coherence tomography, indocyanine-green angiography, and color fundus photography. Demographic data, axial length, best-corrected visual acuity (BCVA) at baseline and 1 year posttreatment, and the proportion of eyes achieving ≥0.20 logMAR improvement were compared over time. RESULTS: A total of 118 patients were included. In the non-PNV group, mean age rose from 74.35 ± 8.42 years to 77.39 ± 7.90 years (p = 0.021), whereas the PNV group showed a smaller, non-significant change from 68.88 ± 7.25 to 70.41 ± 9.19 years (p = 0.48). Among non-PNV cases, both mean age (p=0.021) and axial length (p=0.017) increased significantly over time. In contrast, PNV cases showed no significant changes in age or axial length. BCVA outcomes and the proportion of patients achieving ≥0.20 logMAR improvement were similar across time points within each subtype. Multivariable logistic regression analysis revealed no significant associations between visual improvement and year, subtype, age, or axial length. CONCLUSIONS: This study revealed an aging trend and axial elongation among non-PNV cases over time, underscoring a subtype-specific divergence in clinical trajectory.
Two-year outcomes of half-fluence photodynamic therapy combined with intravitreal aflibercept for treatment-naïve pachychoroid neovasculopathy.
Hoshino J, Matsumoto H, Numaga S … +2 more , Asatori Y, Akiyama H
Jpn J Ophthalmol · 2026 Mar · PMID 41212344 · Publisher ↗
PURPOSE: We previously reported 1-year outcomes of half-fluence photodynamic therapy (HFPDT) combined with intravitreal aflibercept (IVA) in treatment-naïve pachychoroid neovasculopathy (PNV). In this study, we evaluated...
PURPOSE: We previously reported 1-year outcomes of half-fluence photodynamic therapy (HFPDT) combined with intravitreal aflibercept (IVA) in treatment-naïve pachychoroid neovasculopathy (PNV). In this study, we evaluated the 2-year outcomes of HFPDT combined with IVA in treatment-naïve PNV without polypoidal lesions. STUDY DESIGN: Retrospective, interventional case series METHODS: We retrospectively studied 61 eyes with treatment-naïve PNV that received HFPDT combined with IVA and were followed for at least 2 years. Additional treatments were given if a dry macula was not achieved or if exudation recurred. We evaluated the best-corrected visual acuity (BCVA), foveal thickness (FT), central choroidal thickness (CCT), and macular neovascularization thickness (MNVT). Factors associated with additional treatment were also analyzed. RESULTS: BCVA was significantly improved at 1 year (P <.05), but not at 2 years (P = .07). FT, CCT, and MNVT significantly decreased throughout the study period (all P <.01). A dry macula without further treatment was maintained in 44% of the eyes. These eyes were significantly younger (P <.01), with lower MNVT (P <.01) and greater CCT (P <.05) at baseline. Logistic regression identified age and MNVT as significant factors for additional treatment. PDT-induced acute exudative maculopathy (PAEM) was observed in 26.5% of the eyes requiring additional treatment, but not in those without retreatment. CONCLUSION: HFPDT combined with IVA for treatment-naïve PNV maintained a dry macula for 2 years with initial treatment alone in 44% of the cases. Age, MNVT, and PAEM were associated with the need for additional treatment.
Binocular visual function of Japanese eyes with nondiffractive extended depth-of-focus intraocular lenses made of high water-content hydrophobic acrylic material.
Suzuki H, Ota Y, Hata S … +2 more , Minami K, Bissen-Miyajima H
Jpn J Ophthalmol · 2026 Mar · PMID 41186663 · Full text
PURPOSE: To prospectively evaluate bilateral visual function in Japanese patients implanted with nondiffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs). STUDY DESIGN: Multisite prospective observational...
PURPOSE: To prospectively evaluate bilateral visual function in Japanese patients implanted with nondiffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs). STUDY DESIGN: Multisite prospective observational study. PATIENTS AND METHODS: This study included 48 eyes of 24 Japanese patients with cataracts (mean age: 68.7 ± 9.2 years) who underwent bilateral implantation of nondiffractive EDoF IOLs CNAET0 (Clareon Vivity, Alcon), made of high-water-content hydrophobic acrylic material. Three months postoperatively, binocular uncorrected and distance-corrected visual acuities (BUCVA and BDCVA) were assessed at far, 66 cm, and 40 cm. Binocular photopic contrast sensitivity (CSV-1000), binocular defocus curves, spectacle independence, and photic phenomena (glare, halo, starburst, and waxy vision) were also assessed. RESULTS: The mean logMAR BUCVA/BDCVA was -0.11/-0.15 at far, 0.05/0.08 at 66 cm, and 0.18/0.22 at 40 cm. Binocular contrast sensitivity was within the normal range for individuals aged 60-69 years across all spatial frequencies. The mean defocus curve demonstrated 0.1 logMAR or better between -2.0 and +1.0 D addition, with better performance of 0.0 logMAR or better between -1.5 and +0.5 D addition. All patients were spectacle-independent for distance and intermediate vision, whereas nine of the 24 patients (37.5%) required spectacles for near vision. None of the patients reported severe photic phenomena; 17 patients (70.8%) did not experience glare or starburst, and 20 patients (83.3%) did not report halo or waxy vision. CONCLUSION: Bilateral implantation of nondiffractive EDoF IOLs provided good binocular functional vision from far to near, although some patients may require spectacles for near vision. The photic phenomenon was minimal.
Real-world outcomes of anti-VEGF and corticosteroid therapies for diabetic macular edema: up to 10 years of follow-up in Korean patients.
Choi SW, Lee SH, Kim MS
Jpn J Ophthalmol · 2026 May · PMID 41186662 · Publisher ↗
PURPOSE: To examine the long-term real-world outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) and corticosteroid injections in patients with diabetic macular edema (DME). STUDY DESIGN: Single-cente...
PURPOSE: To examine the long-term real-world outcomes of intravitreal anti-vascular endothelial growth factor (VEGF) and corticosteroid injections in patients with diabetic macular edema (DME). STUDY DESIGN: Single-center, retrospective study. METHODS: We reviewed the medical records of patients diagnosed with DME between January 2010 and December 2023. The number of anti-VEGF and corticosteroid injections, along with best-corrected visual acuity (BCVA) and central macular thickness (CMT), were collected and analyzed throughout the follow-up period. RESULTS: A total of 574 patients (774 eyes) were included, with a mean follow-up of 5.1 ± 4.7 years. The mean anti-VEGF injections was 3.6 ± 2.3 times in the first year, significantly decreasing to 1.6 ± 2.0 in the second year (p < 0.001) and 0.29 ± 1.1 by the tenth year. In contrast, corticosteroid injections remained low and stable over ten years (0.16 ± 0.49 in the first year; 0.16 ± 0.68 in the tenth year). Baseline BCVA was 0.43 ± 0.36 logMAR, significantly improving to 0.27 ± 0.29 at year 1 (p < 0.001) and remained stable at 0.32 ± 0.31 by year 10. Mean CMT decreased from 423.1 ± 121.3 μm at baseline to 333.4 ± 93.8 μm in year 1 (p < 0.001), and continued to decline over 10 years, reaching 279.3 ± 71.2 μm. CONCLUSION: This 10-year real-world study confirms the effectiveness of anti-VEGF and corticosteroid injections in achieving functional and anatomical improvements in DME, although the outcomes were less favorable than those reported in clinical trials, primarily due to undertreatment and patient heterogeneity.
Corneal higher-order aberrations after trabecular microbypass stent implantation combined with phacoemulsification.
Shibata S, Hirooka K, Onoe H … +5 more , Okada N, Baba T, Okumichi H, Tokumo K, Sakaguchi H
Jpn J Ophthalmol · 2026 Mar · PMID 41148401 · Publisher ↗
PURPOSE: We investigated changes in corneal higher-order aberrations (HOAs) after iStent inject® W implantation combined with cataract surgery. STUDY DESIGN: Retrospective observational study. METHODS: A total of 41 eyes...
PURPOSE: We investigated changes in corneal higher-order aberrations (HOAs) after iStent inject® W implantation combined with cataract surgery. STUDY DESIGN: Retrospective observational study. METHODS: A total of 41 eyes that underwent this procedure between August 2022 and July 2024 were included. Intraocular pressure (IOP), corneal HOAs, coma-like aberrations, and spherical-like aberrations were measured before and at 1, 2, and 3 months after the surgery. A mixed-effects model was used for statistical analysis. RESULTS: Mean IOP significantly decreased from 14.7 ± 2.9 mmHg before surgery to 13.5 ± 2.9 mmHg (P = 0.002) at 1 month, 13.0 ± 2.4 mmHg (P < 0.0001) at 2 months, and 12.9 ± 2.8 mmHg (P < 0.0001) at 3 months after surgery. The mean corneal HOAs was 0.221 ± 0.136 μm preoperatively, and this was not significantly different compared with those postoperatively (0.208 ± 0.100 μm at 1 month, 0.222 ± 0.134 μm at 2 months, and 0.236 ± 0.176 μm at 3 months postoperatively). Similarly, the mean coma-like aberration (0.205 ± 0.132 μm) and the mean spherical-like aberration (0.080 ± 0.043 μm) preoperatively did not significantly change postoperatively. CONCLUSION: Following iStent inject W implantation IOP is reduced whereas, corneal HOAs remain stable for up to 3 months.
The effects of vitamin d replacement therapy on ocular surface health in children with vitamin d deficiency.
Öztürk C, Cevher S, Duran M … +2 more , Yılmaz SB, Öztürk AH
Jpn J Ophthalmol · 2026 Mar · PMID 41148400 · Publisher ↗
PURPOSE: To investigate the effects of vitamin D replacement therapy on dry eye disease (DED) test parameters in pediatric patients with vitamin D deficiency (VDD). STUDY DESIGN: Prospective clinical study METHODS: This...
PURPOSE: To investigate the effects of vitamin D replacement therapy on dry eye disease (DED) test parameters in pediatric patients with vitamin D deficiency (VDD). STUDY DESIGN: Prospective clinical study METHODS: This prospective study included 46 pediatric patients diagnosed with VDD and 39 sex- and age-matched healthy subjects. DED test parameters, including Schirmer test, tear break-up time (TBUT), upper and lower lid meiboscore and meibomian gland loss (MGL), tear meniscus height (TMH), tear meniscus area (TMA), Ocular Surface Disease Index (OSDI), and corneal fluorescein staining score (CFSS) were assessed. The measurements in the VDD group were performed twice, the first time before the treatment and the second time three months after the vitamin D replacement therapy. Only one assessment was made in the control subjects. RESULTS: Significant improvements were observed in the Schirmer test (p=0.007), TBUT (p=0.03), TMH (p<0.001), TMA (p<0.001), CFSS (p<0.001), and OSDI scores (p=0.016) after vitamin D replacement therapy in children with VDD. Lower eyelid meiboscore and MGL improved significantly after treatment (p=0.022 and p<0.001, respectively), but no significant difference was observed in upper meiboscore and MGL after vitamin D replacement therapy (p=0.986 and p=0.758, respectively). There was no significant difference between the treated VDD group and the healthy controls in Schirmer test, TBUT, TMH, TMA, OSDI scores and lower eyelid meiboscore and MGL (p>0.005 for all). CONCLUSION: Vitamin D replacement therapy significantly improves DED test parameters in pediatric patients with VDD.
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