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• Central serous chorioretinopathy and the sclera: what we have learned so far.

  Koizumi H, Imanaga N, Terao N

  Japanese journal of ophthalmology ( Japanese Journal of Ophthalmology )  68 ( 5 ) 419 - 428   2024年09月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  Central serous chorioretinopathy (CSC) is a common disorder characterized by serous retinal detachment. Several studies using indocyanine green angiography (ICGA) have revealed that choroidal filling delay, choroidal vascular dilation, and choroidal vascular hyperpermeability are the characteristic findings of CSC. These ICGA findings confirm that choroidal circulatory disturbances are the primary factors in the pathogenesis of CSC. With advancements in optical coherence tomography (OCT), choroidal thickness has been found to be significantly greater in eyes with CSC than in normal eyes. Dilated large choroidal vessels reportedly account for the thickened choroid in eyes with CSC. Although many possible mechanisms and risk factors have been suggested, the pathophysiologic features of choroidal circulatory disturbances and choroidal thickening in eyes with CSC have not yet been fully elucidated. Recently, using anterior segment OCT, we proposed that the sclera may induce choroidal circulatory disturbances since CSC eyes have significantly thicker sclera than do normal eyes. This review summarizes updated information on the close relationship between CSC pathogenesis and the sclera.

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• CHANGES IN SCLERAL THICKNESS IN THE ACUTE PHASE OF VOGT-KOYANAGI-HARADA DISEASE.

  Oshiro A, Imanaga N, Terao N, Koizumi H

  Retina (Philadelphia, Pa.) ( Retina )  44 ( 8 ) 1344 - 1350   2024年08月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  PURPOSE: To evaluate changes in scleral thickness in Vogt-Koyanagi-Harada (VKH) disease. METHODS: This study included 34 eyes of 17 treatment-naïve patients with acute-phase VKH disease. Scleral thickness and the presence of ciliochoroidal effusion were examined using anterior segment optical coherence tomography at baseline and 1 week, 2 weeks, and 12 weeks after the start of corticosteroid treatment. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions. RESULTS: Twenty-eight eyes (82.4%) initially had ciliochoroidal effusion, but this rapidly decreased to nine eyes (26.5%) after 1 week. The sclera with ciliochoroidal effusion became thinner from baseline to 1 week at the superior (400.2 ± 46.9-353.5 ± 47.9 µm), temporal (428.4 ± 53.6-387.8 ± 56.1 µm), inferior (451.5 ± 71.0-400.5 ± 50.5 µm), and nasal (452.4 ± 78.0-407.6 ± 62.9 µm) points (P < 0.01 for all), and no further changes were observed. The sclera without ciliochoroidal effusion remained unchanged. CONCLUSION: In VKH disease, eyes with ciliochoroidal effusion exhibited the maximum scleral thickness during the acute phase. This thickening responded rapidly to treatment and became thinner within 1 week. Inflammation in VKH disease may affect not only the choroid but also the sclera.

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• One-year choroidal thickness changes after photodynamic therapy for central serous chorioretinopathy evaluated by widefield optical coherence tomography.

  Sawaguchi S, Terao N, Imanaga N, Wakugawa S, Miyara Y, Oshiro A, Maehira M, Yamauchi Y, Koizumi H

  Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie ( Graefe's Archive for Clinical and Experimental Ophthalmology )    2024年07月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  PURPOSE: To evaluate the changes in choroidal thickness 1 year after half-dose photodynamic therapy (PDT) for central serous chorioretinopathy (CSC) using widefield swept-source optical coherence tomography. METHODS: We retrospectively reviewed 21 patients with CSC who unilaterally underwent half-dose PDT and completed a 12-month follow-up. Choroidal thickness was evaluated before and after PDT within an 18-mm circular grid centered on the fovea subdivided into nine areas in the treated and untreated fellow eyes. RESULTS: All 21 treated eyes showed complete resolution of subretinal fluid at 3 months after PDT, without any recurrence at 12 months. The mean choroidal thickness in all nine areas significantly decreased after PDT at 3 months (P < 0.05) and remained unchanged at 12 months (P < 0.05) compared with that at baseline. However, the subtracted choroidal thickness maps between 3 and 12 months detected significant variations among the cases, classified into an enhanced pattern in 10 eyes (47.6%), an attenuated pattern in six eyes (28.6%), and a stable pattern in five eyes (23.8%). The 21 untreated fellow eyes also showed a decrease in mean choroidal thickness in three of the nine subdivided areas at 12 months (P < 0.05), but this decrease was limited posteriorly. CONCLUSION: The reduction in mean choroidal thickness after half-dose PDT for CSC was extensively maintained for 1 year. However, subclinical hemodynamic changes in the entire choroid occurred longitudinally even in the absence of disease recurrence.

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• Scleral Thickness in Simple Versus Complex Central Serous Chorioretinopathy.

  Imanaga N, Terao N, Wakugawa S, Miyara Y, Sawaguchi S, Oshiro A, Yamauchi Y, Koizumi H

  American journal of ophthalmology ( American Journal of Ophthalmology )  261   103 - 111   2024年05月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  PURPOSE: To evaluate the association between scleral thickness and a newly developed multimodal imaging-based classification of central serous chorioretinopathy (CSC). DESIGN: Retrospective, cross-sectional study. METHODS: This study included 217 eyes of 217 patients classified as simple or complex CSC based on the established protocols. Clinical and anatomical factors were compared between the 2 types. The scleral thickness was measured at 4 locations using anterior-segment optical coherence tomography. RESULTS: Of the 217 eyes, 167 were classified as simple CSC and 50 as complex CSC. The complex CSC group showed older age (P = .011), higher male ratio (P = .001), more bilateral involvement (P < .001), poorer visual acuity (P < .001), greater subfoveal choroidal thickness (P = .025), and higher frequency of loculation of fluid (P < .001) and ciliochoroidal effusion (P < .001) than the simple CSC group. The complex CSC group had significantly greater scleral thicknesses in the superior, temporal, inferior, and nasal directions (all P < .001) than the simple CSC group. Multivariable analysis revealed that older age (odds ratio [OR] 1.054, 95% confidence interval [CI] 1.013-1.097, P < .001), male sex (OR 10.445, 95% CI 1.151-94.778, P < .001), bilateral involvement (OR 7.641, 95% CI 3.316-17.607, P < .001), and the mean value of scleral thicknesses in 4 directions (OR 1.022, 95% CI 1.012-1.032, P < .001) were significantly associated with the complex CSC. CONCLUSIONS: Older age, male sex, bilateral involvement, and thick sclera were associated with the complex CSC. Scleral thickness seemed to determine the clinical manifestations of CSC.

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• Renal coloboma syndrome/dominant optic atrophy with severe retinal atrophy and de novo digenic mutations in PAX2 and OPA1.

  Shimabukuro W, Chinen Y, Imanaga N, Yanagi K, Kaname T, Nakanishi K

  Pediatric nephrology (Berlin, Germany) ( Pediatric Nephrology )  39 ( 8 ) 2351 - 2353   2024年03月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

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• 中心性漿液性脈絡膜症の新規国際分類と強膜厚

  今永直也, 寺尾信宏, 寺尾信宏, 澤口翔太, 玉城環, 玉城環, 山内遵秀, 古泉英貴

  日本眼科学会雑誌   126   2022年

   

  J-GLOBAL

• 中心性漿液性脈絡網膜症に対する光線力学的療法後12か月間の広角脈絡膜厚変化

  澤口翔太, 寺尾信宏, 寺尾信宏, 今永直也, 山内遵秀, 堀江寿雲, 古泉英貴

  日本網膜硝子体学会総会プログラム・講演抄録集   61st   2022年

   

  J-GLOBAL

• 中心性漿液性脈絡網膜症に対する光線力学的療法前後の強膜厚変化

  今永直也, 寺尾信宏, 澤口翔太, 玉城環, 山内遵秀, 古泉英貴

  日本網膜硝子体学会総会プログラム・講演抄録集   60th   2021年

   

  J-GLOBAL

• 片眼性中心性漿液性脈絡網膜症の発症眼・未発症僚眼の強膜厚

  愛知高明, 愛知高明, 今永直也, 寺尾信宏, 澤口翔太, 玉城環, 玉城環, 山内遵秀, 古泉英貴

  日本網膜硝子体学会総会プログラム・講演抄録集   60th   2021年

   

  J-GLOBAL

• 自発蛍光で読み解く 眼底疾患 加齢黄斑変性と眼底自発蛍光

  今永直也, 古泉英貴

  眼科グラフィック ( (株)メディカ出版 )  8 ( 5 ) 547‐559 - 559   2019年10月

   

  J-GLOBAL

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• 強膜断層像に着目した黄斑疾患の病態解明

  若手研究

  課題番号: 20K18349

  研究期間: 2020年04月  -  2023年03月 

  代表者: 今永 直也 

  直接経費: 3,000,000（円）  間接経費: 3,900,000（円）  金額合計: 900,000（円）

  　概要を見る

  脈絡膜は眼血流の80%以上を担う組織であり、近年の眼底イメージング技術の進歩により、断層像の取得が可能となった。その恩恵を受けて登場したパキコロイドという概念は、脈絡膜肥厚や脈絡膜大血管拡張などの特徴を有する脈絡膜所見の概念であり、中心性漿液性脈絡網膜症（CSC）や加齢黄斑変性（AMD）の一群との関連が示唆されている。しかしながら、何故、どのようなメカニズムでパキコロイドが生じるかという点は明らかにされていない。申請者らは強膜の状態が渦静脈の眼外への排出に関連しているという仮説を立て、前眼部光干渉断層計（OCT）を用いることで、CSC眼では正常コントロールよりも有意に強膜が肥厚していることを見出した（Imanaga N, et al. Ophthalmol Retina. 2021）。 また、CSC眼における脈絡膜過灌流における脈絡膜下液の貯留が、強膜厚に依存する可能性を示した（Imanaga N, et al. Am J Ophthalmol 2021, Terao N, Imanaga N, et al. Retina 2022.）。一方で、ステロイドを原因とするCSC眼は特発性CSCと比べて有意に強膜が薄く、CSCは強膜厚のみに依存するものではないことも分かった（Sawaguchi S, Imanaga N, et al. Ophthalmology Science 2022.）。 今後、本研究では広角蛍光眼底造影画像を撮影することにより脈絡膜血管の眼外への排出部である渦静脈膨大部を評価、PSD症例と正常者との差異について検討していく。PSDにおいて強膜構造や鬱滞した渦静脈の関与が示されれば、強膜をターゲットとした病態に即した治療法開発が可能となり、PSDの予防、治療が大きく変革する可能性がある。