Tomoko Sawada

Background: Bacterial endophthalmitis is a rare but serious complication of intravitreal injections (IVIs). Prefilled syringes have been introduced to reduce contamination risk during drug preparation. However, whether they lower the incidence of bacterial endophthalmitis compared to vials remains unclear. Methods: This retrospective cohort study analyzed aflibercept IVIs performed at 17 clinical centers in Japan between 2015 and 2022. Patients aged ≥20 years who received aflibercept IVIs (vial or prefilled syringe) for age-related macular degeneration, diabetic macular edema, retinal vein occlusion, or myopic choroidal neovascularization were included. Bacterial endophthalmitis was diagnosed based on clinical signs (e.g., rapid vision loss, pain, hypopyon, vitreous opacity). Incidence rates were compared using Fisher’s exact test. Results: Among 152,039 injections (43,684 prefilled syringes; 108,355 vials), 12 cases of bacterial endophthalmitis were identified (0.0046% vs. 0.0092%, p = 0.53). Poor visual outcomes were associated with Enterococcus faecalis, Streptococcus spp., and diabetes. Conclusions: Although incidence was lower in the prefilled syringe group, the difference was not statistically significant. Detecting a significant difference requires a larger sample. Further studies are needed to confirm the potential benefits of prefilled syringes in reducing endophthalmitis risk.

Purpose To investigate age-specific prevalence of disease subtypes and baseline best-corrected visual acuity (BCVA) in Japanese patients with treatment-naïve neovascular age-related macular degeneration (nAMD). Study design Retrospective multicenter case series. Methods We reviewed the records of patients with treatment-naïve nAMD who underwent initial treatment in 14 institutions in Japan sometime during the period from 2006 to 2015. In patients in whom both eyes were treated, only the eye treated first was included for analysis. The patients were stratified by age for the analysis. Results In total, 3096 eyes were included. The overall prevalence of subtypes was as follows: typical AMD, 52.6%; polypoidal choroidal vasculopathy (PCV), 42.8%; retinal angiomatous proliferation (RAP), 4.6%. The number of eyes in each age group was as follows: younger than 60 years, 199; 60s, 747; 70s, 1308; 80s, 784; 90 years or older, 58. The prevalence of typical AMD in each age group was 51.8%, 48.1%, 52.1%, 57.7%, and 55.2%, respectively. The prevalence of PCV was 46.7%, 49.1%, 44.7%, 34.4%, and 19.0%, respectively. The prevalence of RAP was 1.5%, 2.8%, 3.2%, 7.9%, and 25.9%, respectively. The prevalence of PCV decreased with age, whilst that of RAP increased. The prevalence of RAP was higher than that of PCV in patients aged 90 years or older. The mean baseline BCVA (logMAR) was 0.53. In each age group, the mean baseline BCVA was 0.35, 0.45, 0.54, 0.62, and 0.88, respectively. The mean logMAR BCVA at baseline significantly worsened with age (P < 0.001). Conclusion The prevalence of nAMD subtypes differed according to age in Japanese patients. The baseline BCVA worsened with age.

Bacterial endophthalmitis is an intraocular infection that causes rapid vison loss. Pathogens can infect the intraocular space directly (exogenous endophthalmitis (ExE)) or indirectly (endogenous endophthalmitis (EnE)). To identify predictive factors for the visual prognosis of Japanese patients with bacterial endophthalmitis, we retrospectively examined the bacterial endophthalmitis characteristics of 314 Japanese patients and performed statistics using these clinical data. Older patients, with significantly more severe clinical symptoms, were prevalent in the ExE group compared with the EnE group. However, the final best-corrected visual acuity (BCVA) was not significantly different between the ExE and EnE groups. Bacteria isolated from patients were not associated with age, sex, or presence of eye symptoms. Genus Streptococcus, Streptococcus pneumoniae, and Enterococcus were more prevalent in ExE patients than EnE patients and contributed to poor final BCVA. The presence of eye pain, bacterial identification, and poor BCVA at baseline were risk factors for final visual impairment.

Purpose We investigated 10-year changes in baseline best-corrected visual acuity (BCVA), as well as functional and anatomical changes at 1 and 2 years after initial treatment, in eyes with treatment-naïve neovascular age-related macular degeneration (nAMD). Methods This retrospective, multicenter, case series reviewed patients with treatment-naïve nAMD who underwent initial treatment from 2006 to 2015, using photodynamic therapy (PDT), anti-vascular endothelial growth factor (VEGF), or a combination of PDT and anti-VEGF. BCVA and central retinal subfield thickness (CRST), were measured at baseline and at 1 or 2 years of follow-up. Results In total, 3096 eyes of 3096 patients were included from 14 hospitals. Mean BCVA at baseline became significantly better over the 10-year study period (P < 0.001). BCVA at 1 year significantly improved from baseline in patients who underwent initial treatment from 2009 to 2015 (P = 0.001, 2009; P = 0.004, 2010; P = 0.01, 2011; P < 0.001, 2012–2015). BCVA at 2 years significantly improved from baseline in patients who underwent initial treatment from 2012 to 2015 (P < 0.001, 2012; P < 0.001, 2013–2015). CRST at 1 year decreased significantly from CRST at baseline, each year from 2006 to 2015 (P < 0.001, 2006–2015). CRST at 2 years decreased significantly from CRST at baseline, each year from 2006 to 2015 (P = 0.03, 2006; P < 0.001, 2007–2015). Conclusion Baseline BCVA with treatment-naïve nAMD tended to become better during the study period. BCVA at 1 year improved in the era of anti-VEGF; BCVA at 2 years improved in patients who underwent initial treatment in 2012 or later; and CRST decreased in each year during the study period.

Importance: Clinical evidence supports the efficacy of bimonthly aflibercept injection for age‐related macular degeneration.Background: The study aimed to evaluate aqueous vascular endothelial growth factor and aflibercept concentrations and the efficacy of bimonthly aflibercept in patients with age‐related macular degeneration.Design: This study is a prospective, interventional case series.Participants: Enrolled were 35 eyes with exudative age‐related macular degeneration from 35 patients.Methods: Patients received three bimonthly intravitreal aflibercept without loading doses. We collected the aqueous humor just before each injection, measured vascular endothelial growth factor and aflibercept concentrations by enzyme‐linked immunosorbent assay and measured best‐corrected visual acuity and central retinal subfield thickness before and after the injections.Main outcome measures: Aqueous vascular endothelial growth factor and aflibercept concentrations were measured.Results: The vascular endothelial growth factor concentration was 135.4 ± 60.5 pg/mL (mean ± standard deviation, range 60.6–323.4) at baseline and below the lowest detectable limit in all eyes at month 2 and in 32 eyes at month 4 (P < 0.001 [month 2] and P < 0.001 [month 4]). The mean aflibercept concentration was 20.3 ng/mL at month 2 and 28.0 ng/mL at month 4. The mean logarithm of the minimum angle of resolution visual acuity improved from 0.50 ± 0.36 at baseline to 0.36 ± 0.40 at month 6 (P < 0.001). The mean central retinal subfield thickness decreased from 353 ± 100 μm at baseline to 236 ± 45 μm at month 6 (P < 0.001).Conclusions and Relevance: Bimonthly aflibercept injections without loading doses may be considered a treatment option for age‐related macular degeneration.

Background/Aims: To evaluate the efficacy of anterior chamber paracentesis for preventing sustained intraocular pressure (IOP) elevation after intravitreal ranibizumab (IVR) injections for age-related macular degeneration (AMD). Methods: The medical records for all cases of exudative AMD treated with IVR injections and followed monthly for 12 months or longer were reviewed retrospectively. Anterior chamber paracentesis was performed just before IVR injections. A sustained IOP elevation was defined as 22 mm Hg or higher during 2 consecutive visits with an increase exceeding 6 mm Hg from baseline. Results: One hundred and eleven eyes met the inclusion criteria, and none of these eyes had a sustained IOP elevation. Conclusions: Anterior chamber paracentesis before IVR injections may prevent sustained IOP elevations.

To evaluate the 1-year results of pars plana vitrectomy for proliferative diabetic retinopathy. Two hundred thirty six patients with proliferative diabetic retinopathy received primary vitreous surgery at Shiga University of Medical Science Hospital and had at least 1 year follow-up period. The indications for pars plana vitrectomy included vitreous hemorrhage in 140 eyes, extramacular tractional retinal detachment in 60 eyes, macular tractional retinal detachment in 24 eyes and combined tractional retinal detachment in 12 eyes. The visual acuity and changes in visual acuity at 1-year postoperatively were evaluated. Preoperative bevacizumab injection and postoperative visual outcomes were compared between patients treated with 20 gauge (20 G) surgery and with micro incision vitrectomy surgery (MIVS). The visual acuity improved by 3 lines or more in 166 eyes (70%) and remained unchanged in 56 eyes (24%); it decreased by 3 lines or more in 14 eyes (6%). Tractional retinal detachment in MIVS received more bevacizumab injections. MIVS systems achieved better visual results in the combined tractional retinal detachment group than 20 G system. Successful visual improvement at 1-year postoperatively was observed in eyes with proliferative diabetic retinopathy after pars plana vitrectomy. Results of this study may suggest the superior performance of MIVS for pars plana vitrectomy in proliferative diabetic retinopathy.

To evaluate the efficacy of bimonthly intravitreal injections of ranibizumab for age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) in a pilot study. This study was a prospective, interventional case series. Thirty eyes of 30 patients received prospectively at least three bimonthly intravitreal injections of ranibizumab (0.5 mg/0.05 ml) without loading doses. The best-corrected visual acuity (BCVA) and the central retinal subfield thickness (CRST) were measured before and monthly after the injections. Twenty-eight patients received the three planned injections; one patient refused the third injection, one patient did not receive the third injection because blood pressure was raised, and one patient received a rescue injection at month 5 because of increased retinal thickness. The mean logarithm of the minimum angle of resolution (logMAR) BCVA was 0.44 ± 0.37 before treatment and significantly improved to 0.25 ± 0.34 at month 6 (p < 0.001). The mean CRST was 335 ± 85.9 μm before treatment and decreased significantly to 261 ± 78.1 μm at month 6 (p < 0.001). Nine of 30 patients received six planned injections for 12 months. The mean logMAR BCVA was 0.38 ± 0.39 before treatment and significantly improved to 0.18 ± 0.33 at month 12 (p = 0.005). The mean CRST was 360 ± 110.8 μm before treatment and decreased significantly to 249 ± 57.0 μm at month 12 (p = 0.025). Bimonthly injections of ranibizumab may be effective for treating AMD and PCV.