小澤 洋子

Abstract Retinal thickness measured using optical coherence tomography (OCT) is a major parameter to evaluate retinal diseases. However, it may be influenced by systemic factors. We retrospectively analyzed OCT images and blood sample data from 266 participants (49.1 ± 10.5 years) including 181 (68.0%) males who underwent medical checkups at Fujita Medical Innovation Center, Tokyo. Those with retinal pathological findings were excluded. Males had thicker retinas in the center and inner circles of Early Treatment Diabetic Retinopathy Study grid (P < 0.01 for all). Mean thicknesses of the superior areas were greater than those of the inferior areas in inner and outer circles (P < 0.01 for both). However, there were eyes with thicker inner inferior areas (72 eyes, 27.1%), which was observed more frequently in males (P = 0.018). Thicker retinas were associated with lower hemoglobin A1c levels in the center (P = 0.012), and inner temporal (P = 0.042) and inferior (P = 0.047) areas; lower creatinine levels in the inner temporal (P = 0.002), superior (P = 0.026), and inferior (P < 0.001) areas; and higher high-density lipoprotein cholesterol levels in the inner nasal (P = 0.029) and inferior (P = 0.029) areas after adjusting for age and sex. These results may be kept in mind in evaluating OCT data during clinical practice and future clinical trials, although further studies are warranted.

Purpose To identify time-specific factors associated with loss to follow-up (LTFU) in the early to medium term after initiating anti-vascular endothelial growth factor (VEGF) treatment in patients with neovascular age-related macular degeneration (nAMD) in Japan. Methods The study had a retrospective multicenter case–control design and was performed across 16 specialist retinal facilities in Japan. Patients diagnosed with nAMD at their initial visit who initiated treatment between January 2017 and December 2020 were included. Patient characteristics were analyzed to identify factors associated with LTFU within 3 months (very early), 3 months to 1 year (early), and 1 year to 2 years (medium term) after starting treatment. Results Data for 2389 patients with nAMD were analyzed. The very early, early, and medium-term LTFU rates were 6.8%, 13.8%, and 21.2%, respectively. Stepwise regression analysis identified factors that were significantly associated with LTFU at a very early stage to be greater central retinal thickness at baseline and a prior treatment history, those associated with early LTFU to be worse baseline best-corrected visual acuity (BCVA), anti-VEGF treatment combined with photodynamic therapy, and a follow-up period that overlapped with the COVID-19 pandemic, and that associated with medium-term LTFU to be worse BCVA at 3 months. LTFU in any period within 3 months to 2 years was more likely in patients aged >80 years, and LTFU very early within 3 months was more likely in those aged <60 years. A poor baseline BCVA (logMAR) of >1 was a risk factor for LTFU within 3 months and 1 year, whereas LTFU was significantly less likely in patients with good baseline BCVA (<0.1). Conclusion The LTFU rate in patients with nAMD increased over time. Factors contributing to LTFU vary depending on the time since initiation of treatment.

Purpose Macular retinal volumes can be measured by optical coherence tomography (OCT). However, the underlying pathogenesis was obscure. We compared the OCT and serum lipid data in participants with or without diabetes mellitus (DM) and diabetic retinopathy (DR) to explore the interpretation of the OCT data. Methods Data for eye examinations and blood tests in 41 eyes of 41 participants (23 men; mean age 49.1 ± 8.3) were analyzed. Eyes without macular lesions were included. Results Mean macular retinal volumes of ganglion cell layer (GCL) (P = 0.023) and neural retinal layers (NRL) including layers from internal to external limiting membranes (P = 0.013) were smaller in the DM without DR group than in the control group. Mean serum malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels were higher in the DM without DR (P = 0.046) and with DR (P = 0.021) groups than in the control group. Serum low-density lipoprotein cholesterol (LDLC) levels showed a negative correlation with GCL volume (P = 0.005), and trends of negative correlations with retinal nerve fiber layer (RNFL) (P = 0.060) and NRL volumes (P = 0.051) in the control group. However, in the DM with DR group, LDLC levels showed significant positive correlations with RNFL (P = 0.002), GCL (P = 0.034), and NRL (P = 0.002) volumes. The DR group also showed positive correlations between MDA-LDL levels and RNFL (P < 0.001) and NRL (P = 0.006) volumes. Conclusions Macular retinal volumes may decrease owing to DM and elevated serum lipid levels. However, the volume may increase as serum lipid levels elevate after DR development. Further studies are warranted to understand the pathogenesis.