The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
To characterize fundus findings and the presence of pseudoxanthoma elasticum (PXE) in Japanese patients with angioid streaks (AS). Retrospective, single-center observational study. This retrospective study included 33 patients (66 eyes) diagnosed with AS who underwent color fundus photography, optical coherence tomography, and fundus autofluorescence. The presence of PXE, peau d'orange, choroidal neovascularization (CNV), macular atrophy, comet tail lesions, pattern dystrophy-like changes, subretinal drusenoid deposits (SDD), outer retinal tubulation (ORT), and optic nerve head drusen were evaluated. PXE was diagnosed in 15 of 33 patients (45.5%), whereas peau d'orange was observed in 36 eyes (54.5%). There were no significant differences in the prevalence of peau d'orange (P=1.00) or comet tail lesions (P=0.70) between patients with and without clinical PXE diagnosis. CNV and macular atrophy were each present in 31 eyes (47.0%). Comet tail lesions, pattern dystrophy-like changes, SDD, and ORT were found in 17 (25.8%), 21 (31.8%), 6 (9.1%), and 13 (19.7%) eyes, respectively; optic nerve head drusen were not detected. Most pattern dystrophy-like changes (81.0%), SDD (83.3%), and ORT (92.3%) were associated with CNV. Japanese patients with AS showed a high frequency of CNV, which is often accompanied by macular atrophy and photoreceptor-related structural changes. Furthermore, the prevalence of peau d'orange was higher than of clinically diagnosed PXE, suggesting possible underdiagnosis of PXE in this cohort.
To investigate the natural course of geographic atrophy (GA) in Japanese patients, with a focus on factors associated with the change of GA size over time and visual acuity decline. Retrospective, single-center observational study. We reviewed 40 eyes of 40 patients with GA and longitudinal fundus autofluorescence (FAF) imaging. Annual progression rates were calculated as square root-transformed (mm/year). Assessed factors included age, sex, smoking history, diabetes, hypertension, baseline best-corrected visual acuity (BCVA), baseline lesion size, foveal center involvement, choroidal thickness, FAF subtypes, and presence of subretinal drusenoid deposits (SDD). Visual outcomes were assessed as change in BCVA (ΔBCVA, logarithm of the minimum angle of resolution (logMAR)). Median age was 75.5 years; 50% of eyes had SDD. The median annual GA progression rate was 0.16 mm/year in square root units. Baseline GA area and the presence of SDD were independent predictors of GA progression (β = -0.0837, p = 0.015; β = +0.3064, p = 0.009, respectively). In multivariable analysis, baseline GA area also remained a significant predictor of visual deterioration (β = +0.1369, p = 0.002). When stratified by FAF patterns, there was significant worsening of BCVA in the Diffuse (p = 0.0027) and Banded (p = 0.0117) subtypes, whereas the None and Other subtypes did not show significant changes in BCVA over one year. SDD was identified as a significant risk factor for GA progression in Japanese patients. These findings improve understanding of natural history of GA in Japanese population and may inform risk stratification.
To investigate the current (2024) use of fixed-combination eye drops in Japanese patients with glaucoma. Cross-sectional survey. The survey included 6323 outpatients (6323 eyes) with glaucoma or ocular hypertension at 82 private practices from March 10 to 16, 2024. The use of fixed-combination eye drops, including prostaglandin F (FP) receptor agonist/β-blocker (FP/β), carbonic anhydrase inhibitor/β-blocker (CAI/β), α2-adrenergic agonist/β-blocker (α2/β), α2-adrenergic agonist/carbonic anhydrase inhibitor (α2/CAI), and α2-adrenergic agonist/Rho-associated protein kinase (α2/ROCK), was analyzed, stratified by the number of medications used. The results were compared with those of a 2020 survey via χ2 tests. FP/β, CAI/β, α2/β, α2/CAI, and α2/ROCK were used by respectively 56.4%, 8.0%, 2.2%, 2.9%, and 0.6% of 2-medication users; 42.5%, 30.2%, 3.2%, 11.2%, and 4.1% of 3-medication users; and 56.6%, 32.1%, 1.7%, 45.5%, and 14.4% of ≥4-medication users. FP/β were the most commonly used in all groups. Compared with the previous survey, the use of FP/β increased significantly in all groups, while that of CAI/β decreased significantly. Among four-medication users, 228 patients (44.4%) used two types of fixed-combination eye drops. In this group, FP/β + α2/CAI (186 cases) was the most common. Among five-medication users, 186 patients (69.9%) used two types of fixed-combination eye drops. In this group, FP/β + α2/CAI + one additional drug (131 cases) was the most common. Fixed-combination eye drops were used in >70% of patients using 2 medications and >90% of patients using ≥3 medications. Over time, the use of FP/β increased, while the use of CAI/β decreased.
We compared the magnitude of surgically induced astigmatism (SIA) following PreserFlo MicroShunt (PMS) implantation versus conventional trabeculectomy (Trab), with both procedures being performed with mitomycin C (MMC). Retrospective cohort study METHODS: We included 113 eyes of 113 patients who underwent standalone PMS surgery and 78 eyes of 78 patients who underwent standalone Trab, all with no previous history of glaucoma surgery. Corneal astigmatism was measured preoperatively and at 3 months postoperatively by use of an automated keratometer. The mean SIA (M-SIA) and centroid SIA (C-SIA) were calculated by use of a dedicated vector analysis tool. Preoperative and postoperative intraocular pressure (IOP) and visual acuity (VA) were compared by use of paired t tests. The Mann-Whitney U test was used to compare the M-SIA between the groups. Postoperatively, the IOP decreased from 20.9 to 11.5 mm Hg in the PMS group and from 20.6 to 9.3 mm Hg in the Trab group (P <0.001 for both). The C-SIA demonstrated an astigmatic shift toward the site of tube insertion in the PMS group and toward the scleral flap location in the Trab group. The M-SIA was significantly lower in the eyes treated with PMS than in those treated with Trab in the superonasal quadrant, but not in the superotemporal site. The VA remained stable in the PMS group, whereas a significant decline was observed in the Trab group. The PMS is an effective surgical option for reducing IOP while minimizing SIA at 3 months postoperatively. By better preserving visual function, the PMS may contribute to improved vision and overall patient satisfaction with the surgical outcomes.
To examine the relationship between posterior vitreous changes and retinal detachment (RD) associated with acute retinal necrosis (ARN). Retrospective, consecutive case study. This study evaluated the clinical findings for 32 eyes of 29 patients (12 women, 17 men) diagnosed with ARN, with the posterior vitreous condition monitored by swept-source optical coherence tomography (SS-OCT). The causative virus, incidence of RD, and relationship between the development of RD and final visual acuity were investigated. Patients were checked for posterior vitreous detachment (PVD) from the initial visit to the last SS-OCT observation. Varicella-zoster virus caused 67% of the ARN cases, with RD developing in 66% of the cases, and proliferative vitreoretinopathy (PVR) in 90% at onset or at recurrence. Silicone oil could not be removed in 38% of the cases with RD. Final best-corrected visual acuity was significantly worse in the RD (+) group than in the RD (-) group (median logMAR 1.02 vs. 0.16, p = 0.04). PVD occurred in 20 of 21 eyes without PVD at the initial examination, with 18 of these 20 eyes developing RD (90%). PVD occurred at an average of 45.8 ± 32.1 days after the initial examination, with 85% of the cases developing PVD within 3 months. The visual prognosis of ARN complicated by RD is poor. PVD is involved in the development of RD and is often associated with PVR, which itself is refractory.
To assess the 6-month efficacy and safety of oxymetazoline hydrochloride ophthalmic solution 0.1% (OMZ 0.1%) versus placebo for acquired blepharoptosis. A phase 3, randomized, double-masked, parallel-group, multicenter study conducted in Japan. Patients were randomized 1:1:1 to OMZ 0.1%, once daily (QD) or twice daily (BID), or placebo. Patients received OMZ 0.1% for 6 months. Patients in the placebo group were randomized after 3 months (Treatment Period 1) to OMZ 0.1%, either QD or BID, for the remaining 3 months (Treatment Period 2). The primary efficacy endpoint was the marginal reflex distance-1 (MRD-1) change from baseline to Day 14 (2 hours after the morning drop) with OMZ 0.1% QD or BID versus placebo. Adverse events and adverse drug reactions (ADRs) were recorded. Overall, baseline MRD-1 (standard deviation) of 336 patients analyzed (n=112 per group) was 1.31 (0.83) mm (Day 0). MRD-1 change from baseline to Day 14 (2 hours after the morning drop) was 1.09 (0.07), 0.93 (0.07), and 0.50 (0.07) mm, with OMZ 0.1% QD, BID, and placebo, respectively. There was a statistically significant difference in the least squares mean (standard error) MRD-1 change versus placebo with OMZ 0.1% QD (0.59 [0.10] mm; 95% CI 0.38, 0.79) and OMZ 0.1% BID (0.43 [0.10] mm; 95% CI 0.23, 0.64) (both p<0.05). All ADRs related to the study drug were mild. Fourteen days of OMZ 0.1% treatment significantly increased MRD-1 versus placebo. There was no loss of effect after 6 months of treatment and no significant safety concerns.
To compare one‑year postoperative outcomes between PreserFlo MicroShunt (PMS) and trabeculectomy (TLE) as primary filtration surgery in Japanese patients with open‑angle glaucoma using propensity score matching. Retrospective, single‑center observational cohort study. Patients with open‑angle glaucoma who underwent stand‑alone PMS implantation or TLE at Kobe University Hospital were included. After applying exclusion criteria, 102 eyes in each of 2 groups were matched 1:1 using propensity scores based on age, sex, lens status, glaucoma subtype, preoperative intraocular pressure (IOP), number of glaucoma medications, and best‑corrected visual acuity (BCVA). The primary outcome was IOP at 12 months postoperatively. Secondary outcomes included longitudinal IOP changes, medication use, BCVA, corneal endothelial cell density (ECD), surgical success rates, postoperative complications, and additional surgery. Mixed‑effects models and Kaplan-Meier analyses were performed. At 12 months, mean IOP was significantly lower in the TLE group than in the PMS group (12.3 vs 14.1 mmHg, P = 0.042). Both groups showed significant IOP reduction from baseline. The proportion of medication‑free eyes did not differ between groups. BCVA worsened transiently after surgery and partially recovered but remained worse than baseline at 12 months, with no between‑group differences. ECD decreased modestly in both groups without significant differences. Surgical success rates were comparable across all criteria. Postoperative complications, particularly hypotony‑related events, were more frequent in the TLE group, and persistent hypotony was observed only after TLE. PMS demonstrated a more favorable safety profile with fewer hypotony‑related complications, whereas TLE achieved greater IOP reduction at 12 months. Surgical success rates were comparable. PMS may represent a less invasive option, while TLE may be preferable when maximal IOP lowering is required.
To investigate the characteristics of Terson syndrome (TS) among survivors of aneurysmal subarachnoid hemorrhage (aSAH). Retrospective study METHODS: Using the Japanese Diagnosis Procedure Combination database, we identified patients diagnosed with aSAH at admission between July 1, 2010 and March 31, 2023 in Japan. The prevalence of TS in aSAH survivors was examined, along with comparisons of patient backgrounds between survivors with TS and those without TS. We compared the characteristics and outcomes in patients with TS who underwent vitrectomy with those in patients who did not, and analyzed the laterality of the surgery. Among 143,058 patients with aSAH, 104,576 (73.1%) survived. TS was diagnosed in 860 (0.8%) survivors. The patients with TS were younger (mean [standard deviation, SD] age: 53.3 [11.4] vs 64.0 [14.6] years) than those without TS. Among the patients with TS, 243 (28.3%) patients underwent vitrectomy during hospitalization, with a median interval of 38 days from admission to surgery. Of the patients with TS who underwent vitrectomy, 160 (66.4%) and 81 (33.6%) patients underwent unilateral and bilateral vitrectomy, respectively. In this retrospective study, the prevalence of TS among aSAH survivors was less than 1%. Vitrectomy was performed in approximately one-third of the patients with TS, with one-third of these patients undergoing bilateral surgery during hospitalization.
The distribution of uveitis varies worldwide and changes over time. Although nationwide surveys in Japan report shifts in disease patterns, updated epidemiological data after 2020 remain limited. In this study, we investigated the current pattern of uveitis among first-time patients at a regional university hospital in Japan and compared the findings with previous nationwide surveys. Retrospective observational study. We retrospectively reviewed the medical records of patients with uveitis who first visited Saitama Medical Center, Jichi Medical University, between January 1, 2020, and December 31, 2023. Collected data included age, sex, diagnosis, and anatomical classification of uveitis. A total of 671 patients were included, with a mean age of 57.8 ± 21.1 years. Panuveitis was the most common anatomical subtype (55.0%), followed by anterior (34.9%), posterior (9.4%), and intermediate uveitis (0.7%). Definitive diagnoses were established in 62.7% of patients. The most frequent etiologies were sarcoidosis (9.7%), Vogt-Koyanagi-Harada disease (8.2%), herpetic iritis (6.3%), intraocular lymphoma (4.5%), and Behçet's disease (3.7%). Compared with previous nationwide surveys, higher proportions of cytomegalovirus retinitis (CMVR) and intraocular lymphoma were found. The findings in this study provide updated epidemiological data on uveitis in Japan, revealing higher proportions of CMVR and intraocular lymphoma among first-time patients at a regional university hospital. These trends might reflect population aging and an increasing number of immunocompromised patients, including those receiving immunosuppressive therapy or having hematologic malignancies.
To evaluate the real-world use, treatment outcomes, and tolerability of the fixed-dose combination of ripasudil 0.4% and brimonidine 0.1% (RBFC) eye drops in patients with uveitic glaucoma (UG). Single-center retrospective case series. Medical records of 39 eyes with open-angle UG treated with RBFC were reviewed. The outcome measures included changes in intraocular pressure (IOP) and glaucoma drug score (GDS) at 12 months, the proportion of eyes with an IOP reduction of ≥2 mmHg at 12 months, the relationship between the duration of UG and the change in IOP at 12 months, changes in IOP in eyes switched from ripasudil plus brimonidine, and adverse events. The median IOP significantly decreased from 19 mmHg at baseline to 14 mmHg at 12 months (p < 0.001), while the median GDS showed no significant change, from 3 at baseline to 4 at 12 months (p = 0.562). At 12 months, 64% of eyes achieved an IOP reduction of ≥2 mmHg. A positive correlation was observed between the duration of UG and the change in IOP at 12 months (rho = 0.539, p < 0.01). In the subgroup analysis restricted to eyes switched from ripasudil plus brimonidine eye drops to RBFC, IOP showed a decreasing trend (p = 0.057). No drug-related adverse events were observed, except for transient conjunctival hyperemia. This real-world study in patients with UG showed that RBFC achieves effective IOP control while reducing treatment burden, with good tolerability, supporting its continued use in UG management.
To investigate the prevalence and spectrum of microbial contamination of donor corneoscleral rims and storage medium in keratoplasty and to report a case of donor-derived fungal keratitis. Single-center, retrospective study. We reviewed 285 eyes that underwent keratoplasty at Hiroshima University Hospital between October 2022 and January 2025. Donor corneas were preserved using Optisol®-GS. The donor rim and storage medium were separately cultured intraoperatively, and the minimum inhibitory concentrations (MICs) were determined. Culture positivity was identified in 10 of the 285 eyes (3.5%): six from donor rims and four from storage media, with no eye yielding positive results in both. All tested bacterial isolates were Gram-positive; three of six tested were not susceptible to levofloxacin and gatifloxacin (MIC ≥4 μg/mL), including methicillin-resistant Staphylococcus aureus, but retained susceptibility to vancomycin and meropenem. All fungal isolates were Candida with low MICs for voriconazole and micafungin. C. albicans and C. glabrata were recovered from the mate corneas of a single donor; the recipient of the cornea contaminated with C. albicans developed keratitis requiring repeat penetrating keratoplasty, whereas the recipient of the C. glabrata-contaminated cornea did not. Adding storage medium to the rim culture improved the detection of donor-associated microorganisms. When donor-derived C. albicans keratitis developed, susceptibility data from contemporaneous cultures enabled prompt targeted antifungal therapy and globe preservation, although repeated penetrating keratoplasty was ultimately required.
To determine whether the effect of three muscle surgery for moderate to large angle exotropia can be better predicted by surgical dosage, or by pre-operative exotropia angle. We examined cases where identical surgical dose was performed for a wide range of preoperative angles 30 to 55Δ. Retrospective, interventional case study. Patients with exotropia 30-55Δ who underwent bilateral lateral rectus (BLR) muscle recession 7 mm and 4 mm unilateral medial rectus (UMR) muscle plication between 2014 and 2024 were included. Surgical effect was analyzed by linear regression against the amount of preoperative exotropia, as well as total millimeters of recession and plication. Success was defined as less than 10Δ exotropia or 5Δ esotropia. Thirty-four patients were included with 32 ± 27 (standard deviation, SD) years mean age. Mean preoperative exotropia at distance was 42 ± 6Δ (range 30-55Δ), and 40 ± 16Δ (range 6-70Δ) at near. Surgical effect varied from 29Δ to 75Δ, averaging 42 ± 10Δ, giving a mean dose response of 2 ± 1Δ/mm. Linear regression showed that average surgical effect was equal to pre-operative deviation, accounting for 34-36% of variation in surgical effect. Success rate of this operation for all exotropia angles was 76% at 2 months mean followup. Surgical effect for moderate to large angle exotropia does not strongly depend on surgical dose, so that successful outcomes measured 2 months post-operatively are obtained by performing a numerically identical procedure regardless of the pre-operative angle exceeding 30Δ. Since outcome is attributable more to the biological response than to amount of surgery, pre-operative measurements require only sufficient precision to confirm that the angle is moderate to large.
To evaluate 1-year outcomes of loading phase treatment followed by a treat-and-extend (TAE) regimen with intravitreal aflibercept 8 mg for neovascular age-related macular degeneration (nAMD). Retrospective, interventional case series. We retrospectively studied 83 eyes of 80 consecutive patients with treatment-naïve nAMD, assessing best-corrected visual acuity (BCVA), foveal thickness (FT), central choroidal thickness (CCT), total number of injections over 1 year, and intended injection interval at the last visit. Sixty eyes (72.3%) completed the 1-year aflibercept 8mg treatment. Their BCVA improved significantly, with significant reductions in FT and CCT, for up to 1 year. The total number of injections was 6.5±0.7, and the intended injection interval at the last visit was 13.4±3.3 weeks. Of the 23 eyes (27.7%) failing to complete the 1-year treatment, 9 (10.8%) developed non-infectious intraocular inflammation (IOI) associated with retinal vasculitis during the loading phase, leading to treatment discontinuation. Moreover, 7 eyes (8.4%) were switched to intravitreal brolucizumab due to persistent exudation with an 8-week interval of aflibercept 8mg injections in the maintenance phase. The remaining 7 eyes (8.4%) dropped out. Loading phase treatment followed by a TAE regimen with intravitreal aflibercept 8 mg appears to be effective for improving visual acuity and ameliorating exudative changes in eyes with nAMD. However, there might be cases in which exudative changes cannot be adequately controlled with injections of aflibercept 8 mg. Moreover, careful monitoring is required due to the potential development of IOI associated with retinal vasculitis during the loading phase.
To evaluate the factors affecting uncontrolled intraocular pressure (IOP) in eyes with crystalline lens, intraocular lens (IOL) dislocation, or aphakia after pars plana vitrectomy (PPV) combined with the flanged intrascleral IOL fixation technique (ISF) (PPV-ISF), and to examine the risk of high IOP or glaucoma surgery after PPV-ISF. Retrospective observational cohort study METHODS: This study investigated 100 eyes (97 patients) who underwent PPV-ISF at Osaka University Graduate School of Medicine between July 2020 and June 2022. We evaluated the association of the outcomes of postoperative IOP control with preoperative and postoperative factors. Uncontrolled IOP was defined as an increase in glaucoma eye-drop use or necessity of glaucoma surgery. The mean patient age was 67.9 ± 16.1 years. Among 100 eyes, 13 (13%) were diagnosed with exfoliation syndrome (XFS). Age and XFS were associated with preoperative ocular hypertension (P = .03, P = .005). After PPV-ISF, the use of eye drops was increased in 25 patients, and 10 eyes (10%) underwent glaucoma surgery. In the multiple logistic regression analysis, the odds ratios for uncontrolled IOP in XFS, previous glaucoma surgery, and previous vitrectomy surgery were 5.67 (P = .001), 8.98 (P = .004), and 1.43 (P = .508), respectively. XFS and history of glaucoma surgery are associated with poor IOP control after PPV-ISF surgery.
To evaluate 6-month outcomes of aflibercept 8 mg administered with two monthly injections followed by a treat-and-extend (TAE) regimen in treatment-naïve neovascular age-related macular degeneration (nAMD). Multicenter retrospective study. This study included 107 treatment-naïve eyes with nAMD, of which 91 eyes of 90 patients (mean age, 74.7 ± 9.4 years) followed for 6 months were analyzed. All eyes received two consecutive monthly injections of aflibercept 8 mg (induction), followed by TAE. Best-corrected visual acuity (BCVA, logMAR), optical coherence tomography (OCT)-based anatomical outcomes, and adverse events were assessed. Sixteen eyes were excluded, mainly due to being lost-to-follow-up or having had treatment changed to an alternative drug. No serious adverse events were observed. Mean BCVA improved from 0.43 ± 0.36 at baseline to 0.37 ± 0.42 at 6 months (P = 0.032). Retinal thickness, pigment epithelial detachment height, and subfoveal choroidal thickness significantly improved (all P < 0.05). The mean number of injections over 6 months was 3.4 ± 0.5, and the mean treatment interval at the end of 6 months was 11.6 ± 2.2 weeks. A dry macula was achieved in 70.3% of eyes, with a higher rate in eyes achieving a dry macula after a two-injection induction than in those requiring a three-injection induction (80.0% vs 51.6%, P < 0.01). Eyes achieving a dry macula after two injections had higher 6-month dry rates than those requiring a third injection. Early treatment response may help predict treatment burden and guide individualized management strategies.
To investigate regional differences in the epidemiology and treatment of retinopathy of prematurity (ROP) from 2016 to 2023. Retrospective multicenter cohort study METHODS: Premature infants screened for ROP at a single tertiary referral center in each of five countries/regions (Taiwan, Hong Kong, Singapore, India, and Portugal) during the study period. Demographic characteristics, incidences of ROP and type 1 ROP, and treatment modalities were analyzed. Screening criteria followed local protocols. Logistic regression was used to assess trends, and intergroup comparisons were performed using Kruskal-Wallis and chi-square tests. A total of 15,031 premature infants were enrolled. Demographics varied significantly (p <0.001); India had the highest gestational age and birth weight, and the lowest proportion of very low birth weight and extremely low birth weight infants with type 1 ROP (p <0.001). Hong Kong had the lowest ROP incidence, while Singapore showed a significant increase over time (p = 0.003). Type 1 ROP rates were higher in Taiwan and India than in Hong Kong and Singapore, with a significant decline observed only in Taiwan (p = 0.005). Anti-Vascular Endothelial Growth Factor (Anti-VEGF) injections were increasingly preferred as initial treatment, with bevacizumab being the most frequently used (87.3%). From 2016 to 2023, ROP incidence and treatment showed significant regional differences. ROP increased in Singapore, while type 1 ROP decreased significantly in Taiwan. Although anti-VEGF therapy has become more common, laser treatment remains dominant in Hong Kong.
To compare physician-assessed and patient-reported outcomes quantified with the Japanese Ocular Surface Disease Index (J-OSDI) following the treatment of bacterial blepharitis and to evaluate the utility of the J-OSDI. Multicenter prospective observational study. Physicians assessed symptoms and findings, calculating clinical total scores at baseline (T0), 7 (T1) and 14 (T2) days post-treatment with 1% azithromycin ophthalmic solution, and 1 month after discontinuation (T3). Patients self-reported symptoms using the J-OSDI at these times. The J-OSDI score trends and differences in temporal changes between the J-OSDI and clinical total scores were analyzed by use of a linear mixed-effects model. Forty-six eyes (46 patients; mean age, 71.8 years) were studied. The J-OSDI scores decreased significantly post-treatment for all the patients, with similar trends for both anterior and posterior blepharitis. For all the patients, the slope difference between the J-OSDI and clinical total scores was not significant in the T0-T1 period (P = .219), meaning that the J-OSDI scores reflected the clinical results, whereas it was significant in the T1-T2 (P = .004) and T2-T3 (P <.001) periods. The within-subject correlation between the 2 scores was 0.525 (95% CI 0.401-0.631). For anterior blepharitis, the slope differences were significant across all the periods, but for posterior blepharitis, no significant differences were observed in the T0-T1 or T1-T2 (P = .205, 0.06, respectively) periods, although significant differences were noted in the T2-T3 period (P = .018). The J-OSDI trajectory often diverges from physician-rated changes. Whilst the J-OSDI does not assess treatment response in anterior blepharitis, it may be partially reflective of improvement in posterior blepharitis.
To evaluate long-term outcomes of photocoagulation (PC) and intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP). Retrospective paired-eye comparison. Twenty-one patients (42 eyes) treated for ROP between 2009-2010 were included. In each subject, one eye received PC and the fellow IVB. Visual acuity (VA), refraction (spherical equivalent [SE], cylinder power [CP], corneal astigmatism [CA]), and ocular biometry (corneal curvature radius, anterior chamber depth [ACD], lens thickness [LT], and axial length [AL]) were assessed at corrected ages of 1, 5, and 9 years. Cross-sectional differences were analyzed using the Wilcoxon signed-rank test, with Bonferroni correction applied at 9 years. Annual rates of change were evaluated using a linear mixed-effects model (LMM). Inter-treatment differences were assessed using Spearman correlation analysis. At 9 years, PC-treated eyes showed significantly worse VA, greater myopia, and shorter AL (all p < 0.05). ACD was deeper in IVB-treated eyes, while CP and CA were greater in PC-treated eyes. LMM revealed a significantly faster progression of myopia and CP in PC-treated eyes. Conversely, the annual rates of ACD deepening and LT thinning were significantly faster in IVB-treated eyes, whereas no significant differences were observed for VA or AL. Inter-treatment differences in SE were significantly correlated with AL differences, whereas VA differences were correlated with ACD. IVB-treated eyes showed better VA, less myopia, and more favorable refractive and biometric parameters. SE differences were associated with AL, whereas VA differences were associated with ACD, indicating distinct structural mechanisms.
To develop and validate time-updated, corrected gestational age (CGA)-specific prediction models for identifying treatment-requiring retinopathy of prematurity (ROP) using routinely available systemic factors, and to assess longitudinal changes in predictor combinations and model performance with advancing CGA. Retrospective cohort study. Preterm infants who met institutional ROP screening criteria from a single tertiary center were included, excluding those with aggressive ROP. Multivariable logistic regression models were independently developed at CGA 28, 30, 32, and 34 weeks using routinely available systemic variables summarized from birth to each CGA. For each CGA-specific analysis, infants treated before the target CGA were excluded. Exhaustive subset selection based on the Akaike information criterion identified CGA-specific optimal predictor sets. Model performance was evaluated using stratified five-fold cross-validation with out-of-fold predictions, and discrimination was assessed by the area under the receiver operating characteristic curve (AUC). Predictor combinations selected by the optimal models differed across CGAs, indicating longitudinal changes in the predictive relevance of systemic factors. Growth-related and inflammatory indices were repeatedly selected, while overall predictor composition evolved with advancing CGA. Discrimination improved at later CGAs, with cross-validated AUCs of 0.650, 0.716, 0.809, and 0.842 at CGA 28, 30, 32, and 34 weeks, respectively. These findings suggest that CGA-specific prediction models may help characterize the evolving risk of treatment-requiring ROP. However, prospective multicenter validation and further refinement are required before clinical application.