Japanese Journal of Ophthalmology (Jpn J Ophthalmol)

Publisher: Nihon Ganka Gakkai, Springer Verlag

Journal description

The Japanese Journal of Ophthalmology, published since 1957, provides a peer-reviewed interdisciplinary forum for bimonthly publication of basic science and clinical research papers in all fields of ophthalmology. The Japanese Ophthalmological Society is dedicated to the preventive care and treatment of the eye, and to scientific research regarding all aspects of ophthalmology. To further these goals, the Society has designated the Japanese Journal of Ophthalmology its official English language publication from January 1997. The purpose of this scientific journal is to disseminate the significant results of study by ophthalmologists worldwide. To help us fulfill our purpose, we encourage you to submit your original papers concerning any area of ophthalmology, as well as Rapid Communications or Letters to the Editor. We welcome your suggestions and criticism.

Current impact factor: 1.80

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.795
2012 Impact Factor 1.274
2011 Impact Factor 0.924
2010 Impact Factor 1.054
2009 Impact Factor 1.272
2008 Impact Factor 1.257
2007 Impact Factor 0.888
2006 Impact Factor 0.77
2005 Impact Factor 0.667
2004 Impact Factor 0.667
2003 Impact Factor 0.543
2002 Impact Factor 0.64
2001 Impact Factor 0.602
2000 Impact Factor 0.479
1999 Impact Factor 0.5
1998 Impact Factor 0.421
1997 Impact Factor 0.348
1996 Impact Factor 0.35
1995 Impact Factor 0.336
1994 Impact Factor 0.369
1993 Impact Factor 0.426
1992 Impact Factor 0.324

Impact factor over time

Impact factor

Additional details

5-year impact 1.49
Cited half-life 7.80
Immediacy index 0.16
Eigenfactor 0.00
Article influence 0.52
Website Japanese Journal of Ophthalmology website
Other titles Japanese journal of ophthalmology (Online), Japanese journal of ophthalmology, JJO
ISSN 1613-2246
OCLC 56124539
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

  • Pre-print
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  • Conditions
    • Author's pre-print on pre-print servers such as arXiv.org
    • Author's post-print on author's personal website immediately
    • Author's post-print on any open access repository after 12 months after publication
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare short-term outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) using a graft prepared with either a femtosecond laser or a microkeratome. Thirty-eight patients underwent DSAEK with grafts prepared with either a femtosecond laser (f-DSAEK; 21 eyes) or a microkeratome (m-DSAEK; 17 eyes). Visual acuity, endothelial cell density, regular astigmatism and irregular astigmatism were compared between the two groups preoperatively and at 1, 3, and 6 months post-operatively. Fourier analysis was conducted to calculate astigmatism of the anterior and posterior surfaces, and total cornea, using anterior segment optical coherence tomography (AS-OCT). Visual acuity (logMAR) improved from 1.20 ± 0.60 to 0.43 ± 0.25 after m-DSAEK (P < 0.001) and from 1.20 ± 0.57 to 0.77 ± 0.33 after f-DSAEK (P = 0.0028) at 6 months following DSAEK. Visual acuity after m-DSAEK was significantly better than after f-DSAEK at 1, 3, and 6 months (P < 0.05). AS-OCT corneal images revealed greater irregularities on the posterior surfaces of f-DSAEK grafts compared to m-DSAEK grafts. Irregular astigmatism of the total cornea and the posterior surface was significantly larger after f-DSAEK than after m-DSAEK, although there was no significant difference in irregular astigmatism of the anterior surface at 6 months. Postoperative visual acuity was significantly correlated with the postoperative irregular astigmatism of the total cornea (r = 0.6657 and P < 0.001) and the anterior (r = 0.416, P = 0.016) and posterior surfaces (r = 0.7046, P < 0.001). Visual outcomes after f-DSAEK were poor compared to conventional m-DSAEK due to an increase in irregular astigmatism caused by posterior surface irregularities.
    Japanese Journal of Ophthalmology 06/2015; DOI:10.1007/s10384-015-0388-y
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    ABSTRACT: To examine the prognosis of patients with diabetic macular edema (DME) before Japanese approval of antivascular endothelial growth factor (VEGF). This retrospective study included 135 eyes of 115 patients who received treatments (photocoagulation, pharmacological treatments, vitrectomy) for DME between January 2003 and August 2012. The best-corrected visual acuity (BCVA) before and 1, 3, 6, 12, and 24 months after treatment was examined. BCVA was classified based on the decimal value of BCVA before treatment as good (BCVA > 0.7, BCVA = 0.7), moderate (BCVA > 0.7 but <0.2), or poor (BCVA < 0.2, BCVA = 0.2), and each prognosis of BCVA was investigated. Thirty-five (25.9 %) patients were classified with good BCVA, while 69 (51.1 %) had moderate and 31 (23.0 %) poor BCVA. Following 24 months of treatment, the averaged good BCVA maintained its value (0.0513 ± 0.0954 to 0.0773 ± 0.258). Similarly, the averaged moderate BCVA maintained its value (0.449 ± 0.169 to 0.441 ± 0.431), whereas the averaged poor BCVA significantly improved (1.070 ± 0.291 to 0.879 ± 0.361: p < 0.001). Specifically, the averaged BCVA of patients who initially received vitrectomy increased 0.380 logMAR after 24 months (0.859 ± 0.414 to 0.479 ± 0.549). DME patients with good BCVA at the time of initial treatment generally maintained the averaged BCVA at 24 months, while patients with moderate BCVA did not significantly improve without a standard regimen of anti-VEGF therapy. However, the results indicate that early vitrectomy is a potential treatment option for DME patients with poor BCVA.
    Japanese Journal of Ophthalmology 05/2015; DOI:10.1007/s10384-015-0384-2
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    ABSTRACT: To examine the clinical utility of femtosecond laser-assisted astigmatic keratotomy (FSL-AK) for eyes after cataract surgery. Eight eyes of 6 patients with an intraocular lens and corneal astigmatism of 2.0 diopters (D) or more underwent FSL-AK. The mean preoperative manifest cylindrical refraction was 2.88 ± 0.64 D and the mean corneal astigmatism was 2.84 ± 0.83 D. Paired symmetrical arcuate incisions were created with the same settings, except for the incision depth. Uncorrected distance visual acuity (UDVA), manifest cylindrical power, and surgically induced astigmatism (SIA) were measured at 1 day, 1 week, and 1 month postoperatively. Fourier analysis of corneal topography and incision depths measured with anterior-segment optical coherence tomography were evaluated 1 month postoperatively. In all eyes, the UDVA improved at 1 week and 1 month postoperatively, and the manifest cylinder also decreased postoperatively, while the SIA showed overcorrections in 6 eyes. Fourier analysis showed decreases in spherical and regular astigmatic components and increases in higher-order irregularity. The mean incision depth was measured as 60 µm deeper than the intended depth. The FSL-AK effectively reduced corneal astigmatism and improved the UDVA, although it was demonstrated that the deeper incisions led to overcorrection.
    Japanese Journal of Ophthalmology 05/2015; DOI:10.1007/s10384-015-0383-3
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    ABSTRACT: To investigate anatomical responses and visual changes in cases of exudative age-related macular degeneration (AMD) with choroidal vascular hyperpermeability (CVH) that responded poorly to multiple ranibizumab injections and were treated with intravitreal aflibercept. Retrospective comparative study. Twenty-five consecutive patients attending the outpatient clinic of the University of Tokyo Hospital who showed an insufficient response to multiple intravitreal ranibizumab injections and were switched to intravitreal aflibercept injections between March and June 2013. All patients were treated with intravitreal aflibercept in a treat-and-extend regimen and followed up for at least 12 months. Presence or absence of CVH was determined by indocyanine green angiography. Changes of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at 12 months were compared between the CVH (+) AMD and CVH (-) AMD eyes. The improvement in logMAR BCVA at 12 months was larger in the CVH (-) AMD eyes than in the CVH (+) AMD eyes (-0.18 vs -0.026; P = 0.0089, t-test). The changes in CRT did not differ significantly between the groups (-122 ± 101 μm in the CVH (-) AMD eyes and -159 ± 118 μm in the CVH (+) AMD eyes; P = 0.44, t-test). The proportion of the eyes without intraretinal or subretinal fluid or hemorrhage was 88 % in the CVH (-) AMD and 67 % in the CVH (+) AMD (P = 0.21, t-test). Compared with AMD without CVH, AMD with CVH showed poorer visual gain resulting from intravitreal aflibercept treatment.
    Japanese Journal of Ophthalmology 05/2015; DOI:10.1007/s10384-015-0387-z
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    ABSTRACT: To understand the current practice pattern for the surgical treatment of congenital/developmental cataracts in Japan. A mail questionnaire was sent to facilities engaged in thesurgical treatment of congenital cataracts in Japan. Thirty-four facilities reported their preferred methods for the surgical treatment of congenital cataracts, including data from 809 eyes of 508 patients who had undergone surgery. More than 85 % of the respondents answered that they would consider surgery even if the visual prognosis was not promising because of possible form-deprivation amblyopia. The most commonly performed surgical maneuvers were scleral tunnel incision (88.4 %), 3.0-mm or smaller incision (78.8 %), manual anterior continuous curvilinear capsulorhexis (90.2 % success rate), posterior capsulotomy (92.5 % for patients aged ≤6 years), anterior vitrectomy by the limbal approach (85.9 % for patients aged ≤6 years), and wound closure with sutures (93.2 %). Posterior capsulotomy and vitrectomy were not usually performed in patients aged >6 years. Implantation of an intraocular lens (IOL) was mostly indicated in patients aged 2 years or older. Implantation of an acrylic foldable IOL (76.6 %) into the capsular bag (89.7 %) was the most common practice among the surgeons. Small incision surgery with implantation of an acrylic foldable IOL into the capsular bag combined with posterior capsulotomy was the preferred surgical treatment of choice for congenital/developmental cataracts.
    Japanese Journal of Ophthalmology 05/2015; DOI:10.1007/s10384-015-0385-1
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    ABSTRACT: To measure retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex thickness (GCCT) in eyes with no light perception due to nonglaucomatous optic neuropathy using spectral-domain optical coherence tomography. Fourteen eyes of 14 patients (9 women, 5 men; mean age 56.0 ± 16.6 (standard deviation) years] with no light perception due to optic neuropathy were recruited to this retrospective study. Only clinically stable eyes were included. Eyes were imaged at least 6 months after the onset of the disease. Five patients lost light perception due to traumatic optic neuropathy, four patients had ischemic optic neuropathy, two patients had optic neuritis, two patients had compressive optic neuropathy, and one patient had optic nerve atrophy. Global and quadrant RNFLTs were measured with the Cirrus HD-optical coherence tomography (OCT) system; global and hemisphere GCCTs were measured by spectral-domain OCT (RTVue OCT system). Only reliable OCT images were used for further analysis. Reliable RNFL images were obtained in 12 eyes, and reliable GCC images were obtained in 11 eyes. Global, superior, temporal, inferior, and nasal RNFLT were 57.5 ± 6.7, 60.6 ± 7.6, 54.1 ± 11.2, 59.7 ± 9.5, and 55.6 ± 7.4 µm, respectively. Global, superior, and inferior GCC thicknesses were 68.8 ± 9.6, 70.7 ± 12.2, and 67.8 ± 8.8 µm, respectively. A considerable proportion of RNFL and GCC remained in eyes with no light perception vision. Clinicians should take this into account when evaluating the severity of optic neuropathy from OCT-measured RNFLT and GCCT.
    Japanese Journal of Ophthalmology 05/2015; DOI:10.1007/s10384-015-0386-0
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    ABSTRACT: To investigate macular morphology on spectral-domain optical coherence tomography (SD-OCT) images after microincision vitrectomy for vitreous hemorrhage associated with proliferative diabetic retinopathy (PDR). In this retrospective case series, 69 eyes (57 consecutive patients) that underwent 23-gauge microincision vitrectomy for vitreous hemorrhage due to PDR were investigated. Qualitative and quantitative characteristics on SD-OCT images [central retinal thickness, external limiting membrane (ELM), and the ellipsoid zone, epiretinal membranes involving the fovea, and hyperreflective foci at the fovea] were assessed 6 months postoperatively. Their association with the logarithm of the minimum angle of resolution visual acuity (logMAR VA) was evaluated. The ELM was disrupted in 15 and the ellipsoid zone in 27 eyes, and associated significantly (P < 0.001, for both comparisons) with poor visual outcomes 6 months postoperatively. Hyperreflective foci in the outer retinal layers were associated with either a disrupted ELM or ellipsoid zone and poor prognoses (P < 0.001, for all comparisons). The accumulation of hyperreflective foci at the fovea in five eyes was correlated significantly (P < 0.001) with poorer logMAR VA. Twenty-nine eyes had center-involved diabetic macular edema 6 months postoperatively, whereas the central thickness was not correlated with the logMAR VA (R = -0.148, P = 0.224). Eight eyes with either epiretinal membrane on SD-OCT images had greater central thickness (P = 0.003), although there were no differences in the logMAR VA between eyes with and without it (P = 0.648). Foveal photoreceptor damage is associated with poor visual outcomes after microincision vitrectomy for vitreous hemorrhage due to PDR.
    Japanese Journal of Ophthalmology 05/2015; DOI:10.1007/s10384-015-0382-4
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    ABSTRACT: To study the indications for and effectiveness of Nunchaku-style silicone tube intubation (NSTI) in treating primary acquired lacrimal drainage obstruction (PALDO). In this interventional cohort study, 235 consecutive patients in 1 institution who had complete lacrimal obstruction were investigated. Of those, 212 PALDO patients were enrolled, and 156 of the PALDO patients ultimately satisfied our treatment protocol and were then followed up for 12 months postsurgery. Patients without dacryocystitis underwent NSTI, while those with dacryocystitis underwent NSTI or endonasal dacryocystorhinostomy (EN-DCR) using the NST as a stent. The tubes were left in place for 8 weeks, and all patients received identical postoperative care. Resolution was deemed as patency assessed by irrigation. Logistic regression analyses were performed to compare the success of NSTI for upper (puncta and canaliculus) and lower (lacrimal sac and nasolacrimal duct) obstruction, NSTI for lower obstruction with and without dacryocystitis, and NSTI and EN-DCR for lower obstruction with dacryocystitis. Comparison of the success rates at 12 months postsurgery showed significance as follows: treatment with NSTI was more successful for upper obstruction (94.6 %) than for lower obstruction (71.4 %) [odds ratio (OR) 8.23; P < 0.01]; treatment with NSTI was more successful for lower obstruction without dacryocystitis (82.9 %) than for dacryocystitis (52.4 %) (OR 4.96; P < 0.05); and treatment with EN-DCR (95.5 %) was more successful than NSTI (52.4 %) for treating lower obstruction with dacryocystitis (OR 16.99; P < 0.001). NSTI is effective for treating PALDO; however, EN-DCR is more effective for treating PALDO cases complicated by dacryocystitis.
    Japanese Journal of Ophthalmology 04/2015; DOI:10.1007/s10384-015-0381-5
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    ABSTRACT: The pathogenesis of unilateral acute idiopathic maculopathy (UAIM) is unknown. The aim of this study was to quantitatively examine changes in choroidal circulation hemodynamics in patients with UAIM. This was a retrospective observational case-series which included five eyes of four patients with UAIM. All UAIM eyes and the fellow eyes in remaining three patients were studied using laser speckle flowgraphy (LSFG) to evaluate the mean blur rate (MBR), a quantitative index of relative blood flow velocity. The changes in MBR between the initial visit and after 1 and 3 months were statistically analyzed. Subfoveal choroidal thickness was measured in three UAIM eyes by enhanced depth imaging optical coherence tomography. The mean logMAR value of best-corrected visual acuity in the UAIM eyes significantly improved (P = 0.04) with recovery of outer retinal morphology. The average MBR of the UAIM eyes significantly increased at 1 (+21.7 % baseline value; P = 0.003) and 3 months (+32.5 % baseline value; P = 0.001), whereas the fellow eyes did not show this tendency. The mean values of subfoveal choroidal thickness decreased with time (316.0 µm at baseline, 186.6 µm at 1 month, and 167.3 µm at 3 months). These results reveal that there is a significant elevation of choroidal blood flow velocity and substantial reduction of choroidal thickness with regression of UAIM, suggesting that impaired choroidal circulation may be involved in the pathogenesis of UAIM.
    Japanese Journal of Ophthalmology 04/2015; DOI:10.1007/s10384-015-0380-6
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    ABSTRACT: To investigate the influence of the optic disc type on the overall and regional correlation between structure and function in open angle glaucoma (OAG). We divided 144 eyes of 144 patients with OAG into four groups according to Nicolela et al.'s classification of optic disc type: focal ischemic (FI), myopic glaucomatous (MY), senile sclerotic (SS), and generalized enlargement (GE). We measured the circumpapillary retinal nerve fiber layer thickness (cpRNFLT) with the 3D OCT-2000 and the mean deviation (MD) with the Humphrey Field Analyzer in each group and determined the influence of the disc type on these parameters with the Spearman rank correlation. We found that cpRNFLT and MD were significantly correlated in the MY (r = 0.61, P < 0.001), GE (r = 0.62, P < 0.001), and SS groups (r = 0.52, P = 0.002), but not in the FI group (r = 0.25, P = 0.130). The region of the optic disc with the highest correlation coefficient between structure and function differed according to the disc type. The correlation between cpRNFLT and MD varied according to the optic disc morphology in OAG. This suggests that different disc types have characteristic regional variations in the correlation between structure and function. The disc type should therefore be considered in investigations of the correlation between structure and function in glaucoma.
    Japanese Journal of Ophthalmology 04/2015; DOI:10.1007/s10384-015-0379-z
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    ABSTRACT: To investigate the safety and efficacy of intravitreal injection of melphalan for retinoblastoma. A retrospective chart review of all patients who were administered intravitreal injections of melphalan for retinoblastoma between 1990 and 2011. A total of 264 eyes of 250 patients were included. All ocular adverse events, systemic prognosis, ocular prognosis, and visual acuity were investigated. The total number of intravitreal injections administered was 1,067; each eye received between one and 25 injections. A postoperative subconjunctival tumor developed in one eye. None of the eyes suffered infections or uveitis, and all other adverse events including chorioretinal atrophy displayed incidences of less than 1.5 %. At 5 postoperative years, the cumulative incidence of cataract surgery was 3.1 % among the eyes that were treated without ocular hyperthermia. Distant metastasis or intracranial invasion occurred in 11 patients, all of whom had high-risk pathological factors for metastasis such as optic nerve invasion, but refused to receive adjuvant chemotherapy. Sixty-eight percent of the eyes achieved complete vitreous seed remission, but recurrence occurred in 19 % of these eyes after 10.0 ± 4.9 months. In addition, 47 and 27 % of the eyes without primary macular tumors retained visual acuity of >0.5 and >1.0, respectively. The risk of extraocular tumor spreading following intravitreal injections is low, and other adverse events are rare. Sixty-eight percent of the treated eyes achieved complete vitreous seed remission, and about half of them retained practical levels of vision. The intravitreal injection of melphalan is a safe and effective treatment for vitreous seeds.
    Japanese Journal of Ophthalmology 03/2015; 59(3). DOI:10.1007/s10384-015-0378-0
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    ABSTRACT: Our aim was to determine the recurrence rate of inflammation in Vogt-Koyanagi-Harada (VKH) disease and to describe its clinical features. We retrospectively evaluated patients diagnosed as having VKH disease with exudative retinal detachment at the Osaka University Hospital or the Japanese Community Healthcare Organization, Osaka Hospital, between 1998 and 2012. All patients received high-dose corticosteroid therapy as the initial treatment and were followed for at least 6 months. Demographic data, including age, sex, visual acuity (VA) levels at initial presentation and at 1 year after initial therapy, treatment received, and recurrent episodes were reviewed. Fifty-five consecutive patients with VKH disease were identified (36 women; mean age 38.6 ± 10.4 years). Fourteen patients (25.5 %) had recurrent inflammation, which manifested as posterior uveitis in eight and as anterior uveitis in six of the patients. Recurrent posterior segment inflammation was more likely to develop in patients whose VA at initial presentation was poor (P = 0.039) and in whom orally administered corticosteroid was tapered rapidly (to 30 mg within 3 weeks or less, to 20 mg within 2 months or less, and to 10 mg within 3 months or less) (P = 0.006, P = 0.066, and P = 0.041, respectively). About 25 % of patients with VKH disease had recurrent inflammation. Poor initial VA and rapid tapering of the corticosteroid were associated with posterior recurrence.
    Japanese Journal of Ophthalmology 03/2015; 59(3). DOI:10.1007/s10384-015-0377-1
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    ABSTRACT: To analyze the relationship between changes in the intraocular pressure (IOP) and dislocation angle in highly myopic strabismus patients who had undergone muscle union surgery. Medical data were examined of eight eyes of seven consecutive patients with highly myopic strabismus, who had some limitation in abduction, received muscle union surgery and undergone pre- and postoperative IOP evaluation with a noncontact tonometer, and were retrospectively reviewed. In addition, 15 eyes of 15 patients with comitant horizontal strabismus who underwent unilateral recess-resect procedure as well as pre- and postoperative IOP evaluation were also included. The correlation between IOP changes after strabismus surgery and the dislocation angle of the globe was analyzed. The IOP was significantly reduced in the highly myopic strabismus group (-5.6 mmHg) but not in the fellow eye or in comitant horizontal strabismus patients. The decrease in IOP after surgery was significantly correlated with the preoperative dislocation angle of the globe (r = -0.725, p = 0.042). IOP is often higher in highly myopic strabismus patients than perceived, and it may indicate abnormal anatomy of the orbit rather than glaucoma. In that case, muscle union surgery can improve eye position and normalizes the IOP.
    Japanese Journal of Ophthalmology 12/2014; 59(2). DOI:10.1007/s10384-014-0364-y
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    ABSTRACT: The purposes of this study are to develop and validate new diagnostic criteria for acute retinal necrosis (ARN) based on the ocular findings, clinical course, and virologic testing of intraocular fluids. The Japanese ARN Study Group, comprising 8 uveitis specialists and 1 statistician, was formed to develop new diagnostic criteria for ARN. The criteria used a combination of clinical features consistent with ARN including 6 early-stage ocular findings ([1a] anterior chamber cells or mutton-fat keratic precipitates; [1b] yellow-white lesion(s) in the peripheral retina [granular or patchy in the early stage, then gradually merging]; [1c] retinal arteritis; [1d] hyperemia of the optic disc; [1e] inflammatory vitreous opacities; and [1f] elevated intraocular pressure), 5 clinical courses ([2a] rapid expansion of the retinal lesion(s) circumferentially, [2b] development of retinal breaks or retinal detachment, [2c] retinal vascular occlusion, [2d] optic atrophy, and [2e] response to antiviral agents), and the results of virologic testing of intraocular fluids by means of either polymerase chain reaction or the Goldmann-Witmer coefficient for herpes simplex virus or varicella zoster virus. Various combinations of findings were analyzed to maximize the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The criteria were then used to retrospectively analyze patients who had been diagnosed as having ARN or control uveitis. Patients were followed at 1 of 7 tertiary uveitis clinics between 2009 and 2011. Analysis of the data allowed delineation of 2 levels of diagnosis: "virus-confirmed ARN" (defined as the presence of both early-stage ocular findings 1a and 1b, the presence of any 1 of the 5 clinical courses, and a positive virologic test result) and "virus-unconfirmed ARN" (defined as the presence of 4 of 6 early-stage ocular findings including 1a and 1b, presence of any 2 of the 5 clinical courses, and a negative virologic test result, or when virologic testing had not been performed). The new diagnostic criteria were applied to 45 patients with ARN and 409 patients with control uveitis, resulting in a sensitivity of 0.89, a specificity of 1.00, a PPV of 1.00, and an NPV of 0.99. New diagnostic criteria for ARN were developed and found to achieve high statistical values.
    Japanese Journal of Ophthalmology 12/2014; 59(1). DOI:10.1007/s10384-014-0362-0
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    ABSTRACT: To elucidate the clinical differences between serous retinal detachment (RD)-type and optic disc (OD) swelling-type Vogt-Koyanagi-Harada (VKH) disease. We performed a retrospective review of 96 patients with new-onset, active VKH disease. Patients were classified into serous RD-type or OD swelling-type VKH disease groups by means of optical coherence tomography and fluorescein angiography, and the differences between the 2 groups were analyzed. Eighty-two patients were classified as having RD-type VKH disease (34 men and 48 women, aged 40.5 ± 12.6 years) and 14 patients as having OD swelling-type VKH disease (1 man and 13 women, aged 54.6 ± 11.6 years). Patients with the OD swelling type had older onset (P < 0.001) and were more proportionately female (P = 0.02) than those with the RD type. OD swelling-type VKH disease had a longer interval between disease onset and treatment initiation (22.4 ± 14.0 days vs 12.6 ± 14.7 days; P = 0.02) and a higher frequency of chronic disease (64.3 vs 30.5 %; P = 0.03) than did serous RD-type VKH disease. In the OD swelling type, patients with pretreatment visual acuity (VA) lower than 20/20 developed chronic disease more frequently than did those with VA of 20/20 or better (P = 0.02). Patients with OD swelling-type VKH disease are more likely to be female, have older onset, and develop chronic disease than patients with RD-type VKH disease. In OD swelling-type VKH disease, worse VA before treatment is associated with the development of chronic disease.
    Japanese Journal of Ophthalmology 12/2014; 59(2). DOI:10.1007/s10384-014-0367-8
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    ABSTRACT: Purpose To describe tumor response and complications after selective ophthalmic arterial injection (SOAI) of melphalan for treatment of intraocular retinoblastoma. Methods A retrospective review of 17 eyes (12 patients) treated with SOAI of melphalan from January 2010 through December 2013 at Chang Gung Memorial Hospital. Results SOAI was successfully performed in 49 of 54 attempts. Six eyes underwent SOAI as the primary treatment and 11 eyes had previously been treated with other treatment modalities. Subsequent to SOAI, tumor regression was observed in 12 of 17 eyes, and vitreous seeding with complete or partial regression in ten of 15 eyes. Globe salvage was achieved in ten of 17 eyes, with three of four in group B and group C eyes, and seven of 13 in group D and group E eyes. Pancytopenia accompanied by neutropenic fever was observed in one case. Twelve eyes had local side effects, including lid edema (two eyes), third cranial nerve palsy (two eyes), sixth cranial nerve palsy (one eye), chorioretinal atrophy (six eyes), retinal arterial occlusion (three eyes), retinal detachment (one eye), and vitreous hemorrhage (seven eyes). Three cases with high-risk features, according to the histopathologic examination, had metastatic disease, and two of them died. Conclusions SOAI of melphalan is an effective treatment for intraocular retinoblastoma, achieving high globe salvage in cases of advanced disease, but can be associated with significant ocular complications. Repetitive SOAI with delayed enucleation could increase the risk of metastasis when used in high-risk cases. Therefore, clinicians should consider the benefits and potential risks and use this new technique with caution.
    Japanese Journal of Ophthalmology 12/2014; 59(2). DOI:10.1007/s10384-014-0356-y
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    ABSTRACT: Purpose To quantitatively evaluate the efficacy of methylprednisolone pulse therapy for extraocular muscle inflammation in thyroid-associated ophthalmopathy (TAO) using the short-tau inversion-recovery (STIR) technique of magnetic resonance imaging (MRI). Methods The signal intensities of the superior rectus (SR), inferior rectus (IR), lateral rectus (LR), medial rectus (MR), and superior oblique (SO) muscles were measured using the STIR images from 34 eyes of 17 patients with TAO before and after methylprednisolone pulse therapy and 19 eyes of 19 controls. The signal intensity ratio (SIR) of the signal intensity in muscles to that in brain white matter was calculated. Results The mean SIRs of the controls were 1.08 ± 0.26 in the SR, 1.32 ± 0.29 in the IR, 1.34 ± 0.19 in the LR, 1.47 ± 0.25 in the MR, and 1.28 ± 0.22 in the SO muscles. SIRs exceeding 2.0 were out of the normal range. The SIRs of the patients with TAO before treatment were 2.19 ± 0.64, 2.44 ± 0.58, 1.96 ± 0.43, 2.24 ± 0.47, and 1.91 ± 0.42, respectively, which was significantly (P P Conclusion Extraocular muscle inflammation in TAO improved with treatment. However, inflammation in some muscles persisted after treatment, and a high SIR in the muscle after treatment suggested the risk of deterioration of TAO.
    Japanese Journal of Ophthalmology 12/2014; 59(2). DOI:10.1007/s10384-014-0365-x
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    ABSTRACT: We sought to describe the histopathologic features of lacrimal ductular cysts with or without inflammation and speculate on the role of cilia in their pathogenesis. A retrospective study of 15 patients referred for lateral canthal subconjunctival cysts from 2001 to 2012 was conducted. All patients underwent cyst removal and a total histopathological examination was done. Patients were classified into 2 groups and analyzed according to their clinical and histopathologic characteristics. Fourteen showed unilateral disease and one had bilateral disease, with a mean age of 42.8 years. Six patients had mild discomfort or no symptoms, and the remaining 9 of 15 patients presented with a symptomatic mass with conjunctival discharge and injection. Two layers of ductal epithelium constituted the whole wall of the cyst in the seven non-inflammatory cysts, three of which showed cilia in the lumen. The presence of stratified columnar epithelium with goblet cells was a peculiar feature in the lining of the nine inflammatory cases, seven of which showed cilia shafts with inflammatory cells and concrete material in the lumen. Pilosebaceous units were not evident in any of the specimens on pathologic examination. Cilia entrapped in the lacrimal ductule may play a role in the formation of lacrimal ductular cysts with or without inflammation. Cilia falling from the eyelid may be caught in the conjunctival fornix then shift toward the horizontal lacrimal ductule in the lateral canthus. It may then serve as a nidus to provoke lacrimal ductular inflammation or cyst formation.
    Japanese Journal of Ophthalmology 11/2014; 59(2). DOI:10.1007/s10384-014-0360-2
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    ABSTRACT: Our goal was to determine the feasibility of using electrochemically treated bulk platinum electrodes with large charge injection capacity for a retinal prosthesis. Seven eyes of seven cats were studied. Small retinal areas were focally stimulated with electrochemically treated bulk electrodes (φ = 500 µm) placed in a scleral pocket. Fundus images with near-infrared (800-880 nm) light were recorded, and a 2D map of the reflectance changes elicited by the electrical currents was constructed by subtracting the images taken before stimulation from those taken after stimulation. The impedance of each electrode was measured at 1 kHz. The degree of retinal elevation by the electrode was measured by optical coherence tomography. Scleral thickness where the electrode array was inserted was measured in histologic sections. The diameter of reflectance changes (full width at half maximum) was 0.42 ± 0.22 mm [mean ± standard deviation (SD)] in minor axes and 1.46 ± 0.82 mm in major axes. The threshold current decreased with a reduction in the residual scleral thickness (R (2) = 0.9215; P = 0.0002); it also decreased with an increase in retinal elevation (R (2) = 0.6259; P = 0.0111).The threshold current also decreased with an increase in electrode impedance (R (2) = 0.2554; P = 0.0147). Electrochemically treated porous platinum electrodes can stimulate localized retinal areas. The threshold current necessary to stimulate the retina was influenced by residual scleral thickness and the electrode tightness of fit against the sclera.
    Japanese Journal of Ophthalmology 05/2014; 58(4). DOI:10.1007/s10384-014-0319-3