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Lacrimal drainage pathway disease-associated keratopathy (LDAK) has been associated with corneal perforation, which arises from both infectious and non-infectious corneal disorders. However, patients with corneal perforation are often not routinely tested for LDAK, and the potential risk posed by LDAK in the development of corneal ulcers has not been investigated in detail. This study aimed to assess the proportion and characteristics of LDAK in patients with non-infectious corneal perforation using lacrimal syringing test. This study enrolled 56 patients with corneal perforation treated at Saitama Medical University Hospital between January 2016 and September 2022. The causes of corneal perforation were trauma (n = 17, 30%), infection (n = 19, 34%), non-infection (n = 16, 29%), and unknown (n = 4, 7%). A lacrimal syringing test was performed on 12 patients with non-infectious corneal perforation and 4 with an unknown diagnosis. Among the 16 patients with non-infectious corneal perforation, 13 (81%) had lacrimal drainage disease, but only 3 (19%) patients had lacrimal puncta, as revealed by slit-lamp examinations. The primary bacterial species identified in lacrimal obstructive disease and lacrimal canaliculitis were Staphylococcus spp. and Actinomycetes spp. respectively. Lower temporal and peripheral corneal perforations were common. All patients underwent lacrimal surgery, and 6 (38%) were treated for corneal perforation without corneal surgery. Interestingly, several patients with LDAK who did not exhibit any lacrimal duct obstruction on slit-lamp examination. The study findings demonstrate the significance of the lacrimal syringing test for assessing LDAK in patients with corneal perforation, indicating LDAK as a potential cause of corneal perforation.

Purpose To compare intraocular lens (IOL) stability and reversibility in phacovitrectomy with air or gas tamponade between one- and three-piece intraocular lenses (IOLs). Study design This retrospective cross-sectional study was conducted at Saitama Medical University Hospital from January to July 2023. Methods This study involved 19 patients who underwent phacovitrectomy with either air or sulfur hexafluoride gas tamponade and postoperative anterior segment optical coherence tomography. Patients who underwent NSP-3 (NIDEK Co., Ltd., Japan) or NX70s (Santen Pharmaceutical Co., Japan) implantation were evaluated. The displacement force (mN) of the IOL was evaluated in a verification experiment using the NSP-2 (NIDEK Co., Ltd., Japan) and the NX70s. The NSP-2 and NSP-3 share the same lens platform.   Results The median age was 66 (58, 77) [median (quartiles)] years for NX70s (n=8) and 67 (55, 71) years for NSP-3 (n=11). The anterior chamber depth (ACD) and IOL position values were substantially elevated after the air or gas disappeared for both IOLs. Comparing the IOLs for the ACD and IOL positions at each time point, no significant difference was found in the ACD and IOL position values in 100% gas or air. However, ACD and IOL position values of the NSP-3 were markedly higher than those of the NX70s in 0% gas or air. In the verification experiment, NSP-2 required a higher IOL displacement force than the NX70s. Following 48 h of 0.5 mm push, the percentage change in the axial distance was smaller for NSP-2 (-6.9%) than for NX70s (-15.5%). Conclusion NSP3 was as stable as NX70s in phacovitrectomy with tamponade and demonstrated better reversibility than NX70s.

Purpose To evaluate the association between axial length and crystalline lens biometry with and without accommodation using the CASIA2 swept-source (SS) optical coherence tomography (OCT) system on the anterior segment. Study design Intervention study. Methods Individuals aged 20 to 39 years were enrolled for SS-OCT imaging at 2 separate visits within 1 week. Each eye was imaged under accommodation stimuli with different amplitudes (0 D, -1 D, -3 D, -5 D, and -7 D). The anterior and posterior lens curvature radii and lens thicknesses were measured. The participants were divided into 4 groups according to axial length. Results Forty-eight participants (96 eyes) were initially enrolled. All 96 eyes were included in the analyses, as they met the eligibility criteria and each had proper OCT images. The mean participant age was 25.9 ± 4.3 years, and the mean spherical error was -3.5 ± 2.5 D. The mean axial length was 25.1 ± 1.2 mm. Multivariate analysis revealed that the anterior curvature radius became flatter and the lens thickness became thicker as the axial length increased (all P < .01). Furthermore, axial length independently contributed to the shape of the lens after adjusting for the effects of age and accommodation stimuli. Conclusion Axial length was associated with lens shape after adjusting for age and accommodation stimuli. These measurements can provide a glimpse of dynamic lens biometry changes, which may help us better understand the role of lenses in various physiologic changes, including accommodation and myopia.

Since 2015, hydroxychloroquine (HCQ) has been widely used as a standard treatment for systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) under the national health insurance system in Japan. However, the status of routine ophthalmological screening for retinopathy, which is a notable safety concern of HCQ, remains unclear. In this retrospective study using the nationwide health insurance claims database, we aimed to investigate the status of ophthalmological screening in routine clinical practice in Japan. A total of 2567 patients with SLE or CLE were included in the analysis. The proportion of ophthalmology visits was 88.0% at the initiation of HCQ prescription, decreased to 76.3% after one year, and then remained constant. Moreover, only 50% of the patients underwent spectral-domain optical coherence tomography (SD-OCT) and automated visual field (VF) tests, which are useful for the early detection of HCQ retinopathy-related changes. Importantly, the proportion of ophthalmology visits remained consistently high among patients who visited an ophthalmologist in the previous year, ranging from 77.3% to 90.2%. These findings highlight the need to improve screening adherence and promote regular ophthalmological evaluations, particularly for patients without prior ophthalmology visits, to enhance the early detection of HCQ retinopathy.

Background/AimsTo evaluate quantitative changes in the foveal avascular zone (FAZ) area after glaucoma surgery using swept-source optical coherence tomography angiography (SS-OCTA).MethodsFifty-four consecutive patients with primary open-angle glaucoma (POAG) who met the inclusion criteria and underwent unilateral glaucoma surgery to reduce intraocular pressure (IOP) between April 2018 and July 2019.Eyes underwent IOP-lowering glaucoma surgery and their fellow (non-surgical) eyes were included. OCTA of the macula was performed in both eyes before glaucoma surgery and 3 months postoperatively. Two blinded examiners reviewed the image quality. Within- and between-group comparisons of the FAZ area and correlation of the FAZ area with age, IOP, central sensitivity and clinical variables.ResultsThe mean (±SD) age was 66.7±11.3 years. After surgery, the IOP and FAZ area significantly decreased from 22.1±9.5 mmHg to 10.3±3.5 mmHg and from 0.485±0.193 mm2 to 0.446±0.174 mm2, respectively (both p<0.001). Conversely, in the non-surgery group, the preoperative and postoperative mean FAZ areas (0.398±0.119 mm2 and 0.396±0.110 mm2, respectively) did not significantly differ (p=0.469). Change in the FAZ area significantly correlated with the preoperative FAZ area, preoperative foveal sensitivity and change in IOP (all p<0.05).ConclusionsThe FAZ area is decreased with IOP-lowering surgery in patients with POAG, and change in the FAZ area was significantly correlated with both preoperative foveal sensitivity and change in IOP.

Background Dominant optic atrophy (DOA) is an inherited optic neuropathy caused by mutations of the OPA1 gene. Patients with DOA have a gradual loss of vision that is often detected in early life. While most cases stabilize at around a decimal best-corrected visual acuity (BCVA) of 0.1, some show mild impairments without visual field abnormalities. This then makes the diagnosis of DOA difficult. We report our longitudinal findings of a 56-year-old man with autosomal dominant DOA whose visual functions remained relatively good and genetic testing was needed for the diagnosis of DOA. Case presentation The patient was first examined 7 years earlier when he was 49-year-old at the Saitama Medical University Hospital. His major complaint was blurred vision. He had no medical or family history of ocular disorders, and his decimal BCVA was 1.0 (Snellen 20/20) in both eyes (OU). The intraocular pressure (IOP) was 13.7 mmHg in the right eye and 14.0 mmHg in the left eye. Slit-lamp examination revealed mild cataracts OU, and fundus examination showed temporal pallor of the optic discs OU. Humphrey visual field analyzer (HFA) standard 30 − 2 white-on-white perimetry indicated that the sensitivity was not reduced. Five years later, the patient returned for further examination because his vision had worsened. The decimal BCVA was 0.8 in the right eye and 0.6 in the left eye, and the IOP was within normal limits OU. The critical fusion frequency (CFF) was 30 Hz in the right eye and 31 Hz (normal values > 39 Hz) in the left eye. Slit-lamp examination and ophthalmoscopy showed no intraocular changes. Optical coherence tomography (OCT) showed a thinning of the retinal nerve fiber layer temporal to the optic disc. The contrast sensitivity was slightly decreased in both eyes, and the Panel D-15 color vision test was normal. Goldmann visual field testing with HFA SITA standard 10 − 2 and 24 − 2 white-on-white perimetry showed no obvious scotomas. However, HFA SITA standard 24 − 2 blue-on-yellow perimetry showed a diffuse decrease of sensitivity. Full-field and focal macular electroretinograms (ERGs) were normal in both eyes. Genetic testing was performed with the patient’s consent, and next generation sequencing analysis identified a new heterozygous c.2331+2T>G variant in the OPA1 gene (NM_130837.3). At the final follow-up examination at age 55 years, the decimal BCVA was still relatively good at 0.8 in the right eye and 0.6 in the left eye. Conclusions These findings indicate that relatively good visual function can be maintained until the late middle age in patients with DOA, and genetic testing should be considered when circumpapillary RNFL thinning is observed, even in patients with relatively good visual acuity.

Visual field (VF) testing has usually been performed with the central gaze as a fixed point. Recent publications indicated optic nerve head deformations induced by optic nerve traction force can promote the progression of optic neuropathies, including glaucoma. We generated a new static test protocol that adds 6° adduction and abduction to gaze position (fixation points) movement. The aim of this study was to investigate both whether quantifying VF sensitivities at lateral horizontal gaze positions is feasible and whether horizontal gaze positions change sensitivities differently in subjects of different ages. Healthy adult eyes from 29 younger (≤ 45 years) and 28 elderly (> 45 years) eyes were examined in this cross-sectional study. After VF testing with central gaze as a fixation point using 24 plus (1) imo static perimetry, subjects underwent VF testing with 6° adduction and 6° abduction as fixation points. The average mean sensitivities with central gaze, adduction, and abduction were 29.9 ± 1.0, 29.9 ± 1.3, and 30.0 ± 1.2 decibels (dB) in younger subjects and 27.7 ± 1.2, 27.5 ± 1.7, and 28.1 ± 1.3 dB in elderly subjects, respectively. Visual sensitivity in young healthy subjects was similar among the three fixation points, whereas visual sensitivity in elderly healthy subjects was significantly better with abduction as a fixation point than with central gaze and adduction (both p < 0.05). We expect this test protocol to contribute to our understanding of visual function during horizontal eye gaze movement in various eye diseases.

Background/Objectives: Long-acting (extended) diquafosol ophthalmic solution 3% (DQSLX) is administered less frequently (three times daily) than diquafosol ophthalmic solution (DQS) (six times daily). However, some patients do not prefer DQSLX because of perceived stickiness. We investigated the subjective and objective characteristics of patients with dry eye who switched from using DQSLX to DQS. Methods: We retrospectively enrolled 51 patients (11 men and 40 women) whose eye drop prescription was changed from DQSLX to DQS between June 2024 and September 2024. Subjective symptoms, tear break-up time, and fluorescein-staining scores were evaluated from baseline to 4 weeks after DQS use. We asked the participants to choose between DQS and DQSLX 4 weeks after using DQS. Results: In total, 51 eyes of 51 patients (11 men and 40 women; mean age: 68.2 ± 14.7 years) were enrolled. The DQS group showed significant worsening of the subjective symptoms, tear break-up time, and fluorescein staining scores (20.8 ± 22.5, 5.2 ± 3.4, and 1.6 ± 2.0, respectively) relative to the baseline (15.9 ± 18.7, 6.3 ± 3.2, and 0.7 ± 1.4, respectively) (p = 0.003, p < 0.001, and <0.001, respectively). Eleven (21.6%) patients expressed their preference for continuing DQS because of the good sensation of the eye drops. An analysis of the group that preferred the DQS ophthalmic solution revealed no significant changes in subjective symptoms or fluorescein staining scores after DQS treatment. Conclusions: DQSLX improved the subjective symptoms and objective findings of patients with dry eye relative to DQS.

Purpose To describe the characteristics of Japanese patients with hydroxychloroquine (HCQ) retinopathy developing within 3 years of treatment outset. Study design Retrospective case series Methods Three patients with HCQ retinopathy developing within 3 years of treatment outset have been identified in Japan since HCQ became available in 2015. Their medical charts, containing optical coherence tomography (OCT), fundus autofluorescence imaging, and visual field tests, were reviewed. Results The treatment durations and cumulative doses until onset were 29–36 months and 182–326 g, respectively. The first patient had possible pre-existing maculopathy, although the abnormalities were ambiguous. The second and third patients had impaired renal function. The patients did not complain of severe visual disturbance at diagnosis, but visual field loss and disruption of the outer retinal segments consisting of a parafoveal pattern in the first case and a pericentral pattern (localized, 8 or more degrees from the center of the fovea) in the second and third cases were clearly observed on OCT. Even after HCQ discontinuation, their retinopathy showed slight progression on the visual field tests and OCT images. A blood sample was obtained from 1 patient on the day after HCQ discontinuation, and the whole blood level of HCQ was measured using validated liquid chromatography-tandem mass spectrometry. The HCQ level 27 h after the last dose was high, at 2240 ng/mL (suggested threshold > 1733 ng/mL). Conclusion Ophthalmologic screening from the initiation of HCQ treatment detected 3 cases of HCQ retinopathy developing within 3 years of treatment outset, including a patient with a high blood level of HCQ.

The center of the fovea, termed the foveola, is the area of highest visual acuity, has the highest density of cone photoreceptors. We investigated the distance between the automatically-determined center of the foveal avascular zone (FAZ) and the manually-determined highest foveal bulge (FB) point using single swept-source optical coherence tomography angiography (OCTA) instrument. This cross-sectional study included 49 eyes of 49 individuals (34 women and 15 men; median age: 68 years) with no history of ocular disorders. The FAZ in the superficial capillary plexus was automatically determined using the Kanno–Saitama macro method, and the center of the FAZ was automatically determined using ellipse approximation. Another candidate foveal center, the highest FB point, was determined manually on the serial cross-sectional B-scan images. As a result, the foveal center was manually identified as the highest FB point on B-scan OCTA images. The center of the FAZ was more likely to be located inferior to the highest FB point ( p  = 0.031). In participants with a total (linear) distance of more than 50 μm between the center of the FAZ and the highest FB point, the displacement was significantly more in the horizontal direction than in the vertical direction ( p  = 0.017). These results can be applicable to further studies regarding the spatial relationships between the center of the FAZ and the highest FB point in various macular diseases or previously-treated eyes.