論文

Purpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study. Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively. Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048). Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test.

Corneal alterations due to radial keratotomy (RK) complicate intraocular lens calculations, which may explain why there have been few reports of toric intraocular lens (TIOL) implantation after excessive or multiple operations. A 71-year-old male with a history of repeated RKs and at least 30 corneal incisions in each eye was referred for cataract surgery. Preoperatively, the best-corrected distance visual acuity was 0.7 decimal (0.15 logMAR) in the right eye and 0.9 decimal (0.05 logMAR) in the left eye. The refractive errors were −8.00 −3.00 × 80 and −6.00 −3.50 × 80, respectively. The total corneal cylindrical powers (real power; anterior and posterior) were, respectively, −0.90 D and −3.60 D at 9 a.m., compared to −1.60 D and −3.80 D at 1 p.m. Corneal astigmatism in the left eye was considered symmetric and diurnally stable; therefore, an XY1AT6 TIOL (Hoya, Tokyo, Japan; cylindrical power at the plane, +3.75 D) was implanted. A non-toric intraocular lens, the XY1 (Hoya), was implanted in the right eye. Six-month postoperative best-corrected distance visual acuities were 1.2 decimal (−0.08 logMAR) and 1.0 decimal (0.00 logMAR) in the right and left eyes, respectively. Post-operative manifest refractions were +0.00 −3.00 × 70 and −1.00 −2.00 × 85, respectively. The TIOL reduced refractive astigmatism in the left eye; therefore, we believe that even after multiple RKs, the TIOL can be a suitable candidate to correct astigmatism if the corneal astigmatism is diurnally stable and symmetric.

Myopia is a common refractive error that affects a large proportion of the population. Recent studies have revealed that alterations in choroidal thickness (ChT) and choroidal blood flow (ChBF) play important roles in the progression of myopia. Reduced ChBF could affect scleral cellular matrix remodeling, which leads to axial elongation and further myopia progression. As ChT and ChBF could be used as potential biomarkers for the progression of myopia, several recent myopia treatments have targeted alterations in ChT and ChBF. Our review provides a comprehensive overview of the recent literature review on the relationship between ChBF and myopia. We also highlight the importance of ChT and ChBF in the progression of myopia and the potential of ChT as an important biomarker for myopia progression. This summary has significant implications for the development of novel strategies for preventing and treating myopia.

Purpose: To investigate the changes in axial length (AL) elongation and other ocular parameters before and during the coronavirus disease 2019 pandemic. Design: A longitudinal school-based study. Participants: Public elementary schoolchildren in Tokyo (grades 1–6; age, 6–12 years) participated in this study from 2018 to 2021. Methods: All participants underwent eye examinations and provided written consent to measurements of the noncycloplegic refraction and ocular biometry including AL, among others. The students’ parents also completed a questionnaire about the students’ lifestyles. We included the right eye in our analysis and compared the changes in the ocular parameters among the periods using a linear mixed-effects model for repeated measures and examined the univariate and step-wise multiple regression analyses to evaluate the associations between myopia and other covariates. Main Outcome Measures: Changes in AL elongation and other ocular parameters from 2018 to 2019 (prepandemic), that of 2019 to 2020 (immediately after the pandemic onset), and that of 2020 to 2021 (during the pandemic). Results: A total of 578 students before the pandemic period, 432 immediately after the pandemic onset, and 457 during the pandemic period were evaluated. The changes in the ALs and spherical equivalents (SEs) a year before, immediately after onset, and during the pandemic were 0.31 mm/−0.20 diopter, 0.38 mm/−0.27 diopter, and 0.28 mm/−0.47 diopter, respectively (ALs, P < 0.001; SEs, P = 0.014). The results of the questionnaire showed that time spent outdoors daily had changed during the 3 years to 79, 63, and 77 minutes/day, respectively (P < 0.001). Time spent using smartphones or tablets increased year by year to 41, 52, and 62 minutes/day (P < 0.001). The greatest AL elongation occurred during the period when the shortest amount of time was spent outdoors during the 3 years. Conclusions: These results suggested that the school closures and decreasing time spent outdoors might have caused greater AL elongation among schoolchildren in Tokyo; however, it is possible that, although the time spent in near work still increased, the return to the time spent outdoors to the prepandemic levels may have affected the slowing of AL elongation after lockdown. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的:白内障術後,眼内レンズ(IOL)のグリスニングとホワイトニングによると考えられる視機能低下によりIOLを交換した症例を報告する。症例:78歳,女性。右白内障手術6年後の視力低下を主訴に受診した。所見:右矯正視力は白内障手術直後の0.8から0.4に低下しており,IOLのグリスニングおよびホワイトニングを認めた。軽度の網脈絡膜萎縮を認めたが,白内障手術直後から変化はなかった。IOL交換により矯正視力は0.8に回復した。結論:IOLのグリスニングおよびホワイトニングにより視機能低下をきたす可能性があり,その場合には眼内レンズの摘出・交換も考慮すべきである。(著者抄録)

目的:白内障手術後の残余屈折異常に対し,追加型眼内レンズ(IOL)を挿入した1症例の報告。症例:70歳男性が白内障手術を希望して受診した。23年前に両眼に放射状角膜切開術,12年前に両眼にレーザー屈折矯正角膜切除術を受けていた。所見:裸眼視力は右0.5,左0.4で,矯正視力は右0.9,左1.0であった。加齢白内障の診断で,左右眼に超音波乳化吸引術とIOL挿入術を行った。1年後の裸眼視力は右0.5,左0.5で,矯正視力は右1.2,左1.0であった。左眼に+3.0D()cyl-2.0D 65°の屈折異常があった。患者の希望により,左眼に追加型単焦点IOLを挿入した。6ヵ月後の左眼の裸眼視力は0.63,矯正視力は1.0であり,合併症はない。結論:追加型IOLの挿入は,白内障手術後の残余屈折異常に対する治療の,1つの選択肢である。(著者抄録)

目的:術後の不満から,多焦点眼内レンズを単焦点眼内レンズに交換した2症例の報告。症例:75歳男性の両眼に白内障手術を行い,回折型多焦点眼内レンズを挿入した。術前からの眼精疲労と羞明感が悪化し,本人の希望で4ヵ月後に単焦点眼内レンズに交換した。症状は持続したが,本態性眼瞼けいれんの治療で症状が改善した。52歳女性の両眼に白内障手術を行い,屈折型多焦点眼内レンズを挿入した。術後に羞明感があり,4ヵ月後に単焦点眼内レンズに交換した。症状は改善しなかった。結論:多焦点眼内レンズを挿入したのち,本人の不満による単焦点眼内レンズへの交換は慎重に判断する必要がある。(著者抄録)

目的:虹彩支持型有水晶体眼内レンズ(phakic IOL)の術後早期成績を検討する。方法:対象はphakic IOLを挿入した高度近視または近視性乱視9例17眼である。術前・術後の屈折、視機能、角膜内皮細胞密度、高次収差、前房内フレア値を検討した。結果:術後、裸眼視力は有意に改善し、矯正視力に有意差はなかった。術後1年の有効係数は0.89、安全係数は1.15であった。術後1年の屈折は±1.0D以内が89%であった。コントラスト感度、角膜内皮細胞密度、高次収差、前房内フレア値は術前と術後1年で有意差はなかった。結論:Phakic IOLの術後早期成績は良好である。(著者抄録)

近視レーザー角膜切削形成術(LASIK)後に超音波水晶体乳化吸引術と眼内レンズ(IOL)移植を受けた白内障患者17例24眼(男性11例、年齢30～67歳)を対象に、OKULIXレイトレーシングソフトウェアを使用して、IOLパワー計算の正確度を後方視的に評価した。OKULIXによる算術的予測誤差は0.53D(範囲-0.93～2.59)で、Camellin-Calossi、Shammas-PL、Haigis-L、ダブルK SRK/T[43.5D]式では各-0.37、-0.54、-0.95、0.59Dであった(OKULIXに比べたp値;各0.004、0.004、0.004、1.00)。また、絶対予測誤差はOKULIXから順に0.62、0.62、0.80、1.13、0.74Dで、OKULIXと他の式との間に有意差はなかった。OKULIXによる予測誤差は18眼で±1.0D以内であり、この割合はHaigis-L式よりも有意に高かった(p=0.028)。OKULIXによるIOLパワー計算は、他の式と同等に正確であることが示された。

目的:多焦点眼内レンズ(IOL)両眼挿入例の術後3ヵ月の両眼視力について検討する。方法:両眼多焦点IOL挿入術を受けた18例36眼(21～73歳、平均年齢59.1±12.7歳)を対象とし、両眼屈折型多焦点IOLを使用した群をR群、回折型をD群、優位眼に屈折型、非優位眼に回折型のミックスアンドマッチ症例をM群とし、術後3ヵ月の遠方、中間、近方の裸眼、矯正視力および自覚的屈折力を検討した。結果:術後の自覚的屈折力(D)は各群間に有意差はなかった。両眼裸眼視力はR群とD群の遠方、近方に有意差はなく(R≒D)、中間はR群がD群より有意によかった(R>D)。また全距離ともM群がD群よりよく(M>D)、近方のみM群がR群よりもよかった(M>R)。両眼矯正視力は、R群とD群では遠方、近方とも有意差がなく(R≒D)、遠方、近方ともM群がD群より有意によかったが(M>D)、R群とは有意差はなかった(R≒M、R≒D)。結論:ミックスアンドマッチ症例は両眼屈折型または回折型を挿入した症例よりも全距離で両眼裸眼視力が良好だった。(著者抄録)

目的:多焦点眼内レンズ(MIOL)挿入眼の近方実用視力を検討する。方法:対象は白内障手術を施行した合併症のない白内障患者16例27眼、平均年齢57.4歳で、使用したMIOLはNXG1(AMO社)、ZM900(AMO社)、SN6AD3(Alcon社)である。術後3ヵ月の自覚屈折、遠方視力、近方視力と近方実用視力(遠方矯正下)を測定した。結果:術後平均屈折は-0.03D、平均遠方視力(logMAR)は裸眼、矯正の順に-0.04、0.13、平均近方視力(logMAR)は裸眼、遠方矯正下、最良矯正の順に0.15、0.08、0.02だった。遠方矯正下において平均近方実用視力は近方視力よりも有意に低かった(p<0.001)。遠方矯正下における近方視力と近方実用視力は3種のIOLの間で有意差はなかった。結論:MIOL挿入眼の遠方矯正下における近方実用視力は、遠方矯正下近方視力より不良であった。(著者抄録)