Ryo Ando

Background/Objectives: Brolucizumab is a potent therapeutic option for neovascular age-related macular degeneration (nAMD), but carries risks of intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RO). This study evaluated the occurrence of these adverse events in eyes treated with intravitreal brolucizumab injection (IVBr) under a treatment strategy incorporating sub-Tenon injection of triamcinolone acetonide (STTA). Methods: This multicenter retrospective study included patients with nAMD who initiated IVBr treatment with STTA and were followed for at least 1 month. IVBr was administered under a treatment strategy incorporating STTA, with repeat STTA when more than 3 months had elapsed since the previous STTA. Results: The study included 80 eyes of 80 patients (59 men and 21 women; mean age, 74.5 ± 7.7 years) from 9 institutions. The mean number of previous intravitreal anti-vascular endothelial growth factor injections was 20.4 ± 18.3. The mean follow-up period was 6.8 ± 4.8 months. The mean numbers of IVBr and STTA administrations were 2.6 ± 1.6 and 1.7 ± 1.0 per eye, respectively. Three eyes (3.75%) developed adverse events: one developed IOI, one developed IOI with RV, and one developed RO without IOI or RV. Conclusions: IOI, RV, and RO occurred in 2.5%, 1.25%, and 1.25% of eyes, respectively. These data may help inform the design and sample-size planning of future prospective comparative studies.

Background/Objectives: The aim of this study was to determine artificial intelligence-based macular fluid (MF) parameters in diabetic macular edema (DME) with optical coherence tomography (OCT) and examine stage-by-stage differences in MF parameters and their relationship with best-corrected visual acuity (BCVA). Methods: This study enrolled 104 eyes with treatment-naïve DME. Intraretinal fluid (IRF) and subretinal fluid (SRF) were detected in horizontal OCT images based on the “Hokkaido University MF segmentation model” when DME was first observed together with BCVA testing. The MF area, the mean brightness, and the variance of brightness were compared between mild or moderate non-proliferative diabetic retinopathy (mNPDR, n = 33), severe NPDR (sNPDR, n = 52), and PDR eyes (n = 19). Correlations between logMAR BCVA and MF parameters were also examined. Results: All the MF parameters tended to increase with DR stages. Especially, the mean brightness of IRF was significantly greater in PDR than in mNPDR. The variance of brightness of IRF increased in sNPDR compared to mNPDR, whereas that of SRF increased in PDR compared to sNPDR. LogMAR BCVA showed positive correlations with MF areas and the variance of brightness of SRF. Conclusions: The qualitative and quantitative MF parameters may be useful for better understanding DME pathogenesis according to DR progression.

Acute acquired comitant esotropia caused by prolonged near work, such as the use of digital devices, has been frequently reported in recent years. However, intracranial examination is necessary even for patients with nonparalytic comitant esotropia. Lhermitte–Duclos disease is a rare tumor that grows in layers in the cerebellum. Among those with this disease, cases of esotropia have been reported due to abduction limitation of the eye, but there have been no reports of comitant esotropia. Here, we report the case of a young woman with acute acquired comitant esotropia who was found to have Lhermitte–Duclos disease. A 16-year-old Japanese female patient, whose ethnicity was Asian, was referred to our hospital for acute acquired comitant esotropia. Fundus examination revealed papilledema in both eyes, and magnetic resonance imaging of the head revealed a cerebellar tumor in the right cerebellum with obstructive hydrocephalus. She underwent partial tumor resection, and a histopathological diagnosis of Lhermitte–Duclos disease was obtained. However, comitant esotropia status remained unchanged, and she underwent strabismus surgery. Finally, diplopia disappeared completely. Neurological and intracranial imaging examinations are essential when acute acquired comitant esotropia is observed. Acute acquired comitant esotropia by Lhermitte–Duclos disease did not improve with partial tumor resection and required strabismus surgery, but good surgical results were obtained.

Purpose To analyze the 2-year treatment outcomes of triple therapy with standard-fluence photodynamic therapy (PDT), intravitreal injection of ranibizumab (IVR)/aflibercept (IVA), and sub-tenon injection of triamcinolone acetonide (STTA) for neovascular age-related macular degeneration (nAMD) in Japanese patients. Study design A retrospective, clinical case-series study. Methods Forty-four eyes of 44 patients with treatment-naïve nAMD followed for more than 24 months were evaluated. Initial treatment was given with triple therapy and retreatment with IVR/IVA as a pro re nata regimen. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), the number of treatments, and intraocular pressure elevation were analyzed. Results The mean age was 73.3 ± 10.0 years. The mean BCVA significantly improved from 0.61 ± 0.30 at baseline to 0.50 ± 0.46 at 24 months (p = 0.034). CRT significantly improved from 373 ± 162 μm at baseline to 200 ± 107 μm at 24 months (p < 0.001). The number of treatments given during the 2-year treatment period was 2.7 ± 1.8. No retreatments were necessary in 18 of 44 eyes (40.9%), with no significant difference between IVR (46.4%) or IVA (31.3%) used during the 2-year follow-up of triple therapy (p = 0.51). Four eyes (9.1%) temporarily required glaucoma eye drop treatments. Conclusion In nAMD patients, induction treatment with triple therapy resulted in approximately 40% of the patients requiring no retreatment for 2 years. The type of anti-VEGF agents used made no difference in the results.

Choroidal circulation hemodynamics in eyes with ocular blunt trauma has not been quantitatively examined yet. We quantitatively examined changes in choroidal blood flow velocity and thickness at the lesion site using laser speckle flowgraphy (LSFG) and enhanced depth imaging optical coherence tomography (EDI-OCT) in a patient with chorioretinopathy associated with ocular blunt trauma. A 13-year-old boy developed a chorioretinal lesion with pigmentation extending from the optic disc to the superotemporal side in the right eye after ocular blunt trauma. The patient’s best-corrected visual acuity (BCVA) was 0.2 in the right eye. Indocyanine green angiography showed hypofluorescence from the initial phase, with a decrease of mean blur rate (MBR) on LSFG color map, which corresponded to the chorioretinal lesion. The BCVA and foveal outer retinal morphologic abnormality spontaneously improved during follow-up. MBR and choroidal thickness increased by 23–31% and 13–17 μm at the lesion site and by 11–22% and 33–42 μm at the fovea, respectively, during the 6-month follow-up period after baseline measurements in the affected eye. In contrast, these parameters showed little or no changes at the normal retinal site in the affected eye and the fovea in the fellow eye. Current data revealed that both blood flow velocity and thickness in the choroid at the lesion site decreased in the acute stage and subsequently increased together with improvements in visual function and outer retinal morphology. These results suggest that LSFG and EDI-OCT may be useful indices that can noninvasively evaluate activity of choroidal involvement in ocular blunt trauma-associated chorioretinopathy.

A highly invasive intracranial malignant schwannoma containing several masses was detected in a 28-week-old male Crl:CD(SD) rat. Macroscopically, 3 masses were noted in the cranial cavity; one was present at the bottom of the cranial cavity and involved the trigeminal nerve, and the other two were in the parietal bone. Histologically, each mass consisted of fusiform cells with interlacing fascicular, wavy and nuclear pseudopalisading arrangements and round cells with cystic lesions. The tumor cells invaded not only the brain but also the parietal bone. In the brain, the tumor cells infiltrated diffusely into the leptomeningeal and perivascular spaces and parenchyma, in which the tumor cell morphology and invasive pattern closely resembled those of malignant astrocytoma and malignant reticulosis. Immunohistochemically, the tumor cells in the masses showed positive reactions for both S-100 protein and GFAP, while those in the cerebral invasion sites were negative for GFAP and less positive for S-100 protein. Electron microscopically, a single basal lamina layer and short intricate cell processes were confirmed in the tumor cells. From these results, the present tumor was diagnosed as a malignant schwannoma arising in the cranial cavity, probably originating from the trigeminal nerve. The present tumor is considered to be a relatively unique malignant schwannoma based on its growth and invasion patterns.