Jpn. J. Ophthalmol. [JOURNAL]
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200 papers
Insights into intraocular pressure spikes following gonioscopy-assisted transluminal trabeculotomy (GATT): timing, predictors and clinical outcomes.
Taskin G, Alagoz N, Cakir I … +3 more , Altan C, Akgun GG, Yasar T
Jpn J Ophthalmol · 2026 Jan · PMID 40900384 · Publisher ↗
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 manageme...
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.
Endoluminal lacrimal duct recanalization for pediatric secondary acquired lacrimal duct obstruction following epidemic keratoconjunctivitis.
Ohno T, Goto S, Nakamura J … +5 more , Kumagai K, Shindo J, Asano M, Mizuki N, Matsumura N
Jpn J Ophthalmol · 2026 Jan · PMID 40900383 · Publisher ↗
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 kera...
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.
Identifying novel risk factors for ocular lesions in patients with fungemia and determining the efficacy of routine screening.
Miyase T, Mochizuki K, Kawakami H … +6 more , Yonetamari J, Inuzuka M, Sakai S, Suemori S, Baba H, Sakaguchi H
Jpn J Ophthalmol · 2025 Nov · PMID 40900382 · Publisher ↗
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 ME...
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.
Gender differences in higher-order aberrations and refractive error in Japanese school children: the Kyoto Childhood Refractive Error Study (KRES).
Nakamura Y, Hieda O, Nakai Y … +3 more , Nakata M, Sotozono C, Kinoshita S
Jpn J Ophthalmol · 2026 Mar · PMID 40892305 · Full text
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...
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.
Genetic and bioinformatic analysis of RHO and PRPH2 variants in north Indian retinitis pigmentosa patients.
Bhardwaj A, Phogat J, Yadav M … +6 more , Yadav A, Panghal V, Singh M, Sharma S, Kumar R, Tanwar M
Jpn J Ophthalmol · 2026 Mar · PMID 40880019 · Publisher ↗
PURPOSE: Retinitis Pigmentosa (RP) represents the most common form of inherited retinal dystrophy (IRD), identified by a gradual degeneration of photoreceptors, ultimately resulting in nyctalopia and impaired vision. Thi...
PURPOSE: Retinitis Pigmentosa (RP) represents the most common form of inherited retinal dystrophy (IRD), identified by a gradual degeneration of photoreceptors, ultimately resulting in nyctalopia and impaired vision. This study was conducted to screen the rhodopsin and peripherin2 genes for possible pathogenic mutations in north Indian RP patients. STUDY DESIGN: We focused on assessing the whole coding region and the intron-exon boundaries of RHO and PRPH2 genes in RP patients and control subjects. METHODS: After institutional human ethical clearance and informed consent, a total of seventy-five sporadic cases of RP and one hundred control subjects were enrolled in the current study. Genomic DNA was extracted from the peripheral blood samples of patients and control subjects. PCR-DNA sequencing was performed for coding exons and intron-exon boundaries of RHO and PRPH2 genes to identify nucleotide variations in patients and controls. The pathogenicity of identified missense variants was predicted by using six different bioinformatics tools. Structural changes of the protein were analyzed using Garnier-Osguthorpe-Robson, PyMol, ChimeraX, and Molecular Dynamic simulations. RESULTS: A total of twenty sequence variants which include 7 missense, 3 synonymous and 10 intronic changes in RHO gene, and fourteen sequence variants which include 9 missense, 4 synonymous and 1 intronic variant in PRPH2 gene were identified. Bioinformatic analysis revealed two possible pathogenic missense mutations [p.(E150K) and p.(P347L)] in RHO gene and three possible pathogenic mutations [p.(G31D), p.(D84N), and p.(R220Q)] in PRPH2 gene. All five mutations have been previously reported and are documented in publicly available variant databases. Structural alterations were observed in the secondary and tertiary structures of the mutated proteins in cases of pathogenic changes both in rhodopsin and peripherin2 proteins. These structural changes led to protein dysfunction, contributing to disease progression. CONCLUSION: In our study population, we identified five previously reported potentially pathogenic missense variants in the RHO and PRPH2 genes, which are associated with retinitis pigmentosa. This data will add to the existing repertoire of disease-causing mutations.
Short-term outcomes of the PreserFlo MicroShunt in Japanese patients with exfoliation glaucoma: a comparison with primary open-angle glaucoma using propensity score matching.
Yamae T, Sakata R, Suzuki H … +6 more , Aoyama Y, Nemoto H, Saito H, Honjo M, Shirato S, Aihara M
Jpn J Ophthalmol · 2026 Jan · PMID 40856918 · Full text
PURPOSE: This study evaluated the efficacy and safety of initially implanted PreserFlo MicroShunt (PMS) in Japanese patients with exfoliation glaucoma (XFG). Using propensity score matching, intraocular pressure (IOP) co...
PURPOSE: This study evaluated the efficacy and safety of initially implanted PreserFlo MicroShunt (PMS) in Japanese patients with exfoliation glaucoma (XFG). Using propensity score matching, intraocular pressure (IOP) control rates were compared between patients with XFG and primary open-angle glaucoma (POAG). STUDY DESIGN: Retrospective observational study. METHODS: This study reviewed 31 eyes of 31 patients with XFG who underwent initial PMS implantation with mitomycin C. IOP, medication scores, and corneal endothelial cell density (CECD) were assessed preoperatively and at up to 6 months postoperatively. Kaplan-Meier analysis was used to estimate the 6-month survival rate, defined as an IOP reduction of > 20% from baseline and an IOP < 15 mmHg. The incidences of needling, reoperation, and complications were also assessed. IOP control was compared between XFG and propensity-score-matched POAG patients using the log-rank test. RESULTS: At 6 months, the mean IOP had decreased significantly, from 22.3 ± 6.6 to 14.7 ± 6.6 mmHg, and the medication score had declined from 4.5 to 1.4. CECD decreased from 2127 to 1902 cells/mm, although this was not statistically significant. The complete success rate (without any glaucoma medications or intervention) was 48%. Postoperative complications included anterior chamber hemorrhage and choroidal detachment. Needling was performed in nine eyes (29.0%), and additional surgery was performed in five eyes (16.1%). Compared to POAG patients (11.9 mmHg), XFG patients had higher postoperative IOP (14.8 mmHg) and higher medication scores (0.5 vs 1.4, p = 0.04) and a lower success rate (62.2% vs 41.7%). CONCLUSIONS: PMS in Japanese patients with XFG resulted in a significant IOP reduction over 6 months, with a relatively favorable safety profile. However, its efficacy was slightly inferior to that in POAG, implying potential differences in PMS responsiveness between glaucoma subtypes.
Clinical and MRI differences in congenital fibrosis of extraocular muscles patients with KIF21A and TUBB3 variants.
Wang D, Jia HY, Liang Y … +4 more , Ma Q, Chang QL, Zhang RR, Jiao YH
Jpn J Ophthalmol · 2026 Jan · PMID 40847091 · Publisher ↗
PURPOSE: To compare the clinical and neuroimaging phenotypes in Chinese patients with congenital fibrosis of extraocular muscles (CFEOM) harboring KIF21A versus TUBB3 variants. STUDY DESIGN: Retrospective, observational...
PURPOSE: To compare the clinical and neuroimaging phenotypes in Chinese patients with congenital fibrosis of extraocular muscles (CFEOM) harboring KIF21A versus TUBB3 variants. STUDY DESIGN: Retrospective, observational case series. METHODS: A retrospective review of 37 CFEOM patients harboring mutations of KIF21A (n = 25) and TUBB3 (n = 12) with clinical examinations was performed. MRI was used to evaluate orbital, encephalic, and intracranial nerve integrity. The diameters of oculomotor nerve (CN3) and abducens nerves (CN6), the cross-section area (CSA) of the optic nerve (ON) and the volumes of extraocular muscles (EOMs) were measured in the mutant groups and normal control group (n = 20). RESULTS: The CFEOM-KIF21A group had a slightly higher percentage of bilateral blepharoptosis (95% vs. 70%) and synergistic convergence (40% vs. 20%) compared with the CFEOM-TUBB3 group. The diameter of CN3 and the CSA of ON were significantly smaller in the mutant groups than the control. The median diameter of CN6 was smaller in the KIF21A group than in the TUBB3 group (P < 0.001). The median volumes of the superior rectus, lateral rectus, and inferior oblique muscle in the KIF21A group were significantly smaller than TUBB3 group. 10% of KIF21A families and 40% of TUBB3 families were accompanied by systemic congenital malformation (P = 0.070). CONCLUSION: Most of the CFEOM-KIF21A patients occur as isolated cases, tend to suffer a more severe ocular phenotype and CN6 hypoplasia. CFEOM-TUBB3 patients tend to present with syndromic CFEOM, systemic involvement is mainly associated with brain malformations, and appear to have a clear genotype-phenotype correlation.
Visual function and patient satisfaction with 3 types of monofocal plus intraocular lenses.
Kabura R, Takeshita T, Yoshioka Y … +4 more , Iwasaki R, Amikawa H, Yasukochi M, Oshika T
Jpn J Ophthalmol · 2026 Jan · PMID 40844678 · Publisher ↗
PURPOSE: To compare visual function and patient-reported satisfaction among 3 types of monofocal plus intraocular lenses (IOLs) STUDY DESIGN: Retrospective case series METHODS: This study included 122 eyes from 61 patien...
PURPOSE: To compare visual function and patient-reported satisfaction among 3 types of monofocal plus intraocular lenses (IOLs) STUDY DESIGN: Retrospective case series METHODS: This study included 122 eyes from 61 patients who underwent bilateral implantation of DIB00V (Johnson & Johnson Vison Care, 22 patients), NSP-3 (Nidek, 18 patients), or XY1-EM (Hoya Surgical Optics, 21 patients) between July 2023 and October 2024. At 3 months postoperatively, corrected distance visual acuity (CDVA) at 5 m, distance-corrected intermediate visual acuity (DCIVA) at 70 cm and 50 cm, manifest refraction, and letter contrast sensitivity were compared. Responses to a questionnaire assessing subjective satisfaction with daily visual activities were analyzed. RESULTS: No significant differences were observed among the 3 groups in CDVA at 5 m and DCIVA at 50 cm (P = .45, P = .12). DCIVA at 70 cm was significantly better with the XY1-EM than with the DIB00V (P <.01). Manifest refraction and letter contrast sensitivity showed no significant differences among the groups (P = .55, P = .88). A significant difference in satisfaction scores for night driving was found, with the DIB00V scoring higher than the NSP-3 (P <.05). Spectacle independence was achieved more frequently with the XY1-EM (81.0%) than with the DIB00V (63.6%) and NSP-3 (66.7%) (P <.05). CONCLUSIONS: The 3 monofocal plus IOLs demonstrated comparable visual function in terms of CDVA at 5 m, DCIVA at 50 cm, and letter contrast sensitivity. However, the XY1-EM exhibited significantly better DCIVA at 70 cm and a higher rate of spectacle independence.
Switching to faricimab alleviates persistent subretinal fluid and pigment epithelial detachment in neovascular age-related macular degeneration.
Maehara Y, Notomi S, Shiose S … +6 more , Fukuda Y, Kiyohara K, Kano K, Ishikawa K, Hisatomi T, Sonoda KH
Jpn J Ophthalmol · 2026 Jan · PMID 40844677 · Publisher ↗
PURPOSE: To evaluate structural outcomes, including subretinal fluid (SRF) and fibrovascular pigment epithelial detachment (fvPED) volume changes, after switching from aflibercept 2 mg to faricimab in Japanese patients w...
PURPOSE: To evaluate structural outcomes, including subretinal fluid (SRF) and fibrovascular pigment epithelial detachment (fvPED) volume changes, after switching from aflibercept 2 mg to faricimab in Japanese patients with neovascular age-related macular degeneration (nAMD). STUDY DESIGN: Retrospective, observational study. METHODS: Patients with nAMD who were switched from aflibercept 2 mg to faricimab were enrolled. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and the volumes of SRF and fvPED were analyzed using three-dimensional spectral-domain optical coherence tomography data. RESULTS: A total of 46 eyes from 46 patients were included. All had been maintained on fixed dosing due to difficulty in extending the injection interval. Patients had received a mean of 25.6 aflibercept 2 mg injections, with a mean interval of 7.5 weeks for the last three injections. Subsequently, three faricimab injections were given at similar intervals (7.6 weeks). BCVA remained unchanged (p = 0.066), while CMT, SRF, and fvPED volumes significantly decreased (p < 0.01). A significant correlation was found between the reductions in SRF and fvPED volumes (p < 0.05). CONCLUSIONS: Switching to faricimab led to favorable structural outcomes in nAMD patients previously treated with aflibercept 2 mg, particularly by reducing SRF and fvPED.
Differences in demographic, etiologic, and clinical features between pure and impure orbital fractures.
Abumanhal M, Miyazaki H, Takahashi Y
Jpn J Ophthalmol · 2026 Jan · PMID 40833546 · Publisher ↗
PURPOSE: To analyze differences in demographics, etiology, and clinical characteristics between pure and impure orbital fractures (with or without orbital rim involvement) STUDY DESIGN: Retrospective observational study....
PURPOSE: To analyze differences in demographics, etiology, and clinical characteristics between pure and impure orbital fractures (with or without orbital rim involvement) STUDY DESIGN: Retrospective observational study. METHODS: A total of 1104 cases of orbital fractures were reviewed. Fractures were classified as pure (881 cases) or impure orbital fractures (223 cases). Impure fractures were further subdivided into frontal bone (14 cases), zygomaticomaxillary complex (ZMC, 187 cases), and multiple (22 cases) fractures. Data on demographics, fracture types, injury mechanisms, field of binocular single vision (BSV), and associated ocular injuries were analyzed across the groups. RESULTS: Patients with ZMC fractures were older than those with orbital or frontal bone fractures (P <.001 and P = .007). Bilateral fractures were more frequent in the multiple-fractures group (P <.001). Falls were the leading cause of injury (39%), particularly in ZMC fractures (52%). Motor vehicle accidents accounted for 50% of multiple fractures. The overall rate of ocular injuries was 7.3%, with all globe ruptures (5 cases) occurring in the pure fracture group. Multiple fractures had higher incidences of optic canal fractures and orbital compartment syndrome (P <.001). Frontal bone fractures demonstrated better BSV outcomes, whilst multiple fractures had the worst. CONCLUSION: This large-scale study highlights the significant influence of age and injury mechanisms on orbital fracture patterns. Frontal bone fractures were associated with more favorable visual function, whilst pure fractures posed greater risk of globe rupture. These findings underscore the importance of tailoring management strategies to specific fracture types and patient demographics.
Clinical characteristics of visual function, retinal ganglion cells, and nerve fiber layer in patients with adult craniopharyngioma.
Shinohara Y, Yamada C, Yamaguchi R … +3 more , Tosaka M, Oya S, Akiyama H
Jpn J Ophthalmol · 2026 Jan · PMID 40833545 · Publisher ↗
PURPOSE: To investigate the relationship between visual function, optical coherence tomography (OCT) parameters, and optic nerve bending before and after tumor resection in adult patients with craniopharyngioma. STUDY DE...
PURPOSE: To investigate the relationship between visual function, optical coherence tomography (OCT) parameters, and optic nerve bending before and after tumor resection in adult patients with craniopharyngioma. STUDY DESIGN: Retrospective observational study. METHODS: We retrospectively evaluated 22 eyes of 11 adult patients with craniopharyngioma who underwent tumor resection surgery. We assessed the preoperative and 1-month postoperative best-corrected visual acuity (BCVA), simple visual field impairment score (SVFIS) for visual field evaluation, 6-segmented macular ganglion cell layer (GCL) + inner plexiform layer (IPL) and 4-segmented circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and optic nerve-canal bending angle (ONCBA). RESULTS: Bilateral hemianopia was observed in 10 patients (91%), whilst homonymous hemianopia was observed in 1 patient (9%). The BCVA and SVFIS scores improved significantly postoperatively (both P <.001), and eyes with optic nerve bending had significantly worse preoperative BCVA and SVFIS (both P <.001), and the ONCBA was significantly correlated with preoperative BCVA, SVFIS, and GCL+IPL thickness in all areas. OCT detected superior nasal GCL+IPL thinning in 10 eyes (45%) and superior cpRNFL thinning in 2 eyes (9%). CONCLUSION: In adult patients with craniopharyngioma, GCL+IPL and cpRNFL thicknesses were associated with postoperative visual function recovery. The ONCBA was associated with preoperative visual dysfunction. ONCBA, GCL+IPL, and RNFL thicknesses may be useful for monitoring visual function in adult craniopharyngiomas preoperatively and postoperatively.
Clinical characteristics and risk factors for corneal guttae in Japanese cataract patients.
Niwa M, Yoshii K, Okumura N
Jpn J Ophthalmol · 2026 Jan · PMID 40824423 · Publisher ↗
PURPOSE: To identify clinical characteristics and risk factors associated with corneal guttae in Japanese patients undergoing cataract surgery and to examine the relationship between guttae severity and anterior segment...
PURPOSE: To identify clinical characteristics and risk factors associated with corneal guttae in Japanese patients undergoing cataract surgery and to examine the relationship between guttae severity and anterior segment parameters. STUDY DESIGN: This retrospective observational study analyzed 410 eyes from 410 patients who underwent cataract surgery between April 2021 and March 2023. METHODS: Corneal guttae were evaluated using specular microscopy and graded according to the modified Reykjavik Eye Study classification (Grades 0-4). Demographics, corneal endothelial characteristics, and ocular biometric parameters were assessed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for corneal guttae. RESULTS: Corneal guttae were present in 23.2% of patients (Grade 1: 17.1%, Grade 2: 4.9%, Grade 3: 0.7%, Grade 4: 0.5%). Multivariate analysis identified female gender (OR=1.81, 95% CI: 1.04-3.14, p=0.036), shallower anterior chamber depth (OR=0.47, 95% CI: 0.23-0.98, p=0.043), corneal endothelial cell density (per 100 cells/mm) (OR=0.84, 95% CI: 0.74-0.94, p=0.003), and higher spherical equivalent refractive error (OR=1.25, 95% CI: 1.12-1.41, p<0.001) as significantly associated factors. Most parameters showed significant trends across severity grades. Endothelial characteristics including cell density, coefficient of variation, and hexagonality demonstrated significant relationships (all p<0.001), along with more pronounced hyperopia with increasing guttae severity (p-trend<0.001). CONCLUSIONS: Female gender, shallow anterior chamber, low endothelial cell density, and hyperopic refractive error are independently associated with corneal guttae in Japanese cataract patients. Progressive changes across severity grades suggest that anatomical factors contribute to endothelial vulnerability. These findings enhance the understanding of guttae pathophysiology and improve preoperative risk assessment.
Clinical characterization of 3-year progression of diabetic macular ischemia on OCT angiography.
Yoshida M, Murakami T, Ishihara K … +2 more , Mori Y, Tsujikawa A
Jpn J Ophthalmol · 2026 Jan · PMID 40782280 · Publisher ↗
PURPOSE: To characterize the progression of capillary nonperfusion in diabetic macular ischemia (DMI) using optical coherence tomography angiography (OCTA) images. STUDY DESIGN: A single-center, prospective case series s...
PURPOSE: To characterize the progression of capillary nonperfusion in diabetic macular ischemia (DMI) using optical coherence tomography angiography (OCTA) images. STUDY DESIGN: A single-center, prospective case series study. METHODS: We acquired 3 × 3 mm swept-source OCTA images and created en face images within a central 2.5 mm circle in 100 eyes of 100 patients with diabetic retinopathy (DR). The circle was divided into 15 × 15-pixel squares; squares without retinal vessels were defined as nonperfusion squares (NPSs). Vessel density (VD) and vessel length density (VLD) were also quantified as perfusion metrics. We compared these metrics at baseline and at the 3-year follow-up visit. RESULTS: Both VD and VLD decreased, and NPS increased at 3 years in both superficial and deep layers. The baseline superficial and deep non profusion squares' (NPS) counts correlated with the count at 3 years but not with its changes. Multivariate analyses demonstrated that logMAR (β = 0.785, P < 0.001) and PDR (β = 0.206, P = 0.002) at baseline predicted poorer VA at 3 years. PDR (β = 0.275, P = 0.007) and NPS counts in the inferior sector of the superficial layer (β = -0.223, P = 0.027) at baseline were mildly associated with VA deterioration. Age was the only baseline parameter correlated with changes in superficial NPS counts (β = 0.242, P = 0.015). Changes in deep NPS counts were associated with systemic hypertension (β = -0.262, P = 0.005), logMAR (β = 0.307, P = 0.001), and prior vitrectomy (β = -0.209, P = 0.024). CONCLUSIONS: We demonstrated changes in the nonperfusion metrics on OCTA images over 3 years and identified baseline factors associated with the progression of nonperfusion areas.
Efficacy of 2% ganciclovir eye drops in the treatment of cytomegalovirus anterior uveitis.
Yoneda Y, Takenaka Y, Taniguchi N … +5 more , Yoneda K, Seki K, Oyama T, Imazeki M, Takeuchi M
Jpn J Ophthalmol · 2025 Nov · PMID 40782279 · Full text
PURPOSE: To investigate the efficacy and safety of 2% ganciclovir (GCV) eye drops for the treatment of primary cytomegalovirus anterior uveitis (CMV-AU) STUDY DESIGN: Retrospective cohort study METHODS: This study includ...
PURPOSE: To investigate the efficacy and safety of 2% ganciclovir (GCV) eye drops for the treatment of primary cytomegalovirus anterior uveitis (CMV-AU) STUDY DESIGN: Retrospective cohort study METHODS: This study included 12 patients diagnosed with CMV-AU who were treated with 2% GCV eye drops. The patients' demographics, clinical presentations, treatment regimens, and outcomes were analyzed. RESULTS: The cohort consisted predominantly of men (11:1 ratio), with a mean age of 63.4 years and all presenting with unilateral disease. Common presenting symptoms were blurred vision and elevated intraocular pressure (IOP). After the initiation of 2% GCV eye drops, all the patients demonstrated positive responses, with improvement in BCVA, decreased IOP, and resolution of keratic precipitates including coin-shaped lesions. Recurrence of uveitis occurred in 66.7% of the patients and was managed with intensified topical corticosteroids, antiglaucoma medications, and/or short-term oral GCV. IOP significantly decreased after treatment (P <.05), whilst BCVA and corneal endothelial cell counts remained stable. No patients developed bullous keratopathy or required intravenous GCV. One patient underwent trabeculectomy for uncontrolled IOP. CONCLUSION: This study's findings suggest that 2% GCV eye drops are a safe and effective treatment option for primary CMV-AU, offering improvements in IOP and uveitis control. All the patients completed the treatment without serious adverse events, supporting the favorable safety profile of 2% GCV eye drops.
Comparison of 1-year outcomes after switching to faricimab in neovascular age-related macular degeneration previously treated with anti-VEGF agents with/without a loading phase.
Hikichi T, Kurabe H, Notoya A … +3 more , Oguro Y, Hirano M, Doi Y
Jpn J Ophthalmol · 2026 Jan · PMID 40773002 · Publisher ↗
PURPOSE: To compare the 1-year outcomes after switching to faricimab with/without a loading phase of three monthly injections followed by a treat-and-extend (TAE) regimen in eyes with neovascular age-related macular dege...
PURPOSE: To compare the 1-year outcomes after switching to faricimab with/without a loading phase of three monthly injections followed by a treat-and-extend (TAE) regimen in eyes with neovascular age-related macular degeneration previously treated with anti-VEGF agents. STUDY DESIGN: Retrospective consecutive case study. METHODS: Eyes with persistent exudative changes despite injection intervals of 10 weeks or less were switched to faricimab between June 2022 and December 2023 and included in this study. All eyes switched to faricimab between June 2022 and June 2023 received a single injection followed by a treat and extend (TAE) regimen (group 1). Thereafter, all eyes switched to faricimab received three consecutive monthly injections followed by a TAE regimen (group 2). RESULTS: Of 153 eyes switched to faricimab, 21 eyes (17 in group 1, four in group 2) were excluded because of discontinuation of faricimab due to persistent exudative changes despite bimonthly injections; 132 eyes of 132 patients were analyzed. Faricimab treatment significantly improved the best-corrected visual acuity, anatomic parameters, with extended injection interval 1 year after the switch in 132 eyes and 45 eyes of group 2. That improvement, except the injection interval in 87 eyes of group 1, did not reach significance. The injection interval in group 2 was extended significantly compared with group 1 (P=0.023). CONCLUSION: Switching to faricimab with a loading phase followed by a TAE regimen may improve outcomes in previously treated eyes. Further studies are warranted to confirm these findings.
Dacryoendoscopy as a frontier technology for lacrimal drainage disorders.
Sugimoto M, Inoue Y, Shiraishi A
Jpn J Ophthalmol · 2025 Sep · PMID 40773001 · Full text
Dacryocystorhinostomy (DCR) for adult patients with acquired nasolacrimal duct obstruction can be performed via 2 approaches: an external nasal approach from the skin and an internal nasal approach from the nasal cavity....
Dacryocystorhinostomy (DCR) for adult patients with acquired nasolacrimal duct obstruction can be performed via 2 approaches: an external nasal approach from the skin and an internal nasal approach from the nasal cavity. Both techniques have a history of over 100 years and are the gold standard approaches for the treatment of nasolacrimal duct obstructions. Alternatively, researchers have also attempted lacrimal passage reconstruction using various stents to restore the patency of the lacrimal passage, with nunchaku-type silicone tubes showing good surgical results according to several published reports. However, in cases in which the procedure required blind manipulation, the results were largely dependent on the surgeon's skill. Under such circumstances, the dacryoendoscope was introduced at the beginning of this century and is currently widely used. In other fields, especially in gastroenterology, the introduction of gastrointestinal endoscopes that enable observation and treatment of lesions under direct observation has dramatically improved the treatment of gastrointestinal disorders. Considering that the dacryoendoscope has become standardized over the past 20 years since its introduction, this review summarizes the current status of lacrimal passage treatment using the dacryoendoscope.
Advancements in robotic surgery for vitreoretinal diseases: current trends and the future.
Nakao S, Tadano K, Sonoda KH
Jpn J Ophthalmol · 2025 Jul · PMID 40748553 · Full text
Medical robotics, such as the da Vinci Surgical System, Hinotori, and Saroa, has been rapidly expanding in the field of general surgery in recent years. Because of the need for high precision in vitreoretinal surgery, ge...
Medical robotics, such as the da Vinci Surgical System, Hinotori, and Saroa, has been rapidly expanding in the field of general surgery in recent years. Because of the need for high precision in vitreoretinal surgery, general surgery robots are not applicable; therefore, a variety of robots specifically designed for vitreoretinal surgery have been developed around the world. These robotic systems can be broadly categorized into operation systems, operation assistance systems, and observation systems. The purpose of the operation robots is mainly internal limiting membrane peeling and retinal vascular cannulation. The PRECEYES Surgical System was already approved in the European Union in 2019 on the basis of positive clinical results. The aim of operation assistance robots, such as iARMs, is to suppress tremors. Meanwhile, we have developed an observation robot, an intraocular endoscope-holding robot (OQrimo), which was approved as a medical device in Japan in 2023. This robot allows surgeons to perform intraocular manipulations using both hands during vitreoretinal surgery for proliferative diabetic retinopathy and other intractable retinal diseases and may also make it easier to manipulate the anterior tissues around the ciliary body. In the future, by being combined with artificial intelligence in vitreoretinal clinics, robotic surgery will be applied to preoperative, intraoperative, and postoperative surgical procedure decisions, programs, and education.
Vascular characteristics of pediatric patients with familial Mediterranean fever: a study of optical coherence tomography angiography findings.
Soysal GG, Seyyar SA, Doğru V … +3 more , Saygili O, Güngör K, Tanatar A
Jpn J Ophthalmol · 2025 Nov · PMID 40748552 · Publisher ↗
PURPOSE: The aim of this study was to investigate the vascular characteristics of pediatric patients with familial Mediterranean fever (FMF) with homozygous c.~(p.M694V) mutations in the MEFV gene by comparing their reti...
PURPOSE: The aim of this study was to investigate the vascular characteristics of pediatric patients with familial Mediterranean fever (FMF) with homozygous c.~(p.M694V) mutations in the MEFV gene by comparing their retinal vascular densities with those of healthy controls by use of optical coherence tomography angiography (OCTA). STUDY DESIGN: Prospective observational study. METHODS: A total of 80 participants, 35 FMF pediatric patients and 45 healthy controls, were included in the study. The baseline demographic and clinical characteristics were examined, and OCTA was used to assess vascular densities in various regions of the superficial and deep capillary plexus (DCP) and optic disc. Statistical analyses were performed to identify significant differences between the groups. RESULTS: The study demonstrated that patients with FMF exhibited a significant reduction in vascular density within the parafoveal deep capillary plexus (DCP) (P = 0.047). Additionally, vascular density in the inferior and temporal subregions of the perifoveal DCP was significantly lower in the FMF group than in the controls (P = 0.038 and P = 0.027, respectively), with a similar trend observed for the overall perifoveal DCP vascular density (P = 0.025). In addition, optic disc vascular density was significantly lower in the FMF patients than in the healthy controls (P = 0.026). Approximately 60% of the FMF patients had severe disease symptoms, whilst 40% of them had mild symptons. CONCLUSIONS: The findings suggest significant reductions in deep capillary plexus and optic disc vascular density in children with FMF, further suggesting an underlying vascular pathology related to this autoinflammatory disease. Regular ophthalmic evaluations are necessary to monitor potential effects on retinal health in pediatric FMF patients, even when anterior segment examination findings are normal.
Midterm outcomes of Ahmed glaucoma valve implantation and trabeculectomy in exfoliative glaucoma.
Koiwa C, Hayashi Y, Asaoka S … +9 more , Kuroda K, Asada Y, Kasuga T, Iwamoto S, Hirakata T, Honda R, Obazawa H, Sasaki H, Matsuda A
Jpn J Ophthalmol · 2025 Nov · PMID 40748551 · Publisher ↗
PURPOSE: To report the midterm outcomes of Ahmed glaucoma valve (AGV) implantation and trabeculectomy (Trab) in exfoliative glaucoma (XFG). STUDY DESIGN: We performed a retrospective comparison analysis of 95 eyes of 81...
PURPOSE: To report the midterm outcomes of Ahmed glaucoma valve (AGV) implantation and trabeculectomy (Trab) in exfoliative glaucoma (XFG). STUDY DESIGN: We performed a retrospective comparison analysis of 95 eyes of 81 patients with AGV implantation versus 88 eyes of 82 patients with Trab for XFG up to 3 years. METHOD: The intraocular pressure, number of medications, corneal endothelial cell numbers, and surgical complications were analyzed. The cumulative probability of success was analyzed by 5 ≦IOP ≦18 mm Hg and reduction of IOP ≧20% from the preoperative IOP. Kaplan-Meier survival analysis was used to analyze the probability of success and for the comparison between the Trab group and the AGV group. RESULTS: The cumulative probability of the qualified surgical success rate was higher, but the complete success rate was lower in the AGV group than in the Trab group. AGV insertion for the eyes with a history of Trab failure and for the eyes without a history of previous glaucoma operations showed no significant difference in postoperative IOP. The occurrence of layered hyphema was higher in the AGV group, but the overall occurrence rates of other complications were similar in the 2 groups. CONCLUSION: AGV implantation is a reasonable surgical method for XFG, especially for patients with a history of previously failed Trab.
Surgical outcomes of primary filtering surgery in secondary childhood glaucoma patients: a retrospective cohort study.
Suvannachart P, Chansangpetch S, Surukrattanaskul S … +4 more , Ratanawongphaibul K, Manassakorn A, Tantisevi V, Rojanapongpun P
Jpn J Ophthalmol · 2025 Nov · PMID 40715616 · Publisher ↗
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 c...
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%.
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