Jpn. J. Ophthalmol. [JOURNAL]
Sun
200 papers
Reconsideration of conversion to multiple sclerosis: one-year cerebral lesion appearance rate of Japanese aquaporin-4 antibody-negative optic neuritis patients.
Ueki S, Hasegawa Y, Hatase T … +2 more , Kawachi I, Fukuchi T
Jpn J Ophthalmol · 2025 Nov · PMID 40542980 · Publisher ↗
PURPOSE: To analyze the rate of new cerebral lesions' appearance within 6-12 months in Japanese optic neuritis patients who at onset had no cerebral lesions suggestive of multiple sclerosis (MS) and were negative for aqu...
PURPOSE: To analyze the rate of new cerebral lesions' appearance within 6-12 months in Japanese optic neuritis patients who at onset had no cerebral lesions suggestive of multiple sclerosis (MS) and were negative for aquaporin-4 (AQP4) antibodies. STUDY DESIGN: Retrospective study. METHODS: Medical records of 66 adult patients with optic neuritis were reviewed. Patients positive for AQP4, myelin oligodendrocyte glycoprotein, or antinuclear antibodies were excluded. Those without cerebral lesions on initial magnetic resonance imaging (MRI) underwent follow-up MRI within 6-12 months. Clinical characteristics and subsequent neurological diagnoses were analyzed. RESULTS: Forty-seven patients met the inclusion criteria (mean age, 41.9±16.7 years; 13 men, 34 women). Forty-two cases were unilateral, five bilateral; 19 had disc swelling, and 28 did not. The mean worst logMAR was 1.13±0.96. Two patients experienced recurrence within 1 year. Of the 27 patients without initial cerebral lesions, 20 underwent follow-up MRI; 3 (15%) developed new lesions. These three were later diagnosed as two MS and one suspected MS cases. CONCLUSION: Follow-up MRI within 6-12 months revealed new cerebral lesions in 15% of patients, with 10% diagnosed with MS. This highlights the importance of follow-up imaging even in AQP4 antibody-negative optic neuritis patients without initial cerebral lesions, especially in the absence of other diseases like neuromyelitis optica spectrum disorders.
Scleral thickness in patients with obstructive sleep apnea syndrome.
Akgun Z, Degirmenci C, Tasbakan S … +2 more , Basoglu OK, Palamar M
Jpn J Ophthalmol · 2025 Nov · PMID 40542209 · Full text
PURPOSE: Evaluation of scleral thickness with anterior segment optical coherence tomography (AS-OCT) in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Cross-sectional study. METHODS: A total of 30 s...
PURPOSE: Evaluation of scleral thickness with anterior segment optical coherence tomography (AS-OCT) in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Cross-sectional study. METHODS: A total of 30 severe (Group 1), 30 moderate (Group 2) and 30 mild (Group 3) OSAS patients and 22 healthy volunteers (Group 4) were included in the study. Scleral thickness measurements were taken with AS-OCT, 6 mm, 4 mm and 2 mm posterior to the scleral spur, in four gaze positions. Data and findings were examined comparatively. RESULTS: At 6 mm posterior to the scleral spur, the mean thickness was found to be significantly higher in all quadrants in Group 1 (p<0.05 for all). Superior thickness was higher in Group 2 compared to Group 4 (p=0.034). At 4 mm posterior to the scleral spur; in Group 1, the mean thickness was found higher than Group 2 and 3 only in the inferior (p=0.01, p=0.021, respectively) and was found higher than Group 4 in the nasal and inferior (p<0.001, p=0.006, respectively). At 2 mm posterior to the scleral spur; significant difference was observed between Groups 1 and 2 only in the inferior (p=0.002), between Groups 1 and 3 in the nasal and inferior (p=0.029, p=0.002), and between Groups 1 and 4 the in nasal and inferior (p=0.002, p<0.001). CONCLUSION: The scleral thickness measured from 6 mm posterior to the scleral spur was higher in all quadrants in patients with severe OSAS. It is possible that the increase in scleral thickness, especially in severe OSAS, is due to extracellular matrix accumulation in the scleral tissue.
Increased macular atrophy area with photodynamic therapy over intravitreal aflibercept at 2-year follow-up of pachychoroid neovasculopathy.
Kojima H, Shiragami C, Yamashita A … +4 more , Miyoshi Y, Osaka R, Ono A, Suzuma K
Jpn J Ophthalmol · 2025 Jul · PMID 40542208 · Publisher ↗
PURPOSE: To compare the therapeutic outcomes of intravitreal aflibercept injection (IVA) and reduced-fluence photodynamic therapy (rfPDT) for pachychoroid neovasculopathy (PNV) over 2 years. STUDY DESIGN: Observational,...
PURPOSE: To compare the therapeutic outcomes of intravitreal aflibercept injection (IVA) and reduced-fluence photodynamic therapy (rfPDT) for pachychoroid neovasculopathy (PNV) over 2 years. STUDY DESIGN: Observational, retrospective case series. Single-center study. METHODS: This study involved 36 eyes of 36 patients with PNV. The IVA group comprised 18 eyes treated with IVA monotherapy (injection every 3 months followed by a pro re nata regimen), whereas the rfPDT group consisted of 18 eyes treated with rfPDT monotherapy. Post-treatment changes in best-corrected visual acuity (BCVA), macular atrophy (MA) area, central retinal thickness (CRT) and subfoveal choroidal thickness (SFCT) were compared between the 2 groups. RESULTS: The IVA group received 8.94 ± 4.77 injections, whereas the rfPDT group received rfPDT 1.06 ± 0.24 times. The logMAR BCVA improved in both groups but did not differ between the 2 groups. The MA area increased from 0.163 ± 0.418 mm to 0.227 ± 0.480 mm (P = .024) and from 0.139 ± 0.402 mm to 0.597 ± 0.939 mm (P < .001) in the IVA and rfPDT groups, respectively, with the rfPDT group showing a greater increase than the IVA group (P = .013). The CRT was reduced in both groups but did not differ between the 2 groups. The SFCT was reduced in both groups, but the reduction was higher in the rfPDT group than in the IVA group (P = .027). The factors affecting change in the MA area were the treatment method and patient age. CONCLUSIONS: The increase in the MA area and the decrease in the SFCT were greater in the rfPDT group than in the IVA group for PNV, suggesting that IVA may be preferred over rfPDT for PNV treatment.
Choroidal changes after vitrectomy performed for macular hole retinal detachment.
Sumida H, Umeda I, Baba T
Jpn J Ophthalmol · 2025 Sep · PMID 40531256 · Full text
PURPOSE: To investigate changes in the choroidal area (CA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), and choroidal thickness (CT) before and after vitrectomy in eyes with macular hole reti...
PURPOSE: To investigate changes in the choroidal area (CA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), and choroidal thickness (CT) before and after vitrectomy in eyes with macular hole retinal detachment (MHRD). STUDY DESIGN: Retrospective observational study. METHODS: We measured the best-corrected visual acuity (BCVA), intraocular pressure (IOP), CA, LA, SA, CVI, and CT preoperatively and 1, 3, and 6 months postoperatively in 10 eyes with MHRD. CA was measured within a 3-mm-wide area around the fovea in the horizontal and vertical images. LA and SA were quantified using the Niblack method, and CVI was calculated as the ratio of LA to CA. CT was measured at the subfovea and at 1 and 3 mm vertically and horizontally away from the fovea. RESULTS: BCVA improved significantly at 1 and 3 months postoperatively (P = 0.036 and 0.016). IOP remained stable. CA and LA decreased significantly 6 months postoperatively in both the horizontal (P = 0.002 and 0.014) and vertical sections (P = 0.006 and 0.002). SA remained stable. CVI reduced significantly at 1 month horizontally and at 3 months vertically (both P = 0.027). CT decreased significantly in the subfovea at 3 and 6 months postoperatively (P = 0.027 and 0.020, respectively). Significant reductions were also observed at 1 mm nasal, temporal, and superior regions (P = 0.014, 0.014, and 0.004) and at 2 mm temporal and superior regions 1 month postoperatively (P = 0.020 and 0.014). CONCLUSION: Choroidal thinning was observed after vitrectomy in eyes with MHRD, driven by a reduction in the luminal area.
Relationship between acceleration of axial elongation and ocular biometry in schoolchildren.
Yamashita T, Terasaki H, Hamada T … +4 more , Asaoka R, Yoshihara N, Kakiuchi N, Sakamoto T
Jpn J Ophthalmol · 2025 Nov · PMID 40526207 · Full text
PURPOSE: The speed of axial elongation typically slows during the growth phase; however, in some eyes, it accelerates, leading to myopia progression during school age. This study examined the association between ocular b...
PURPOSE: The speed of axial elongation typically slows during the growth phase; however, in some eyes, it accelerates, leading to myopia progression during school age. This study examined the association between ocular biometrics and the acceleration of axial elongation (AAE) in children. STUDY DESIGN: Longitudinal, prospective, observational study METHODS: This cohort study included 67 right eyes of elementary school children, tracked over six years (from ages 8.5 to 14.5). Annual measurements were conducted for optical axial length, anterior chamber depth, and lens thickness. Yearly axial elongation was calculated for each time period, and AAE was estimated using regression analysis coefficients. Spearman's correlation was used to evaluate the association between AAE and ocular biometric parameters measured in the first year. RESULTS: The average axial length in the initial year was 23.37 ± 0.89 mm. By the sixth year, the mean axial elongation reached 1.50 ± 0.49 mm, while the average AAE was recorded as -0.015 ± 0.048. AAE was significantly correlated with first-year axial length (r = - 0.40, p < 0.001), anterior chamber depth (r = 0.33, p = 0.007), and lens thickness (r = - 0.42, p < 0.001). CONCLUSION: Some eyes with hyperopic ocular biometry at 8.5 years of age exhibited accelerated axial elongation during school age. Future research on myopia should consider both acceleration and axial elongation.
Reduction in choroidal thickness associated with the progression of pachychoroid spectrum diseases.
Matsumoto H, Hoshino J, Nakamura K … +3 more , Asatori Y, Kishi S, Akiyama H
Jpn J Ophthalmol · 2025 Nov · PMID 40515783 · Publisher ↗
PURPOSE: Pachychoroid spectrum diseases reportedly progress from central serous chorioretinopathy (CSC) to pachychoroid neovasculopathy (PNV) and polypoidal choroidal vasculopathy (PCV). We investigated and compared chor...
PURPOSE: Pachychoroid spectrum diseases reportedly progress from central serous chorioretinopathy (CSC) to pachychoroid neovasculopathy (PNV) and polypoidal choroidal vasculopathy (PCV). We investigated and compared choroidal thicknesses in the macular and peripheral areas among eyes with CSC, PNV, and PCV, as well as in normal control eyes. STUDY DESIGN: Retrospective case-control study. METHODS: We studied 117 consecutive eyes with treatment-naïve pachychoroid spectrum diseases, comprising 52 eyes with CSC, 27 with PNV, and 38 with PCV, along with 106 age-, gender-, and axial length-matched normal control eyes. Widefield choroidal thickness maps generated by widefield optical coherence tomography were quantitatively analyzed. Mean choroidal thickness values in the macular, superotemporal, inferotemporal, superonasal, and inferonasal areas were determined, and then compared among the three pachychoroid spectrum diseases, and also assessed in normal controls. RESULTS: The mean choroidal thickness reduction with aging was greater in eyes with pachychoroid spectrum diseases than in normal controls across all measured areas. Patient age increased in the order of CSC, PNV, and PCV, whereas there was no significant difference between PNV and PCV (P<0.01, CSC vs. PNV, CSC vs. PCV). Mean choroidal thickness exhibited a progressive decrease from CSC to PNV and PCV across all areas, although there were no significant differences between PNV and PCV (P<0.01, CSC vs. PCV, CSC vs. PNV). CONCLUSIONS: Overall choroidal thickness appears to decrease during the progression of pachychoroid spectrum diseases. This decline might be attributable to reduced choroidal blood flow due to the choriocapillaris attenuation associated with aging and pachychoroid pathophysiology.
Quantitative evaluation of inflammation after phacoemulsification surgery: anterior chamber flare and choroidal vascular index.
Simsek M, Cakir GY, Koser E … +2 more , Altan C, Taşkapılı M
Jpn J Ophthalmol · 2025 Sep · PMID 40504426 · Full text
PURPOSE: To evaluate the relationship between phacoparameters and inflammation parameters (anterior chamber flare (ACF), macular and peripapillary choroidal vascular index (mCVI and pCVI)) changes after cataract surgery....
PURPOSE: To evaluate the relationship between phacoparameters and inflammation parameters (anterior chamber flare (ACF), macular and peripapillary choroidal vascular index (mCVI and pCVI)) changes after cataract surgery. STUDY DESIGN: Prospective study METHODS: This prospective observational study included patients without systemic and ocular diseases who underwent uncomplicated cataract surgery that may have affected intraocular inflammation. Preoperative, postoperative 1st week, 1st, 3rd and 6th months ACF were measured. At the same visits, mCVI and pCVI were calculated. The relationship between phacoparameters and postoperative ACF, mCVI and pCVI values were evaluated by correlation analysis. RESULTS: Fifty eyes of 50 patients were included in the study. Postoperative 1st week ACF was significantly higher than preoperative ACF (p<0.001). ACF decreased significantly from postoperative 1st week to 6th months. Postoperative 1st month and 3rd month mCVI were significantly higher than preoperative mCVI (p<0.001, p=0.04, respectively). It was observed that pCVI reached its peak value in the 1st postoperative week and decreased to base value in the postoperative 6th month. A strong positive linear correlation was found between total cumulative dissipated energy (CDE) and the difference between postoperative 1st week and preoperative ACF (p<0.001, r=0.68). CONCLUSION: Particularly in the early period after phacoemulsification, ACF, mCVI and pCVI increased. The increase in ACF lost its significance at the third month and the increase in mCVI and pCVI remained significant, which may indicate that the inflammatory effect of cataract surgery lasts longer in the posterior segment. Total CDE can be used to predict postoperative inflammation levels.
Six-year findings of polypoidal choroidal vasculopathy in the EVEREST II study: Japanese subgroup analysis.
Yanagi Y, Mori R, Teo KYC … +16 more , Park KH, Ngah NF, Chen SJ, Ruamviboonsuk P, Kondo N, Lee WK, Rajagopalan R, Obata R, Wong IYH, Chee C, Terasaki H, Sekiryu T, Chen SC, Lai TYY, Cheung G, Honda S
Jpn J Ophthalmol · 2025 Nov · PMID 40504425 · Publisher ↗
PURPOSE: To evaluate long-term outcomes for polypoidal choroidal vasculopathy (PCV) in Japanese patients in the EVEREST II study. STUDY DESIGN: A multicenter, cross-sectional study of the long-term outcomes of a cohort o...
PURPOSE: To evaluate long-term outcomes for polypoidal choroidal vasculopathy (PCV) in Japanese patients in the EVEREST II study. STUDY DESIGN: A multicenter, cross-sectional study of the long-term outcomes of a cohort of patients originally treated with ranibizumab alone (monotherapy group) or in combination with photodynamic therapy PDT (combination group) in the EVEREST II study (ClinicalTrials.gov identifier, NCT01846273). METHODS: Ninety participants from the six-year EVEREST II follow-up: 20 Japanese and 70 non-Japanese were included. Long-term changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) were reported in the Japanese compared to non-Japanese participants. Number of injections, types of anti-vascular endothelial growth factor (VEGF) agents used, and cases with equal visits and injections, indicating fixed dosing or treat-and-extend (TAE) administration were investigated. Outcomes were also compared between those who had verteporfin PDT during the six-year period (n=14) and those who did not (n=6). RESULTS: The Japanese and non-Japanese participants had similar baseline characteristics. The mean age for Japanese participants was 76±4.47 years, with 25% being women. BCVA improved from baseline to year 2 in both groups (P < 0.05). At six years, BCVA was maintained in the Japanese (67.2 ETDRS letters) but decreased in the non-Japanese participants (from 68.8 to 53.5 letters). The Japanese participants received more injections than the non-Japanese (12.5 vs. 7.57, P=0.017). Aflibercept was the most frequently used anti-VEGF agent, and the number of fixed dosing or TAE administration was higher in the Japanese participants. No significant differences were found in functional and anatomical outcomes between those who received PDT and those who did not (all P > 0.05). However, non-PDT participants had numerically worse BCVA at the final visit. CONCLUSIONS: This study highlights positive long-term outcomes for Japanese PCV patients and underscores the need for further research to validate these findings in broader patient populations.
Factors determining timing of first recurrence after three loading aflibercept injections in newly diagnosed neovascular age-related macular degeneration.
Lee SH, Lee MY
Jpn J Ophthalmol · 2025 Nov · PMID 40504424 · Publisher ↗
PURPOSE: To investigate factors affecting timing of the first recurrence after three loading aflibercept injections in patients with newly diagnosed neovascular age-related macular degeneration (NAMD). STUDY DESIGN: Retr...
PURPOSE: To investigate factors affecting timing of the first recurrence after three loading aflibercept injections in patients with newly diagnosed neovascular age-related macular degeneration (NAMD). STUDY DESIGN: Retrospective chart review. METHODS: A retrospective study was conducted on 193 eyes from 193 patients newly diagnosed with NAMD who received monthly three loading aflibercept injections and a fourth injection by pro-re-nata therapy regimen for recurrence between January 2016 and May 2023. Recurrence was defined as reaccumulation of subretinal or intraretinal fluid or new or increased retinal or subretinal hemorrhage. Patients were divided into two groups. One group received a fourth injection within 12 weeks after the third dose of aflibercept (Group A) and the other group received a fourth injection after 12 weeks (Group B). RESULTS: In group A (65 eyes) compared to group B (128 eyes), the frequency of polypoidal choroidal vasculopathy (PCV) was higher (60.0%: 36.7%), the frequency of retinal angiomatous proliferation was lower (6.2%: 18.0%), and the optical coherence tomography (OCT) findings showed that pigment epithelial detachment (PED) of hollow type was more likely to be observed compared to solid type (OR=3.14, p=0.013) or mixed type (OR=3.67, p=0.003) of PED; sharply peaked PED was more common (OR=2.05, p=0.045) and less likely to be seen in females (OR=0.46, p=0.034). CONCLUSION: In patients with newly diagnosed NAMD who received three injection loading doses of aflibercept, earlier recurrence was predicted when PCV was present, when a hollow type of PED was observed on OCT, and when the patient was a man.
Real-world outcomes, including intraocular inflammation, after intravitreal brolucizumab for diabetic macular edema.
Hirano T, Chiku Y, Hoshiyama K … +3 more , Takahashi Y, Ito S, Murata T
Jpn J Ophthalmol · 2025 Sep · PMID 40500587 · Full text
PURPOSE: This study aimed to assess the real-world outcomes, including intraocular inflammation (IOI), following administration of intravitreal brolucizumab (Beovu 6.0 mg/0.05 mL; Novartis) injections (IVBr) for diabetic...
PURPOSE: This study aimed to assess the real-world outcomes, including intraocular inflammation (IOI), following administration of intravitreal brolucizumab (Beovu 6.0 mg/0.05 mL; Novartis) injections (IVBr) for diabetic macular edema (DME). STUDY DESIGN: Retrospective study. METHODS: A total of 56 eyes of 47 patients with DME were treated with IVBr for a minimum follow-up of at least 6 months between May 2022 and November 2023. A "non-strict pro re nata" dosing protocol for IVBr was used. The best corrected visual acuity (BCVA), central macular thickness (CMT), at baseline, 6 months, 1 year, and the latest visit date and IVBr frequency were assessed to evaluate the treatment efficacy. IOI incidence, baseline characteristics of patients with IOI, and treatment course were investigated. RESULTS: BCVA significantly improved at 6 months and at the latest visit compared to baseline (P = 0.008 and 0.006, respectively). CMT was significantly thinner at 6 months, 1 year, and the latest visit compared to baseline (all, P < 0.001). In 46 eyes followed for more than 1 year, the number of IVBr from baseline to 1 year was 3.8 ± 1.9. Four eyes (7.1%) of four patients (8.5%) developed IOI during the observation period. All patients were women, with an average age of 70.8 ± 9.0 years (59-81 years). Upon IOI diagnosis, all patients received posterior sub-Tenon's triamcinolone acetonide and topical betamethasone sodium phosphate, resulting in rapid resolution. CONCLUSION: IOI developed in four of 56 (7.1%) eyes and responded well to prompt steroid therapy after 1.5 years of IVBr use for DME. BCVA and CMT improved at all evaluation time points. With an average of 3.8 IVBr injections per year, IVBr showed long-term efficacy for DME in the real-world setting, although the occurrence of IOI should be monitored.
En-face quantitative evaluation using ultra-high-resolution OCT of hyperreflective foci in neovascular age-related macular degeneration.
Wada I, Nakao S, Shiose S … +6 more , Kaizu Y, Yamaguchi M, Ishikawa K, Kiyohara K, Ishibashi T, Sonoda KH
Jpn J Ophthalmol · 2025 Sep · PMID 40500586 · Publisher ↗
PURPOSE: This study quantifies hyperreflective foci (HRFs) in neovascular age-related macular degeneration (nAMD) before and after anti-VEGF therapy in the initial loading phase using en-face ultra-high-resolution spectr...
PURPOSE: This study quantifies hyperreflective foci (HRFs) in neovascular age-related macular degeneration (nAMD) before and after anti-VEGF therapy in the initial loading phase using en-face ultra-high-resolution spectral domain OCT (UHR-SD-OCT), investigating their correlation with clinical findings. STUDY DESIGN: Retrospective observational study METHODS: This retrospective study included 30 eyes from 30 patients with treatment-naïve nAMD. The patients received monthly intravitreal injections of anti-VEGF therapy for three months as the initial loading phase. At each visit, comprehensive ophthalmic examinations were conducted. HRFs were quantified using our custom-developed software from an en-face UHR-SD-OCT. The number of HRFs was compared before and after the loading phase and investigated the relationship with best-corrected visual acuity (BCVA), greatest linear dimension (GLD), macular neovascularization (MNV) size and incidence of macular atrophy (MA). RESULTS: This evaluation system showed a significant reduction in the number of HRFs after anti-VEGF therapy compared to before the loading phase (p < 0.0001). The number of pre-treatment HRFs significantly correlated with pre-treatment BCVA, GLD, and MNV size. The number of post-treatment HRFs significantly correlated with pre-treatment GLD and pre-treatment MNV size. Additionally, patients who developed MA two years after treatment initiation exhibited significantly higher counts of pre-treatment HRFs compared to those without the MA development (465.7 ± 187.0 vs. 212.9 ± 93.8, p < 0.05). CONCLUSIONS: Quantification of HRF using en-face UHR-SD-OCT may be a useful clinical biomarker during anti-VEGF therapy in nAMD.
Efficacy of switching from existing anti-vascular endothelial growth factor drugs to ranibizumab biosimilar in neovascular age-related macular degeneration.
Ota H, Takeuchi J, Nonogaki R … +3 more , Tamura K, Kaneko H, Nishiguchi KM
Jpn J Ophthalmol · 2025 Nov · PMID 40500585 · Full text
PURPOSE: This study evaluated the clinical outcomes and aqueous humor cytokine levels in eyes with neovascular age-related macular degeneration (nAMD) switched from intravitreal aflibercept to ranibizumab biosimilar (BS)...
PURPOSE: This study evaluated the clinical outcomes and aqueous humor cytokine levels in eyes with neovascular age-related macular degeneration (nAMD) switched from intravitreal aflibercept to ranibizumab biosimilar (BS). STUDY DESIGN: Prospective observational study. METHODS: Thirty-eight eyes of 38 patients with nAMD who received aflibercept under a treat-and-extend (TAE) regimen were prospectively switched to ranibizumab BS. Eight eyes with cataracts undergoing surgery served as controls for aqueous humor cytokine analysis. Best-corrected visual acuity (BCVA) and anatomical outcomes were assessed over one year. The aqueous humor levels of vascular endothelial growth factor (VEGF)-A, angiopoietin-2 (Ang-2), and placental growth factor (PlGF) were measured before and after switching in eyes with nAMD and at surgery in controls. RESULTS: Disease activity remained controlled in 94.3% of patients with nAMD for over one year. No significant changes were observed in the BCVA (P=0.65) after one year. Ang-2 levels remained unchanged (P=0.66) and were not significantly different between eyes with nAMD and controls both before (P=0.64) and after switching (P=0.30). PlGF levels also remained stable (P=0.12) but were significantly higher in eyes with nAMD than in controls both before (P<0.01) and after switching (P=0.03). VEGF-A levels significantly increased after switching (P<0.01) but remained lower than in the controls both before (P<0.01) and after switching (P=0.02). CONCLUSION: Switching from aflibercept to ranibizumab BS effectively maintained disease stability and cytokine balance in eyes with nAMD. These findings support ranibizumab BS as a viable and cost-effective alternative for long-term treatment.
Refractive error and axial length prediction using fundus parameters of normal eyes in the Kumejima population study.
Yamashita T, Asaoka R, Iwase A … +4 more , Sakai H, Terasaki H, Sakamoto T, Araie M
Jpn J Ophthalmol · 2025 Jul · PMID 40488808 · Full text
PURPOSE: To evaluate the accuracy of predictive refractive error (RE) and axial length (AL) using regression analysis of fundus parameters in the Kumejima study and to identify RE- or AL-related fundus changes. STUDY DES...
PURPOSE: To evaluate the accuracy of predictive refractive error (RE) and axial length (AL) using regression analysis of fundus parameters in the Kumejima study and to identify RE- or AL-related fundus changes. STUDY DESIGN: Prospective cross-sectional observational population study. METHODS: Non-mydriatic color fundus photographs (CFPs) from 1,646 right eyes of healthy Kumejima participants were analyzed. Mean red (R), green (G), and blue (B) intensities at eight locations around the optic disc and fovea were quantified, and the tessellation fundus index was calculated as R/(R + G + B). Optic disc ovality ratio, papillomacular angle, and retinal vessel angle were measured. Least absolute shrinkage and selection operator regression with leave-one-out cross-validation predicted RE and AL, validated using Pearson's correlation coefficient. RESULTS: The mean ± standard deviation actual RE and AL of participants (834 men and 812 women) were -0.14±1.62 diopter and 23.50±0.88 mm. The mean ± standard deviation predicted RE and AL based on fundus parameters was -0.14±1.05 diopter and 23.50±0.48 mm, with a mean absolute error of 0.91 diopter and 0.59 mm, and the correlation coefficients between actual and predicted RE and AL were 0.63 and 0.51 (p<0.001). Eyes with a longer AL had narrower temporal vessel angles, weaker green intensities, stronger blue intensities, and increased tessellation of the fundus color (p<0.001). CONCLUSION: RE and AL could be predicted using CFP parameters; the RE- or AL-related changes in the fundus, such as vessel angles and peripapillary color intensity, may enhance our understanding of myopia mechanisms.
Prevalence and prognosis of sagging eye syndrome in Japanese population.
Fukaya K, Iida K, Aoki T … +4 more , Kuga S, Shioya N, Kunimi K, Goseki T
Jpn J Ophthalmol · 2025 Sep · PMID 40478508 · Publisher ↗
PURPOSE: Sagging eye syndrome (SES) is the leading cause of acquired diplopia; however, there are no comprehensive reports on its treatment and prognosis in Japan. This study aimed to examine the disease classification o...
PURPOSE: Sagging eye syndrome (SES) is the leading cause of acquired diplopia; however, there are no comprehensive reports on its treatment and prognosis in Japan. This study aimed to examine the disease classification of binocular diplopia in patients aged over 40 years old and examine the treatment methods and prognosis of SES. STUDY DESIGN: Retrospective observational case series. METHODS: We reviewed the medical records of all new patients aged 40 years or older with binocular diplopia who visited the International University of Health and Welfare, Atami Hospital, between January 2020 and December 2022. Clinical causes of diplopia were analyzed based on age and sex; binocular alignment, treatment types, and post-treatment outcomes were documented for patients with SES, age-related distance esotropia, and cyclovertical strabismus. RESULTS: Among the 199 patients with binocular diplopia, SES was identified as the most common cause, affecting 95 (47.7%) individuals. Women comprised 52.6% of SES cases and 49% of non-SES cases (p=0.67). The mean age of onset was 71.2 ± 10.8 years for binocular diplopia, 76.2 ± 6.5 years for SES, and 66.6 ± 12.0 years for other etiologies (p<0.001). SES treatments included surgery (48.4%, n=46), prism glasses (35.9%, n=34), and observation (15.8%, n=15). Among the 46 patients who underwent surgery and 34 who were prescribed prism glasses, 7 and 2 had residual diplopia, respectively, which resolved after additional treatment. CONCLUSION: SES is a common cause of binocular diplopia in adults; however, effective treatment can successfully resolve diplopia in most cases.
Efficacy and limitations of amniotic membrane transplantation in cases of severe ocular surface disorders: retrospective analysis over a 21-year period.
Harada K, Fukuoka H, Kitazawa K … +9 more , Aziza Y, Inatomi T, Hino T, Horiguchi G, Teramukai S, Kinoshita S, Uematsu M, Kitaoka T, Sotozono C
Jpn J Ophthalmol · 2025 Sep · PMID 40478507 · Full text
PURPOSE: To examine the reoperation rate of amniotic membrane transplantation (AMT) and clarify the risk factors for AMT reoperation in severe ocular surface (OS) disorders (OSD). STUDY DESIGN: Retrospective cohort study...
PURPOSE: To examine the reoperation rate of amniotic membrane transplantation (AMT) and clarify the risk factors for AMT reoperation in severe ocular surface (OS) disorders (OSD). STUDY DESIGN: Retrospective cohort study. PARTICIPANTS: We reviewed the medical records of all AMT cases between April 1998 and June 2019 at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. METHODS: Primary diseases and AMT reoperation rates were examined. In severe OSD cases (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and chemical/thermal burns), preoperative OS Grading Score (OSGS), surgical procedures combined with AMT, and risk factors for reoperation were investigated and assessed. RESULTS: Over a period of 21 years and 3 months, 750 AMTs were performed on 664 eyes of 594 cases. AMT was repeated on 51 of those 664 eyes (7.7%), and most frequently performed on 25 out of 196 eyes (12.8%) afflicted with severe OSDs. In severe OSDs, OSGS was significantly higher in the reoperation group compared to no-reoperation group (P<0.05), suggesting corneal epithelial defects, conjunctival hyperemia, trichiasis, mucocutaneous junction involvement, and corneal opacity as being risk factors for re-AMT (univariate analysis). In logistic regression analysis, only conjunctival hyperemia was a risk factor, with odds ratios (OR) of 2.65 (95%CI: 1.34-5.22, P=0.005). AMT combined with cultivated or donor corneal epithelial transplantation reduced reoperation risk with an OR of 0.92 and 0.63, respectively. CONCLUSIONS: In severe OSD cases, the effect of AMT is limited. Higher OSGSs, especially in conjunctival hyperemia, are associated with a high risk of repeat AMT.
Biometric risk factors for myopia onset in emmetropic school-age children.
Nakai Y, Hieda O, Nakamura Y … +3 more , Nakata M, Sotozono C, Kinoshita S
Jpn J Ophthalmol · 2025 Sep · PMID 40459824 · Full text
PURPOSE: To identify the potential biometric risk factors for the onset of myopia in emmetropic school-age children. STUDY DESIGN: Longitudinal study. METHODS: First, we performed a preliminary study in which objective r...
PURPOSE: To identify the potential biometric risk factors for the onset of myopia in emmetropic school-age children. STUDY DESIGN: Longitudinal study. METHODS: First, we performed a preliminary study in which objective refraction, corneal refractive power, higher-order aberrations (HOAs), and axial length (AL) was measured annually in 98 Grade-3 (age 8) elementary schoolchildren over a 4-year period from 2006 to 2009. We also examined the refractive changes over 3 years, and assessed the correlation between those changes and the baseline data. Based on those findings, we performed the primary study in which objective and subjective refraction, corneal refractive power, HOAs, and AL was measured annually in Grade 1 (age 6) through Grade 8 (age 13) schoolchildren from 2013 to 2022. We investigated the risk factors for AL elongation over 1 year in children with emmetropia at the first year using a multivariable linear mixed model. RESULTS: Findings in the preliminary study revealed that AL in the first year (age 8) had the strongest correlation with myopia progression for 3 years. The risk factors for AL elongation among emmetropia were 1) lower grade, 2) sex (female), 3) myopic objective refraction (spherical equivalent), 4) longer AL (mm), 5) lower corneal coma-like aberration (CA) at the pupil diameter of 6 mm, and 6) higher ocular spherical aberration (SA) of 4 mm and lower ocular SA at the pupil diameter of 6 mm in the primary study. CONCLUSION: Risk factors for myopia onset in emmetropic school-age children include AL, refraction, corneal CAs, and ocular SAs.
Assessment of retinal, choroidal and peripapillary microvascular changes in patients with chronic myeloid leukemia.
Cicek MF, Oba T, Perk FFNK … +2 more , Ayer M, Onder F
Jpn J Ophthalmol · 2025 Sep · PMID 40418491 · Publisher ↗
PURPOSE: To quantitatively assess the microvascular alterations and structural parameters in the optic disc, retina, and choriocapillaris of chronic myeloid leukemia (CML) patients devoid of leukemic retinopathy, while a...
PURPOSE: To quantitatively assess the microvascular alterations and structural parameters in the optic disc, retina, and choriocapillaris of chronic myeloid leukemia (CML) patients devoid of leukemic retinopathy, while also examining the correlation between these parameters and serum laboratory results. STUDY DESIGN: Prospective, cross-sectional, observational clinical study METHODS: This study included 30 eyes from 15 patients diagnosed with CML and 30 eyes from age 15- and gender-matched healthy individuals (control group). All participants underwent comprehensive ophthalmologic assessments, including optical coherence tomography angiography (OCTA). Statistical analyses, including Student's t-test and the Mann-Whitney U test, were conducted to compare structural and vascular parameters between CML patients and controls. Spearman's correlation was used to evaluate the relationship between OCTA measurements and serum parameters. RESULTS: The analysis of macular vessel density revealed significant reductions in all assessed parameters in the patient group compared to the control group. These parameters include whole image superficial vessel density (wisVD, p=0.005), parafoveal superficial vessel density (pfsVD, p=0.002), perifoveal superficial vessel density (pefsVD, p=0.007), whole image deep vessel density (widVD, p=0.005), parafoveal deep vessel density (pfdVD, p=0.004), and perifoveal deep vessel density (pefdVD, p=0.005). Higher white blood cell levels were associated with lower optic nerve head whole image VD, wisVD, pfsVD, pefsVD, widVD, and pefdVD. Higher platelet levels were correlated with lower widVD. Additionally, hemoglobin showed a positive correlation with choriocapillaris vessel flow density, while it exhibited a negative correlation with superior and inferior macular ganglion cell complex thickness. CONCLUSION: Subclinical retinal perfusion loss was observed in CML patients, and this perfusion loss was associated with hematological parameters. The marked reduction in macular perfusion could be valuable for understanding the pathogenesis of the disease and predicting potential retinal complications such as hypoxia and ischemia in more advanced stages. Further studies are needed to investigate the functional and prognostic significance of the changes we observed.
Descemet membrane endothelial keratoplasty after cataract surgery with presbyopia-correcting intraocular lens for coexisting Fuchs endothelial corneal dystrophy and cataract.
Yokogawa H, Hayashi T, Kobayashi A … +6 more , Mori N, Yamazaki K, Ohta H, Takeda M, Igarashi A, Yamagami S
Jpn J Ophthalmol · 2025 Sep · PMID 40418490 · Publisher ↗
PURPOSE: To assess the outcomes of Descemet membrane endothelial keratoplasty (DMEK) staged after implantation of presbyopia-correcting intraocular lenses (IOLs) in patients with coexisting Fuchs endothelial corneal dyst...
PURPOSE: To assess the outcomes of Descemet membrane endothelial keratoplasty (DMEK) staged after implantation of presbyopia-correcting intraocular lenses (IOLs) in patients with coexisting Fuchs endothelial corneal dystrophy (FECD) and cataract. STUDY DESIGN: Retrospective, interventional case series METHODS: We enrolled six eyes of three patients with coexisting FECD and cataract (3 women, age 67.8 ± 6.5 years) treated with presbyopia-correcting IOL implantation, followed by DMEK. The modified Krachmer grade, visual outcomes, and incidence of intra- and postoperative complications were analyzed. RESULTS: Modified Krachmer FECD grades 4, 5, and 6 were observed in one, two, and three eyes, respectively. The mean best-corrected visual acuity (BCVA) was dissatisfactory with the primary presbyopia-correcting IOL (decimal 0.45), it improved significantly (decimal 1.0, P = 0.027) after DMEK and all eyes acquired satisfactory uncorrected distance and near (30 cm) vision (mean, decimal, distance 0.85 and near 0.56). The manifest spherical equivalent after DMEK was within the acceptable range (-0.375 D to 0.0 D). Rebubbling was required in four eyes, but no instances of other postoperative complications or primary graft failure were encountered. CONCLUSION: DMEK staged after implantation of presbyopia-correcting IOLs is a viable option for patients with coexisting FECD and cataract.
Comparative study of efficacy and safety of pulse versus half-pulse steroid therapy for Vogt-Koyanagi-Harada Disease.
Tsubota K, Goto H, Asakage M … +6 more , Kinoshita Y, Nonaka R, Wakatsuki K, Sugawara R, Fukai R, Usui Y
Jpn J Ophthalmol · 2025 Sep · PMID 40418489 · Full text
PURPOSE: High-dose steroid therapy is commonly used for Vogt-Koyanagi-Harada (VKH) disease in Japan, but the optimal initial dose remains uncertain. This study investigated the efficacy and safety of conventional steroid...
PURPOSE: High-dose steroid therapy is commonly used for Vogt-Koyanagi-Harada (VKH) disease in Japan, but the optimal initial dose remains uncertain. This study investigated the efficacy and safety of conventional steroid pulse therapy (pulse group) and half-dose steroid pulse therapy (half-pulse group) for the initial treatment of VKH disease. STUDY DESIGN: This was a single-center, retrospective observational study based on a review of medical records. SUBJECTS AND METHODS: Seventy-two patients with initial-onset VKH disease treated at Tokyo Medical University Hospital were analyzed. The pulse group (44 patients) received 1000 mg/day of intravenous methylprednisolone (MPSL), while the half-pulse group (28 patients) received 500 mg/day of MPSL. In both groups, steroids were tapered according to ocular findings, and the minimum follow-up period was eight months. RESULTS: Recurrence rate during follow-up period (pulse group: 41%, half-pulse group: 34%, p = 0.48), mean number of recurrences (pulse group: 1.9 ± 1.2, half-pulse group: 1.5 ± 0.9, p = 0.42), and type of recurrence (anterior uveitis: pulse group: 11%, half-pulse group: 17%, p = 0.33; posterior inflammation: pulse group: 34%, half-pulse group: 22%, p = 0.14) were not significantly different between the two groups. The proportion of patients requiring cataract surgery during the follow-up period tended to be higher in the pulse group (pulse group: 10%, half-pulse group: 3%, p = 0.12), although not significantly different. The incidence of sunset glow fundus was not significantly different between the two groups (pulse group: 23%, half-pulse group: 10%, p = 0.22). CONCLUSIONS: No significant difference in clinical efficacy for VKH disease was observed between conventional steroid pulse therapy and half-pulse therapy, and by reducing the total steroid dose, half-pulse therapy potentially lowers the risk of adverse effects related corticosteroid.
Five-year effect of sequential argon-Nd:YAG prophylactic laser peripheral iridotomy on corneal endothelial cell density in Japanese eyes with narrow angles.
Mishima K, Mataki N, Murata H … +7 more , Ohtani S, Sakai H, Tomidokoro A, Aihara M, Miyata K, Iwase A, Araie M
Jpn J Ophthalmol · 2025 Sep · PMID 40418488 · Full text
PURPOSE: To evaluate the effects of prophylactic sequential argon- Nd:YAG laser peripheral iridotomy (pLPI) on the corneal endothelial cell density (CECD) over 5 years in Japanese eyes with narrow angles (NA-eyes). STUDY...
PURPOSE: To evaluate the effects of prophylactic sequential argon- Nd:YAG laser peripheral iridotomy (pLPI) on the corneal endothelial cell density (CECD) over 5 years in Japanese eyes with narrow angles (NA-eyes). STUDY DESIGN: Prospective observational study METHODS: The CECD of NA-eyes before and after pLPI and of untreated NA-eyes were assessed annually over 5 years with non-contact specular microscopy. Routine ophthalmic examinations and measurements using anterior-segment imaging devices were performed at baseline. The time courses of the CECD were analyzed using a multivariable linear mixed-effect model and factors obtained at baseline. RESULTS: Sixty-nine pLPI-treated NA-eyes (69 subjects; mean age, 68.9 years) and 67 pLPI-untreated NA-eyes (67 subjects; mean age, 64.4 years) were enrolled. In the pLPI-untreated NA-eyes, no baseline factors were correlated significantly with the time course of the CECD, and its decline rate - 4.7 (95% Confidence interval (I: - 13.3 to 4.0) cells/mm was not significant (p = 0.267). In the pLPI-treated NA-eyes, the CECD declined with marginal significance - 12.2 (- 24.7 to 0.3) cells/mm/year (p = 0.0513) over 5 years. Higher laser energy used, thicker iris, and shallower central anterior chamber depth (cACD) at baseline were significantly negatively correlated with the post-laser CECD (p = 0.0092, 0.0119, and 0.0158). No significant difference was seen in the baseline factors-adjusted CECD decline rate (p = 0.262) between both the groups. CONCLUSION: Prophylactic sequential argon-Nd:YAG pLPI had no clinically significant effects on the time course of the CECD over 5 years in Japanese NA eyes. However, higher laser energy used, thicker iris, and shallower cACD significantly negatively affected the post-laser CECD.
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