論文 - 古泉　英貴

【抗VEGF薬の最新情報】ブロルシズマブ(ベオビュ)の特徴

湧川 空子, 古泉 英貴

眼科 ( 金原出版(株) )  64 ( 10 ) 923 - 930   2022年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

＜文献概要＞ブロルシズマブ(ベオビュ)は,滲出型加齢黄斑変性(AMD)の治療薬として2020年3月25日に国内で承認された血管内皮増殖因子(VEGF)阻害薬である。製品名のベオビュは「Beautiful」+「Vision」から命名された。ぺガプタニブ(マクジェン),ラニビズマブ(ルセンティス),アフリベルセプト(アイリーア)に続く,4番目のVEGF阻害薬であり,新たなVEGF阻害薬の承認は約8年ぶりであった。ブロルシズマブは,VEGF-Aに対するヒト化一本鎖抗体フラグメントであり,VEGF-Aのすべてのアイソフォームに対して高い結合親和性を示し,血管内皮細胞表面に発現するVEGF受容体(VEGF receptor:VEGFR)であるVEGFR1およびVEGFR2に対するVEGF-Aの結合を阻害する。注目すべきは,分子量が約26kDaであり,既承認のVEGF阻害薬よりも小さいことである。ゆえに,モル換算では,アフリベルセプトの約12倍,ラニビズマブの約22倍もの高濃度での投与が可能となり,より効果的に組織に浸透し,投与間隔の延長が期待される薬剤である(図1)。

【眼底自発蛍光の導入と活用法】(2章)導入後の活用法　加齢黄斑変性

寺尾 信宏, 古泉 英貴

眼科グラフィック ( (株)メディカ出版 )  11 ( 5 ) 583 - 593   2022年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

【スリットランプ再考】スリットランプによる網膜硝子体の観察　硝子体観察にフォーカス

澤口 翔太, 古泉 英貴

眼科グラフィック ( (株)メディカ出版 )  11 ( 4 ) 402 - 407   2022年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

【眼疾患と慢性炎症】加齢黄斑変性の臨床知見

古泉 英貴

別冊Bio Clinica: 慢性炎症と疾患 ( (株)北隆館 )  11 ( 1 ) 32 - 35   2022年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

加齢黄斑変性(AMD)ではドルーゼンを特徴とする前駆病変から、黄斑部新生血管(MNV)を生じ時に急激な視力低下をきたす滲出型AMD、または境界明瞭な地図状萎縮(GA)が徐々に進行する萎縮型AMDに進行する。近年、脈絡膜肥厚、脈絡膜大血管拡張などを特徴とするpachychoroidという脈絡膜所見の概念が注目されており、ドルーゼンを経ずにMNVやGAを生じうるため注意が必要である。滲出型AMDの治療の主体は抗血管内皮増殖因子(VEGF)薬硝子体内注射であり、複数の抗VEGF薬が使用可能となっている。(著者抄録)

Regional and sex differences in retinal detachment surgery: Japan-retinal detachment registry report

Funatsu R.

Scientific Reports ( Scientific Reports )  11 ( 1 )   2021年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Relentless placoid chorioretinitisのマルチモダルイメージング

我謝 朱莉, 寺尾 信宏, 大城 綾乃, 南場 研一, 古泉 英貴

眼科臨床紀要 ( 眼科臨床紀要会 )  14 ( 10 ) 681 - 681   2021年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

【生理機能検査を使いこなす-最近の考え方-】眼底自発蛍光

澤口 翔太, 古泉 英貴

眼科 ( 金原出版(株) )  63 ( 9 ) 811 - 821   2021年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

【抗VEGF療法をマスターする:患者への説明と具体的な治療法のポイント解説】加齢黄斑変性(PCVとRAP)

寺尾 信宏, 古泉 英貴

眼科グラフィック ( (株)メディカ出版 )  10 ( 4 ) 382 - 395   2021年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Gaucher病患者に発症した牽引性網膜剥離の1例

湧川 空子, 今永 直也, 山内 遵秀, 古泉 英貴

日本眼科学会雑誌 ( (公財)日本眼科学会 )  125 ( 6 ) 591 - 595   2021年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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背景:Gaucher病は糖脂質代謝異常によりグルコセレブロシドが進行性に全身に蓄積する先天代謝異常症である.さまざまな眼合併症が報告されているが,牽引性網膜剥離の報告はまれである.今回著者らは,Gaucher病3型に生じた牽引性網膜剥離に対し硝子体手術を施行し,2年以上経過観察できた症例を経験したので報告する.症例:29歳男性.2歳時にGaucher病3型と診断された.2015年4月に近医で左眼の硝子体混濁を指摘され,徐々に牽引性網膜剥離を来したため,2018年2月に当科を紹介受診となった.初診時の矯正視力は右(1.2),左(0.05),両眼の硝子体混濁および硝子体内と網膜上に不定形な白色物が大量に存在し,左眼に広範囲の牽引性網膜剥離を認めたため硝子体手術を施行した.術中,硝子体は高度に液化していたが,肥厚した後部硝子体膜と網膜の強い癒着を認めた.輪状締結術を追加し,シリコーンオイルタンポナーデを行った.術後に網膜は復位し,徐々に白色物の減少がみられた.初回手術から98日後にシリコーンオイルを抜去した.初回手術より2年以上が経過したが,矯正視力は左(0.7)で網膜剥離の再発や白色物の再燃は認めていない.右眼に白色物の増加を認めるが,牽引性網膜剥離の所見はない.結論:Gaucher病では,経過中に牽引性網膜剥離を生じる可能性がある.硝子体と網膜の癒着が強固であり,手術の際は十分な注意を要する.(著者抄録)

Scleral Thickness in Central Serous Chorioretinopathy

Imanaga, N; Terao, N; Nakamine, S; Tamashiro, T; Wakugawa, S; Sawaguchi, K; Koizumi, H

OPHTHALMOLOGY RETINA ( Ophthalmology Retina )  5 ( 3 ) 285 - 291   2021年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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PURPOSE: To evaluate scleral thickness in central serous chorioretinopathy (CSC) using anterior segment (AS) OCT. DESIGN: Retrospective, comparative study. PARTICIPANTS: Forty-seven eyes of 40 patients with CSC and 53 eyes of 47 age- and gender-matched normal control participants. METHODS: Spherical equivalent, axial length, subfoveal choroidal thickness, and scleral thickness were compared between the CSC and control groups. Scleral thickness was measured by AS OCT 6 mm posterior to the scleral spur in 4 directions. MAIN OUTCOME MEASURE: Scleral thickness in CSC eyes. RESULTS: No differences were found between the 2 groups in age, gender, spherical equivalent, or axial length. Subfoveal choroidal thickness was significantly greater in CSC eyes than in normal control eyes (424.0 ± 101.4 μm vs. 324.3 ± 91.8 μm; P < 0.001). Scleral thickness was significantly greater in CSC eyes than in normal control eyes at the superior (429.4 ± 50.3 μm vs. 395.2 ± 55.4 μm; P = 0.005), temporal (447.7 ± 45.7 μm vs. 396.5 ± 64.1 μm; P < 0.001), inferior (455.7 ± 81.2 μm vs. 437.8 ± 46.9 μm; P = 0.022), and nasal (454.9 ± 44.7 μm vs. 416.6 ± 51.2 μm; P = 0.001) points. CONCLUSIONS: Scleral thickness measured by AS OCT was significantly greater in CSC eyes than in normal control eyes, although no differences were found in spherical equivalent or axial length. Thick sclera may have a role in the pathogenesis of CSC.

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Retrospective exploratory analyses on gender differences in determinants for incidence and progression of diabetic retinopathy in Japanese patients with type 2 diabetes mellitus

Nakayama, Y; Yamaguchi, S; Shinzato, Y; Okamoto, S; Millman, JF; Yamashiro, K; Takemoto, N; Uema, T; Arakaki, K; Higa, M; Koizumi, H; Shimabukuro, M; Masuzaki, H

ENDOCRINE JOURNAL ( 一般社団法人 日本内分泌学会 )  68 ( 6 ) 655 - 669   2021年

掲載種別: 研究論文（学術雑誌）

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<p>Gender differences in risks for macrovascular complications in type 2 diabetes mellitus (T2DM) have been well established. However, the impact of gender differences on diabetic retinopathy (DR) has not been fully elucidated. We therefore retrospectively explored gender-specific determinants for DR in patients with T2DM in a small sized Japanese cohort in Okinawa. There were 214 patients who were diagnosed as no DR (<i>n</i> = 142) and non-proliferative DR (<i>n</i> = 72) in 2009. During the follow-up of median 7 years, 41/142 of incidence, 26/72 of progression, and 67/214 of incidence and progression were observed, respectively. DR was assessed using the modified international clinical DR severity scales. The risks for incidence, progression as well as incidence and progression of DR were comparable between men and women, respectively. Cox proportional hazard models in multivariate analyses demonstrated that the only common determinant in both men and women for DR was the duration of T2DM. Regarding gender-specific determinants, lower level of serum albumin in men as well as higher HbA1c, lower level of estimated glomerular filtration rate, and lower level of serum uric acid in women were extracted, respectively. Although precise mechanisms for such gender-specific determinants of DR still remain unsolved, the present study would highlight a couple of factors associated with gender-specific determinants for DR in a limited numbers of Japanese cohort. Prospective observational studies on gender-specific determinants of DR in a large scale cohort are warranted to further clarify underlying mechanisms.</p>

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Two cases of anti-MOG antibody-positive pediatric optic neuritis that required additional treatment after steroid pulse therapy

Oshiro A.

Japanese Journal of Clinical Ophthalmology ( Japanese Journal of Clinical Ophthalmology )  75 ( 9 ) 1259 - 1265   2021年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

【再考!脈絡膜疾患診療】脈絡膜の構造と機能

澤口 翔太, 古泉 英貴

OCULISTA ( (株)全日本病院出版会 )  ( 92 ) 1 - 9   2020年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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近年の画像診断技術の進歩に伴い、従来の蛍光眼底造影検査だけでなく、光干渉断層計(optical coherence tomography:OCT)、OCT angiography(OCTA)でも脈絡膜が可視化できるようになり、さまざまな知見が報告されている。脈絡膜が病態の首座となる疾患眼においては、日常診療で各種検査所見に馴染みがあると思う。しかし正常脈絡膜については普段から何気なく診ているようで、意外ときちんと診ていないのではないだろうか。先人達が脈絡膜を理解するために行った貴重な研究成果を振り返ることで、正常脈絡膜の構造と機能を理解し、脈絡膜疾患診療の礎としていただきたい。(著者抄録)

【眼科イメージング2020Q&A】網膜・硝子体　加齢黄斑変性関係　自発蛍光を用いた加齢黄斑変性へのアプローチを教えてください

湧川 空子, 古泉 英貴

あたらしい眼科 ( (株)メディカル葵出版 )  37 ( 臨増 ) 71 - 76   2020年11月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Short axial length and hyperopic refractive error are risk factors of central serous chorioretinopathy

Terao, N; Koizumi, H; Kojima, K; Kusada, N; Nagata, K; Yamagishi, T; Yoneda, K; Yoshii, K; Kinoshita, S; Sotozono, C

BRITISH JOURNAL OF OPHTHALMOLOGY ( British Journal of Ophthalmology )  104 ( 9 ) 1260 - 1265   2020年09月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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BACKGROUND/AIMS: To evaluate the axial length (AL) and refractive status in central serous chorioretinopathy (CSC). METHODS: This retrospective observational case series involved 140 patients with CSC (180 eyes) and 78 age-matched and gender-matched control subjects. A detailed ophthalmic examination was performed, including an interferometer measurement of AL. Multimodal imaging comprised colour fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence photography and spectral domain optical coherence tomography. RESULTS: Eighty eyes of 40 patients were categorised into the bilateral-CSC (b-CSC) group and 100 eyes of 100 patients were categorised into the unilateral-CSC (u-CSC) group. AL of the b-CSC (23.19 mm) and u-CSC (23.75 mm) groups was significantly shorter than that of the control (24.85 mm) group (p<0.001 for both). Moreover, AL was significantly shorter in the b-CSC group than in the u-CSC group (p=0.020). Spherical equivalent (SE) in the b-CSC (0.25 D) group was significantly greater than in the u-CSC (-0.81 D) and control (-1.38 D) groups (p<0.001 for both). Gender (male; OR 4.55; 95% CI 1.13 to 18.40; p=0.033), AL (OR 0.38; 95% CI 0.23 to 0.63; p<0.001), area of choroidal vascular hyperpermeability (OR 1.08; 95% CI 1.03 to 1.13; p=0.002) and presence of descending tract (OR 7.22; 95% CI 1.86 to 28.00; p=0.004) were the variables found to be significantly associated with b-CSC via multiple regression analyses. CONCLUSION: Anatomical features, such as shorter AL and greater SE, may be associated with the pathogenesis of CSC.

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Two-Year Outcomes of Treat-and-Extend Intravitreal Aflibercept for Exudative Age-Related Macular Degeneration: A Prospective Study.

Maruko I, Ogasawara M, Yamamoto A, Itagaki K, Hasegawa T, Arakawa H, Nakayama M, Koizumi H, Okada AA, Sekiryu T, Iida T

Ophthalmology. Retina ( Ophthalmology Retina )  4 ( 8 ) 767 - 776   2020年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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PURPOSE: To report the 2-year outcomes of intravitreal aflibercept injections (IAIs) in Japanese patients with neovascular age-related macular degeneration (AMD) using a 1-month adjusted treat-and-extend (TAE) regimen. DESIGN: Multicenter, prospective, nonrandomized, interventional study. PARTICIPANTS: Ninety-seven eyes of 97 patients with treatment-naive AMD were studied at 3 tertiary ophthalmological institutions. METHODS: The patients were treated with 3 consecutive monthly IAIs followed by the TAE regimen with a 1-month adjustment for a maximum of 3 months. Our TAE regimen allowed us to shorten and extend the treatment intervals even after a 3-month or 1-month treatment interval, or both, were reached. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and subfoveal choroidal thickness (SCT) were analyzed. MAIN OUTCOME MEASURES: The mean changes in the BCVA, CRT, and SCT from the baseline to 2 years after initiating the treatment were determined. In addition, the number of injections also was determined. RESULTS: The mean BCVA significantly improved from 0.27 logarithm of the minimum angle of resolution (logMAR) units to 0.14 logMAR at 2 years (P < 0.01). The mean CRT decreased significantly from 307±132 μm to 202±76 μm at 2 years (P < 0.01). The mean SCT decreased significantly from 247±106 μm to 203±96 μm at 2 years (P < 0.01). Seventy eyes (72.2%) showed a dry macula at 2 years. The treatment interval at 2 years was 1 month in 20 eyes (20.6%), 2 months in 18 eyes (18.6%), and 3 months in 59 eyes (60.8%). In 49 (50.5%) eyes with a 3-month treatment interval immediately after the loading phase, no fluid was seen in 25 eyes (51.0%) for the duration of this study. The rest had switched to a more frequent scheme. The mean number of injections during the 2-year period was 13.0±3.9. CONCLUSIONS: Intravitreal aflibercept injections with a 1-month adjusted TAE regimen significantly improved the BCVA and CRT with a reduced number of injections at 2 years. The treatment interval was adjusted to extend to 3 months in 60% and to shorten to 1 month in 20% of the eyes at 2 years.

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Macular atrophy after aflibercept therapy for neovascular age-related macular degeneration: outcomes of Japanese multicenter study

Koizumi, H; Yamamoto, A; Ogasawara, M; Maruko, I; Hasegawa, T; Itagaki, K; Sekiryu, T; Okada, AA; Iida, T

JAPANESE JOURNAL OF OPHTHALMOLOGY ( Japanese Journal of Ophthalmology )  64 ( 4 ) 338 - 345   2020年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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PURPOSE: To evaluate the development and rate of growth in macular atrophy after intravitreal injections of aflibercept (IVAs) for neovascular age-related macular degeneration (AMD) over a 2-year period. STUDY DESIGN: Retrospective, interventional, consecutive case series. METHODS: This study included 94 eyes of 92 patients with treatment-naïve AMD involving the foveal center treated with IVAs at 3 university hospitals in Japan. The patients underwent IVAs bimonthly after 3 initial monthly doses in the first year. The protocol was converted to a treat-and-extend regimen in the second year. The incidence and growth rate of macular atrophy were quantified based on hypoautofluorescence detected by fundus autofluorescence images. Additionally, possible background factors related to the development and rate of growth of macular atrophy were investigated. RESULTS: Of 94 eyes, 39 (41.5%) had typical AMD and 55 (58.5%) had polypoidal choroidal vasculopathy. Ten eyes (10.6%) had macular atrophy at the baseline. Of the remaining 84 eyes, 14 (16.7%) had developed new macular atrophy at 2 years, the square root of the growth rate of atrophy was 0.52 mm/year. In multivariate analyses, a poorer best-corrected visual acuity (P = 0.01) and the presence of intraretinal fluid (P = 0.04) at baseline were found to be the independent predictors for the development of macular atrophy. No factors were found that were significantly related to the growth rate of the macular atrophy. CONCLUSIONS: Our study determined the incidence and rate of growth of macular atrophy after IVAs for neovascular AMD in clinical settings. Eyes with vision reduction and intraretinal fluid at the baseline develop macular atrophy more frequently after IVAs for neovascular AMD.

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Latest Developments in Polypoidal Choroidal Vasculopathy: Epidemiology, Etiology, Diagnosis, and Treatment

Chaikitmongkol, V; Cheung, CMG; Koizumi, H; Govindahar, V; Chhablani, J; Lai, TYY

ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY ( Asia Pacific Journal of Ophthalmology )  9 ( 3 ) 260 - 268   2020年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelial detachments, and neurosensory retinal detachments due to abnormal aneurysmal neovascular lesions. It is generally considered as a variant of neovascular age-related macular degeneration, but there are some differences between the clinical presentation, natural history, and treatment response between patients with PCV and typical neovascular age-related macular degeneration patients. Over the past decade, new research and technological advancements have greatly improved our understanding of the PCV disease process and the management of PCV. This review aims to summarize the recent research findings to highlight the epidemiology, pathogenesis, genetics, the application of various diagnostic tools for PCV, and the available treatment options for PCV.

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QUANTIFICATION OF CHOROIDAL VASCULATURE BY HIGH-QUALITY STRUCTURE EN FACE SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY IMAGES IN EYES WITH CENTRAL SEROUS CHORIORETINOPATHY

Ogawa, Y; Maruko, I; Koizumi, H; Iida, T

RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES ( Retina )  40 ( 3 ) 529 - 536   2020年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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PURPOSE: To determine the density of the choroidal vasculature by high-quality structure en face optical coherence tomography (OCT) scanned at the same time as OCT angiography in eyes with central serous chorioretinopathy (CSC). METHODS: Thirty-five eyes of 30 patients with CSC (20 men and 10 women; average age, 48.4 years) were studied. Volume scans (12 × 12 mm-square) were obtained at the same time as OCT angiographic scans (Plex Elite 9000; Swept-Source OCT, Zeiss). High-quality structure en face images were flattened at Bruch membrane and binarized to identify and quantify the choroidal vascular density by the Bernsen method of the segmentation slab of one-half of the choroidal thickness. Similarly, high-quality structure en face choroidal images of 35 healthy eyes of 29 patients (18 men and 11 women; average age, 51.7 years) were binarized and analyzed as controls. The en face images were cropped to exclude the optic disk. RESULTS: The mean cropped image size was 9.57 mm × 9.57 mm in the eyes with CSC and 9.48 mm × 9.48 mm in the healthy eyes (P = 0.41). In the eyes with CSC, the choroidal vascular density was 61.6 ± 7.5% of the choroid, which was significantly greater than that in the healthy eyes at 49.4 ± 7.5% (P < 0.01). CONCLUSION: High-quality structure en face OCT can be used to assess the density of the choroidal vessels quantitatively and noninvasively in eyes with CSC.

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【高齢者に対する包括的感覚器ケアと疾患治療】高齢者に対する加齢黄斑変性の抗VEGF薬治療

寺尾 信宏, 古泉 英貴

Geriatric Medicine ( (株)ライフ・サイエンス )  58 ( 2 ) 111 - 117   2020年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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加齢黄斑変性は、欧米をはじめとした先進国の視覚障害の原因として重要な疾患であり、近年増加傾向である。脈絡膜新生血管を伴う滲出型加齢黄斑変性に対する治療は、抗血管内皮細胞増殖因子(VEGF)薬の登場により、治療困難な時代から視力維持・改善を目指す時代へと進化している。しかし抗VEGF薬治療は根治治療ではないため、滲出性変化の継続的な管理および頻回の抗VEGF薬治療が必要となる。高齢者では家族環境、全身状態などの患者背景が様々であり、長期視力予後を考慮しながら、患者個別に適した治療計画の設定を心掛けることが大切である。(著者抄録)