記述言語：英語   出版者・発行元：Journal of Clinical Medicine  

Background: Pachychoroid neovasculopathy (PNV) is a pachychoroid-spectrum disease. As blood circulation throughout the choroid may be involved in PNV pathogenesis, analysis using ultra-wide-field (UWF) fundus imaging is crucial. We evaluated choroidal thickness after half-fluence photodynamic therapy (PDT) combined with intravitreal aflibercept injection for PNV using UWF swept-source optical coherence tomography. Methods: Seventeen eyes with PNV that underwent half-fluence PDT with an adjuvant single intravitreal aflibercept injection were analyzed. To compare choroidal thicknesses in the central and peripheral choroids, we set subfields <3, <9, and 9–18 mm from the fovea. The <9 and 9–18 mm subfields were divided into four quadrants. Results: Choroidal thickness in each subfield decreased significantly after half-fluence PDT (p < 0.001); this reduction was more pronounced in the central area. We also investigated the relationship between the dominant side of the deep choroidal veins that harbor choroidal vein efflux from the macula. When choroidal thickness in the supratemporal and infratemporal 9 mm subfields were evaluated, the ratio of choroidal thickness reduction was not significantly different between the dominant and non-dominant sides. The dominant side was not associated with the extent of choroidal thickness reduction in PNV. Conclusions: Half-fluence PDT caused thinning of the entire choroid, especially in the central area, in PNV.

DOI： 10.3390/jcm13061608

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PubMed

記述言語：日本語   出版者・発行元：(公社)日本視能訓練士協会  

【目的】片眼の視力低下を初発自覚症状として慢性骨髄性白血病の診断に至った症例を報告する。【症例】20歳女性。全身既往歴なし。2021年X月、突然の右眼視力低下を主訴に当院救急科を受診し、同日、精査目的に当科紹介受診した。初診時、視力は右眼(0.1)、左眼(1.5)。右眼に内境界膜下出血、左眼にRoth斑を認めた。当院内科に即日入院し、全身精査で慢性骨髄性白血病と診断された。【結論】慢性骨髄性白血病は自覚症状に乏しく、眼症状のみを初発症状に診断されることは稀である。全身既往歴がなくとも、Roth斑を含む網膜出血を認めた場合は、鑑別として白血病を考慮し、早急に全身精査を行う必要がある。(著者抄録)

記述言語：英語   出版者・発行元：Journal of Clinical Medicine  

Background: Although anti-vascular endothelial growth factor (anti-VEGF) therapy is the first choice of treatment for eyes with neovascular age-related macular degeneration (AMD), it sometimes results in retinal pigment epithelium (RPE) tears. This study presents the detailed clinical characteristics of RPE tears to help predict their occurrence before anti-VEGF therapy initiation. Methods: This study retrospectively analyzed neovascular age-related macular degeneration (nAMD) patients who visited the Kyushu University Hospital and started anti-VEGF therapy between April 2013 and June 2020. Using medical records, we collected the clinical data of patients with RPE tears, including age, sex, best-corrected visual acuity (BCVA), number of anti-VEGF drug injections and the type and size of pigment epithelial detachment (PED). Results: RPE tears occurred in 16 (1.50%) eyes of 16 patients in all 1068 nAMD eyes of 987 patients. The mean age of these patients with RPE tear was 81.7 ± 8.7 years. Fifteen eyes had typical AMD and one eye had polypoidal choroidal vasculopathy. The mean number of anti-VEGF drug injections before RPE tears was 5.0 ± 5.1. All patients experienced PED before the RPE tear (hemorrhagic, 4 eyes; serous vascular, 2 eyes; fibrovascular, 10 eyes). The average PED height and area were 615.7 ± 175.3 μm and 21.0 ± 7.2 mm2, respectively. The sub-RPE cleft was observed in 10 eyes. The logMAR BCVA immediately after the RPE tear (0.73 ± 0.40) at 6 months (0.86 ± 0.51) and 12 months (0.84 ± 0.43) after the RPE tear were significantly worse than that before the RPE tear (0.58 ± 0.31; p < 0.05). The BCVA of patients with RPE tears that spread to the fovea was poorer than that of patients without RPE tears. Conclusions: In patients with nAMD, RPE tears tended to occur in typical AMD eyes with high or large PEDs, and sub-RPE clefts. The visual prognosis depended on whether the RPE tear included the fovea.

DOI： 10.3390/jcm12175496

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PubMed

記述言語：英語   出版者・発行元：Journal of Clinical Medicine  

Age-related macular degeneration (AMD) causes visual impairment in individuals who are >50 years of age. However, no study has investigated AMD when using ultra-wide-field swept-source optical coherence tomography (UWF SS-OCT). We aimed to evaluate central and peripheral choroidal thicknesses using UWF SS-OCT, and to compare these across the AMD subtypes. We included 75 eyes of patients with typical AMD (tAMD), 56 with polypoidal choroidal vasculopathy (PCV), 29 with pachychoroid neovasculopathy (PNV), and 12 with retinal angiomatous proliferation (RAP). To compare choroidal thicknesses in the central and peripheral choroids, we established subfields of <3 mm, <9 mm, and 9–18 mm from the fovea. PNV patients were significantly younger than those with tAMD (p = 0.01). The choroidal thicknesses of PNV were significantly greater than that of tAMD in all subfields (p < 0.01), and choroidal thickness significantly correlated with age and axial length in all subfields (p < 0.05). Even after adjusting for age and axial length, the choroidal thickness in PNV was significantly greater than that in tAMD (p < 0.05). In addition, the ratio of the posterior <9 mm to a peripheral 9–18 mm choroidal thickness in PNV was significantly greater than that in tAMD (p < 0.01). A thickened choroid in PNV was more pronounced in the posterior choroid than in the periphery.

DOI： 10.3390/jcm12165364

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PubMed

Web of Science

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1410214765

CiNii Research

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞目的:ポリープ状脈絡膜血管症(PCV)に対する抗血管内皮増殖因子(VEGF)薬併用光線力学的療法(PDT)後2年における治療成績の検討。対象と方法:対象は2017年8月～2019年8月に九州大学病院眼科で未治療PCVに初回からPDTと抗VEGF薬導入期3回投与(1クール)を施行し,2年以上経過観察できた20例20眼。眼底写真での新たな出血,光干渉断層計で確認された滲出性変化,および蛍光眼底造影でのポリープを認めたものを再発と定義した。治療前患者背景,治療前病巣径(GLD),治療前,1,2年後の視力,中心窩網膜厚(CRT),中心窩脈絡膜厚(CCT),dry fovea率,2年間の治療回数,再発率について,診療録をもとに後ろ向きに検討した。結果:治療前平均logMAR視力(0.23)は,1年後0.12,2年後0.14と改善し,治療前CRT(333.3±21.2μm),CCT(264.6±17.8μm)は,1年後(CRT 231.9±10.7μm,CCT 220.3±17.0μm),2年後(CRT 237.7±9.56μm,CCT 234.9±18.4μm)に減少していた(p<0.05)。1年後80%,2年後70%でdry foveaが得られていた。1年目の抗VEGF薬投与回数は導入期の3回を含めて平均4.65回±0.47回/年,2年目1.9回±0.60回/年であった。2年後の視力不良との関連因子を検討したところ,治療前視力不良,治療前GLDが大きいこと,と有意に関連があった。15例(75%)が再発し,そのうち40%が1年未満に再発していた。それらの早期再発症例の治療前平均CCT(234.9μm)は,1年以上後で再発した症例の平均CCT(314.3μm)に比べ有意に薄くなっていた。結論:PCVに対するPDT併用抗VEGF薬治療は2年後の視力,網膜形態を改善したが,症例により再発し,追加治療が必要となることが示唆された。治療前CCTが薄いと再発までの期間が短い傾向があった。

記述言語：英語   出版者・発行元：Ophthalmic Research  

Introduction: Drusen and pigmentary abnormality are found as the hallmark to predict progression of age-related macular degeneration (AMD). In Asian populations, exudative AMD often appears in the absence of drusen but is rather accompanied by pigmentary abnormality. Recently, shallow irregular retinal pigment epithelium (RPE) elevations (SIRE) have been shown as a sign of subclinical nonexudative macular neovascularization. In this study, we aimed to investigate the characteristics of optical coherence tomography (OCT) findings including SIRE before the appearance of exudative AMD. Methods: We retrospectively reviewed 32 cases of exudative AMD that occurred in the fellow eye within the 5-year-observation period. Color fundus photography, OCT, and fluorescein/indocyanine-green angiography at the beginning of observation and at the time when exudative AMD appeared were examined to diagnose SIRE and the subtype of exudative AMD. Results: Exudative AMD was found in 19 eyes with large drusen and 13 eyes without large drusen. Mean sub-foveal choroidal thickness without large drusen was significantly thicker than that with large drusen (336 ± 109 and 220 ± 96 μm, respectively; mean ± SD). Six eyes with pachychoroid neovasculopathy, 4 eyes with type 1 macular neovascularization, and 3 eyes with PCV had occurred in the fellow eye without large drusen. Among those, 6 eyes had been accompanied by SIRE with a greatest transverse linear dimension of 1 mm or more at the beginning of observation period. Besides, small RPE elevations with a longest diameter of less than 1 mm had been observed in other 5 eyes. Three cases of polypoidal choroidal vasculopathy had originated from small RPE elevations. Moreover, pachyvessels, choriocapillaris thinning, or choroidal hyperpermeability were observed with SIRE or small RPE elevations. Conclusions: There is a non-drusen type of exudative AMD that originates from small RPE elevations as well as SIRE.

DOI： 10.1159/000526445

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PubMed

記述言語：日本語   出版者・発行元：公益社団法人 日本視能訓練士協会  

<p> <b>【目的】</b>片眼の視力低下を初発自覚症状として慢性骨髄性白血病の診断に至った症例を報告する。</p><p> <b>【症例】</b>20歳女性。全身既往歴なし。2021年X月、突然の右眼視力低下を主訴に当院救急科を受診し、同日、精査目的に当科紹介受診した。初診時、視力は右眼（0.1）、左眼（1.5）。右眼に内境界膜下出血、左眼にRoth斑を認めた。当院内科に即日入院し、全身精査で慢性骨髄性白血病と診断された。</p><p> <b>【結論】</b>慢性骨髄性白血病は自覚症状に乏しく、眼症状のみを初発症状に診断されることは稀である。全身既往歴がなくとも、Roth斑を含む網膜出血を認めた場合は、鑑別として白血病を考慮し、早急に全身精査を行う必要がある。</p>

DOI： 10.4263/jorthoptic.53f107

CiNii Research

記述言語：日本語   出版者・発行元：(公社)日本視能訓練士協会  

【目的】急性帯状潜在性網膜外層症(AZOOR)として長期経過観察された急性梅毒性後部脈絡網膜炎の症例を報告する。【症例】39歳男性。2019年X月左眼光視症を主訴に前医を受診し、AZOORとして経過観察された。13ヵ月後、確定診断目的に当科紹介受診した。初診時、左眼の眼底に黄斑反射の低下と視神経乳頭発赤を認め、OCTでellipsoid zoneの不整、造影検査で視神経乳頭の蛍光漏出と多発性の蛍光貯留を認めた。血液検査で、梅毒性ぶどう膜炎と診断された。【結論】眼梅毒は特徴的な臨床所見が乏しく、診断と治療の開始が遅れてしまうことが多い。診断に苦慮する症例では梅毒を鑑別診断に考慮する必要がある。(著者抄録)

記述言語：英語   出版者・発行元：Graefe's Archive for Clinical and Experimental Ophthalmology  

Purpose: This study aimed to evaluate the one-year outcomes of photodynamic therapy (PDT) as a rescue treatment for age-related macular degeneration (AMD) refractory to anti-vascular endothelial growth factor (VEGF) therapy. Methods: Patients with AMD refractory to anti-VEGF therapy, treated with “rescue-PDT” were retrospectively investigated. The time of PDT was defined as the baseline value. Baseline characteristics including sex, age, best-corrected visual acuity (BCVA), central macular thickness (CMT), and foveal choroidal thickness (FCT) were examined. The changes in BCVA, CMT, and recurrence were also assessed at the 1-year follow-up. The logMAR VA change of 0.3 or more was defined as “improved” or “declined.” Results: Twenty-three consecutive eyes (typical AMD: 10 eyes, polypoidal choroidal vasculopathy: 10 eyes, and pachychoroid neovasculopathy: 3 eyes), which underwent “rescue-PDT,” were analyzed in this study. The BCVA was improved in three patients and maintained in 20 patients at 12 months after PDT (mean BCVA change: 0.11 ± 0.19). The CMT improved in 19 patients (82.6%), and the mean CMT changed from 318.5 ± 93.7 μm to 225.9 ± 51.6 μm (p < 0.01) 12 months after PDT. “Retreatment” of anti-VEGF drug injections was considered if the retinal fluid or retinal hemorrhage recurred after PDT. The baseline FCT of the “retreatment group (15 eyes)” was significantly lower than that of the “no retreatment group (8 eyes)” (206.3 ± 50.7 μm vs 293.9 ± 85.7 μm: p = 0.033). Conclusions: PDT could be an effective treatment option for anti-VEGF refractory AMD to maintain visual acuity and control retinal fluid for up to 12 months.

DOI： 10.1007/s00417-022-05553-5

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PubMed

記述言語：英語   出版者・発行元：Case Reports in Ophthalmology  

Bullous retinal detachment is a rare complication in the chronic phase of central serous chorioretinopathy (CSC). Only a small subset of eyes with chronic CSC develops into the bullous variant of CSC (bCSC). In patients with bCSC, the elevated concentration of fibrin in the subretinal space leads to persistent retinal detachment and eventually, severe vision loss. We experienced a case of unilateral bCSC with a massive accumulation of subretinal fibrin. Multiple leakage points and dilated choroidal veins were also observed. The patient underwent surgical removal of subretinal fibrin and silicone oil injection followed by photodynamic therapy (PDT). After this treatment, the retina was successfully reattached, and the affected eye was free from recurrent exudative changes for more than 18 months. Massive subretinal fibrin could be surgically removed to prevent the formation of subretinal fibrosis and retinal fold, and PDT under silicone oil can control the underlying exudative changes in bCSC.

DOI： 10.1159/000524515

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PubMed

記述言語：日本語   出版者・発行元：公益社団法人 日本視能訓練士協会  

<p><b>【目的】</b>急性帯状潜在性網膜外層症（AZOOR）として長期経過観察された急性梅毒性後部脈絡網膜炎の症例を報告する。</p><p><b>【症例】</b>39歳男性。2019年X月左眼光視症を主訴に前医を受診し、AZOORとして経過観察された。13か月後、確定診断目的に当科紹介受診した。初診時、左眼の眼底に黄斑反射の低下と視神経乳頭発赤を認め、OCTでellipsoid zoneの不整、造影検査で視神経乳頭の蛍光漏出と多発性の蛍光貯留を認めた。血液検査で、梅毒性ぶどう膜炎と診断された。</p><p><b>【結論】</b>眼梅毒は特徴的な臨床所見が乏しく、診断と治療の開始が遅れてしまうことが多い。診断に苦慮する症例では梅毒を鑑別診断に考慮する必要がある。</p>

DOI： 10.4263/jorthoptic.52f113

CiNii Research

記述言語：日本語  

記述言語：日本語  

記述言語：日本語