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Hosoya H, Ueta T, Hirasawa K, Toyama T, Shiraya T. Subthreshold micropulse laser combined with anti-vascular endothelial growth factor therapy for diabetic macular edema: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06460-7. [PMID: 38662102 DOI: 10.1007/s00417-024-06460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To evaluate the effects of subthreshold micropulse laser (SML) in addition to anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME). METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were systematically searched for studies that compared anti-VEGF with SML and anti-VEGF monotherapy for DME. Outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of anti-VEGF injections. RESULTS Eight studies including 493 eyes were selected. Four studies were randomized controlled, and the other four were retrospective. Meta-analysis showed that there was no significant difference in BCVA (mean difference [MD] -0.04; 95%CI -0.09 to 0.01 logMAR; P = 0.13;). CMT was thinner in the group of anti-VEGF with SML (MD -11.08; 95%CI -21.04 to -1.12 µm; P = 0.03); however, it was due to a single study that weighed higher, and the sensitivity and subcategory analyses did not support the finding. The number of anti-VEGF injections was significantly decreased in the group of anti-VEGF with SML (MD -2.22; 95%CI -3.02 to -1.42; P < 0.0001). CONCLUSION Current evidence indicates that adding SML to anti-VEGF therapy could significantly reduce the number of anti-VEGF injections compared to anti-VEGF monotherapy, while achieve similar BCVA and CMT.
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Affiliation(s)
- Hironori Hosoya
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, Tokyo, Japan
| | - Taku Toyama
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoyasu Shiraya
- Department of Ophthalmology, Showa General Hospital, Tokyo, Japan
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Kawai M, Goseki T, Hirasawa K, Ishikawa H, Shoji N. Changes in Optic Nerve Head Blood Flow During Horizontal Ocular Duction. Invest Ophthalmol Vis Sci 2024; 65:7. [PMID: 38170537 PMCID: PMC10768701 DOI: 10.1167/iovs.65.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose In this study, we aimed to compare blood flow changes in the optic nerve head (ONH) during horizontal ocular duction among normal, primary open-angle glaucoma (POAG), and normal-tension glaucoma (NTG) eyes. Methods In this cross-sectional study, we included 90 eyes from 90 participants (30 control eyes, 30 POAG eyes, and 30 NTG eyes). ONH blood flow was measured with laser speckle flowgraphy using an external fixation light to induce central gaze, abduction, and adduction at 30 degrees for each eye. The mean blur rate (MBR) of the entire ONH area (MA), vascular region (MV), and tissue region (MT), and the change ratio were analyzed. The change ratio was defined as abduction or adduction value/central gaze value. Results In the control group, MA significantly decreased during adduction (22.9 ± 3.7) compared with that during central gaze (23.6 ± 3.9, P < 0.05). In the POAG group, MA (adduction = 17.4 ± 3.8 and abduction = 17.3 ± 3.6) and MV (adduction = 37.9 ± 5.6 and abduction = 38.0 ± 5.6) significantly decreased during adduction and abduction compared with those during central gaze (18.0 ± 4.1 and 39.5 ± 6.3, respectively, P < 0.05). In the NTG group, MA significantly decreased during adduction (17.4 ± 4.2) compared with that during central gaze (18.1 ± 4.6) and abduction (18.1 ± 4.8, P < 0.05). The change ratio did not differ between the glaucoma and control groups. Conclusions ONH blood flow decreased during horizontal ocular duction regardless of normal or glaucoma states; however, the change ratio was comparable between the normal and glaucoma groups.
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Affiliation(s)
- Manami Kawai
- Department of Ophthalmology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshiaki Goseki
- Department of Ophthalmology, Kitasato University School of Medicine, Kanagawa, Japan
- Department of Ophthalmology, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hitoshi Ishikawa
- Department of Orthoptics and Visual Science, Kitasato University School of Allied Health Sciences, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, Kanagawa, Japan
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Tomita R, Asaoka R, Hirasawa K, Fujino Y, Nakakura S, Murata H, Omura T, Shoji N, Obana A, Nishiguchi KM, Tanito M. Accuracy of pattern deviation in estimating the glaucomatous damage in the central 10° visual field in eyes with glaucoma and cataract. Br J Ophthalmol 2023; 108:78-83. [PMID: 36261260 DOI: 10.1136/bjo-2022-322274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS The accuracy of pattern deviation (PD) in estimating the damage to the glaucomatous visual field (VF) in the central 10° in eyes with glaucoma and cataract is unclear. METHODS This retrospective study includes 63 eyes of 52 glaucoma patients who successfully underwent cataract surgery or cataract surgery plus iStent implantation. Using the Humphrey Field Analyser 10-2 test, VF was measured within 6 months preoperatively and postoperatively (VFpre and VFpost, respectively). The mean total deviation values in VFpost (mTDpost) indicates glaucomatous damage without cataract and the difference between this value and mean PD values in VFpre (mPDpre) was evaluated (εmPD). The effect of cataract was then evaluated as the difference between mTDpost and mTDpre (ΔmTD), while the effects of mTDpost and ΔmTD on εmPD were also assessed. In addition, based on preoperative visual acuity (VApre) and VFpre, the optimal model for predicting mTDpost was identified. The error of this method (εOptimalModel) was estimated as the difference against mTDpost, which was compared with εmPD. RESULTS Compared with mTDpre, there was a significant improvement in mTDpost (p=0.028). A significant difference was observed between mPDpre and mTDpost (p<0.001). Further, εmPD significantly increased with the increase of mTDpost or ΔmTD (p<0.001 and p=0.0444, respectively). The absolute εOptimalModel was significantly smaller than the absolute εmPD (p<0.001). CONCLUSIONS This study warns clinicians that PD of the central 10° VF might underestimate the glaucomatous VF damage with the progression of glaucoma and overestimate it as a cataract progresses.
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Affiliation(s)
- Ryo Tomita
- Ophthalmology, Nagoya University Graduate School of Medicine Faculty of Medicine, Nagoya, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu Hospital, Hamamatsu, Japan
- Seirei Christopher University, Hamamatsu, Japan
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Japan
| | - Kazunori Hirasawa
- Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuri Fujino
- Department of Ophthalmology, Seirei Hamamatsu Hospital, Hamamatsu, Japan
- Ophthalmology, Shimane University Faculty of Medicine Graduate School of Medicine, Izumo, Japan
| | | | - Hiroshi Murata
- Ophthalmology, National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Tetsuo Omura
- Ophthalmology, Shimane University Faculty of Medicine Graduate School of Medicine, Izumo, Japan
| | | | - Akira Obana
- Department of Ophthalmology, Seirei Hamamatsu Hospital, Hamamatsu, Japan
- Department of Medical Spectroscopy, Hamamatsu University School of Medicine Preemenent Medical Photonics Education and Research Center Institute for Medical Photonics Research, Hamamatsu, Japan
| | - Koji M Nishiguchi
- Ophthalmology, Nagoya University Graduate School of Medicine Faculty of Medicine, Nagoya, Japan
| | - Masaki Tanito
- Ophthalmology, Shimane University Faculty of Medicine Graduate School of Medicine, Izumo, Japan
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Kono Y, Kasahara M, Sato N, Yokozeki Y, Hirasawa K, Shoji N. Comparison of Short-term Visual Acuity Changes After Trabeculotomy ab Interno Using Trabectome and Trabeculectomy ab Externo. Ophthalmol Glaucoma 2023; 6:609-615. [PMID: 37169173 DOI: 10.1016/j.ogla.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To compare short-term visual acuity (VA) changes after trabeculotomy ab interno (TAI) using trabectome and trabeculectomy ab externo (TAE) performed on pseudophakic eyes. DESIGN A single-center retrospective study. PARTICIPANTS Patients with pseudophakic eyes who had primary open-angle glaucoma or exfoliation glaucoma and underwent TAI or TAE alone. METHODS Changes in intraocular pressure (IOP), medication score, Snellen VA, and the number of eyes with vision loss (loss of ≥ 2 Snellen lines) were evaluated at baseline, week 1, and months 1, 3, and 6. The risk factors for vision loss at 6 months postoperatively were analyzed in both groups. MAIN OUTCOME MEASURES Visual acuity changes. RESULTS A total of 112 eyes of 112 patients were examined: 46 in the TAI group and 66 in the TAE group. Intraocular pressure was significantly lower in both groups at each visit than at baseline. The TAI group had a significantly higher mean postoperative IOP than the TAE group. Medication scores in the TAI group were significantly different after 3 months compared with baseline; however, decreased significantly at all study visits in the TAE group. The mean VA in the TAI group did not decrease significantly at each visit. In the TAE group, it decreased significantly up to 3 months but was not significantly different at 6 months. At all study visits, the number of eyes with vision loss was significantly lower in the TAI group than in the TAE group. Only 2 eyes in the TAI group (4.3%) had vision loss at 6 months, which was caused by macular edema. In the TAE group, 13 eyes (19.7%) experienced vision loss at 6 months. In all cases, the presence of preoperative split fixation [odds ratio = 7.30, P < 0.05] and the occurrence of hypotony-related complications [odds ratio = 6.76, P < 0.05] within 6 months were risk factors for vision loss. CONCLUSIONS TAI lowered IOP less than TAE; however, there was less vision loss with TAI. For eyes with a target IOP in the mid-teens, TAI can be recommended as initial surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosuremay be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yusuke Kono
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masayuki Kasahara
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuyuki Sato
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yukako Yokozeki
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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Sato N, Kasahara M, Kono Y, Hirasawa K, Shoji N. Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity. Graefes Arch Clin Exp Ophthalmol 2023; 261:2611-2623. [PMID: 37103621 DOI: 10.1007/s00417-023-06076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To investigate the early visual acuity (VA) changes that occur after trabeculectomy and their reversal with recovery. METHOD Two hundred ninety-two eyes of 292 patients after initial trabeculectomy as a standalone procedure fulfilling the following conditions were included: 1) patients with a postoperative follow-up of at least 3 months; 2) patients with preoperative corrected VA less than 0.5 logMAR equivalent; 3) patients with reliable results of visual field; and 4) patients who had open angle glaucoma. VA and intraocular pressure (IOP) changes during the first 3 months after surgery and factors affecting VA postoperatively at 3 months were investigated. RESULTS The mean IOPs (mmHg) after trabeculectomy were significantly lower than preoperatively during the entire period (P < 0.0001). The mean corrected VA for all patients was 0.06 ± 0.17, 0.24 ± 0.38, 0.19 ± 0.26, and 0.14 ± 0.27 preoperatively and at 1 week, 1 month, and 3 months postoperatively, respectively, showing a significant decrease from the preoperative period at all time points (P < 0.0001). VA loss of two or more levels was observed in 13 eyes (4.45%) at 3 months postoperatively. Foveal threshold (FT), shallow anterior chamber (SAC), and choroidal detachment (CD) affected the change in VA before and at 3 months after surgery (P < 0.0001, P = 0.0002, P = 0.0004, respectively). The factors that had significant effects on VA change were FT, SAC, and CD in POAG, FT and hypotonic maculopathy in NTG, and FT in XFG (p < 0.05). CONCLUSION The frequency of serious vision loss was 4.45% for two or more levels of vision loss, and early postoperative VA changes after trabeculectomy may not be reversed even 3 months later. VA loss is influenced by preoperative FT, postoperative SAC and CD, but the impact of postoperative complications vary with disease type.
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Affiliation(s)
- Nobuyuki Sato
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masayuki Kasahara
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yusuke Kono
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan.
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Hirasawa K, Yamaguchi J, Nagano K, Kanno J, Kasahara M, Shoji N. Degree of loss in the tissue thickness, microvascular density, specific perimetry and standard perimetry in early glaucoma. BMJ Open Ophthalmol 2023. [DOI: 10.1136/bmjophth-2023-001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
ObjectiveTo identify the degree of loss of the circumpapillary retinal nerve fibre layer (cpRNFL), the layer from the macular RNFL to the inner plexiform layer (mGCL++), circumpapillary (cpVD) and macular vascular density (mVD), Pulsar perimetry and standard perimetry in early glaucoma.MethodsIn this cross-sectional study, one eye from each of 96 healthy controls and 90 eyes with open-angle glaucoma were measured with cpRNFL, mGCL++, cpVD, mVD, Pulsar perimetry with Octopus P32 test (Pulsar) and standard perimetry with Humphrey field analyser 24-2 test (HFA). For direct comparison, all parameters were converted to relative change values adjusted in both their dynamic range and age-corrected normal value.ResultsThe degree of loss in mGCL++ (−24.7%) and cpRNFL (−25.8%) was greater than that in mVD (−17.3%), cpVD (−14.9%), Pulsar (−10.1%) and HFA (−5.9%) (each p<0.01); the degree of loss in mVD and cpVD was greater than that in Pulsar and HFA (each p<0.01); and the degree of loss in Pulsar was greater than that in HFA (p<0.01). The discrimination ability between glaucomatous and healthy eyes (area under the curve) was higher for mGCL++ (0.90) and cpRNFL (0.93) than for mVD (0.78), cpVD (0.78), Pulsar (0.78) and HFA (0.79).ConclusionThe degree of loss of cpRNFL and mGCL++ thickness preceded by approximately 7%–10% and 15%–20% compared with the micro-VD and visual fields in early glaucoma, respectively.Trial registration numberUMIN Clinical Trials Registry (http://www.umin.ac.jp/; R000046076 UMIN000040372).
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Asaoka R, Murata H, Fujino Y, Aoki S, Hirasawa K, Shoji N. Comparing the structure-function relationship between the visual fields measured with variational Bayes linear regression and SITA standard. PLoS One 2023; 18:e0282638. [PMID: 36877701 PMCID: PMC9987807 DOI: 10.1371/journal.pone.0282638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
PURPOSE We recently constructed an algorithm to measure visual field (VF) using the variational Bayes linear regression (VBLR). This algorithm enabled a faster VF measurement than the Swedish interactive thresholding algorithm (SITA) standard while maintaining the test-retest reproducibility (Murata H, et al. Br J Ophthalmol 2021). The current study aimed to compare the structure-function relationship between the SITA standard and VBLR. METHOD In 78 eyes of 56 patients with primary open-angle glaucoma, VF measurements were conducted using both SITA standard and VBLR VF, as well as spectral-domain optical coherence tomography. The structure-function relationship was investigated between visual sensitivity and circumpapillary retinal nerve fiber layer in the whole VF. This analysis was repeated for each of the 12 sectors (30 degrees). The strength of the structure-function relationship was evaluated using the second-order bias-corrected Akaike Information Criterion (AICc) index. RESULT In the whole VF, AICc values of SITA standard and VBLR were 601.6 and 597.3, respectively. The relative likelihood that VBLR had a better structure-function relationship than the SITA standard was 88.2% (when the entire field was averaged) or 99.9% (when all test points were analyzed in the pointwise manner). With the sector-wise analysis, SITA standard had a better structure-function relationship than VBLR in 1 sector (Superior sector in the retina), whereas VBLR had a better structure-function relationship than SITA standard in 4 sectors (Supero-Nasal, Infero-Nasal, Inferior, and Infero-Temporal sectors) with >95% relative likelihood. CONCLUSION Although it depends on locations and similar between SITA standard and VBLR-VF, but VBLR-VF had a better structure-function relationship than the SITA standard overall.
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Affiliation(s)
- Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Shizuoka Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, National Center for Global health and Medicine, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan
- Department of Ophthalmology, Shimane University, Matsue, Shimane, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Myagmardorj R, Nabeta T, Hirasawa K, Singh G, Van Der Kley F, De Weger A, Ajmone Marsan N, J Bax J, Delgado V. The impact of chronic obstructive pulmonary disease on right ventricular dysfunction and remodeling after aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in patients with aortic stenosis (AS) and has been associated with a poor prognosis after both transcatheter and surgical aortic valve replacement (AVR). Since COPD is associated with an increase in right ventricular (RV) afterload, some studies already suggested that COPD causes RV dysfunction (RVD) and dilatation. On the other hand, RVD and remodeling can also occur due to chronic pressure overload secondary to the AS itself. However, there is no data that studied RVD and remodeling in AVR recipients in terms of COPD severity.
Purpose
We aimed to evaluate the impact of COPD on RVD and remodeling in patients with severe AS undergoing AVR before AVR and at 1-year follow-up, as well as the association between COPD severity and all-cause mortality.
Methods
Patients with severe AS who received either transcatheter or surgical AVR were included. Patients' demographic data, medical history and documented spirometry data were carefully collected, while two-dimensional and speckle tracking echocardiography measurements were performed according to recommended guidelines to evaluate RV systolic function and RV size. RVD was defined as tricuspid annular plane systolic excursion (TAPSE) ≤17mm. RV dilatation was defined by RV mid cavity >35 mm, RV basal diameter >42mm, and RV longitudinal diameter >83mm. RV wall thickness above 5mm was considered as RV hypertrophy. Diagnosis of COPD was determined by the Society of Thoracic Surgeons' definition based on forced expiratory volume in first second (FEV 1<75%, cut-off for COPD). The primary outcome was all-cause death at 1-year.
Results
A total of 293 patients (78.0 years, 58.4% male) were included. RVD was detected in 54 (18.4%) patients, while 55 (18.8%) patients had mild COPD and 43 (14.7%) patients had moderate or severe COPD. At 1-year follow-up, the prevalence of RVD significantly increased (18.4% versus 23.6%, p=0.004). Compared to baseline, RV free wall strain of lateral basal segment (p=0.046), TAPSE (p<0.0001) and tricuspid regurgitation gradient (p=0.018) impaired whereas RV wall thickness (p=0.014), RV diameter index of lateral basal segment (p<0.0001), and RV diameter index of lateral mid segment (p<0.0001) increased, respectively. At 1-year follow-up, 33 patients died (Figure 1). On multivariate cox regression analysis, RVD (hazard ratio (HR) 2.781, 95% confidence interval (CI) 1.172–6.598; p=0.020) as well as mild (HR 4.695, 95% CI 1.787–12.336; p=0.002) and moderate-severe COPD (HR 4.725, 95% CI 1.717–13.006; p=0.003) were significantly associated with the endpoint (Table 1).
Conclusions
The prevalence of RVD significantly increased and it deteriorated at 1-year after AVR. RV remodeling observed more at lateral basal and mid segments of RV as well as wall thickness. RV dysfunction and COPD were the strongest predictors of mortality in this population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Myagmardorj
- Leiden University Medical Center , Leiden , The Netherlands
| | - T Nabeta
- Leiden University Medical Center , Leiden , The Netherlands
| | - K Hirasawa
- Leiden University Medical Center , Leiden , The Netherlands
| | - G Singh
- Leiden University Medical Center , Leiden , The Netherlands
| | - F Van Der Kley
- Leiden University Medical Center , Leiden , The Netherlands
| | - A De Weger
- Leiden University Medical Center , Leiden , The Netherlands
| | | | - J J Bax
- Leiden University Medical Center , Leiden , The Netherlands
| | - V Delgado
- Leiden University Medical Center , Leiden , The Netherlands
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Stassen J, Galloo X, Hirasawa K, Van Der Bijl P, Marsan NA, Bax JJB. Pathophysiological mechanisms and prognostic implications of right atrial reservoir strain in patients with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Renal and hepatic dysfunction complicate the treatment course of patients with heart failure and negatively affect outcomes. Because the right atrium functions as a reservoir between the right ventricle and the venous circulation, a reduced right atrial compliance may enhance venous congestion, thereby promoting worsening renal function and hepatic congestion.
Purpose
To evaluate the association between RA reservoir strain (RS) and end-organ dysfunction (renal dysfunction and hepatic congestion), as well as survival in patients with advanced HF.
Methods
RARS was evaluated with speckle-tracking echocardiography in patients with advanced HF (i.e. left ventricular ejection fraction <35% and persistent symptoms of HF despite optimal medical therapy). Linear regression analysis was used to investigate the association between RARS and renal function (i.e. estimated glomerular filtration rate [eGFR]) and hepatic congestion (i.e. gamma-glutamyl transferase [GGT]). Patients were followed-up for all-cause mortality.
Results
A total of 917 patients (mean age 65±11 years, 76% male) were included. Age, male sex, atrial fibrillation, larger left atrial and right ventricular dimensions and right ventricular systolic dysfunction were all associated with lower RARS values. On multivariable analysis (adjusting for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, ischemic etiology, atrial fibrillation, QRS duration, left ventricular end-diastolic volume, left ventricular ejection fraction, left atrial volume index, RV basal diameter and tricuspid annular plane systolic excursion), RARS was independently associated with eGFR (β 0.076; 95% CI 0.012 to 0.367; p=0.037) and GGT (β −0.122; 95% CI −1.800 to −0.034; p=0.038). On multivariable Cox regression analysis, adjusting for baseline clinical and echocardiographic variables, RARS was independently associated with all-cause mortality (HR 0.984; 95% CI 0.972 to 0.996; p=0.008) (Figure 1 and Table).
Conclusion
Reduced RARS is independently associated with renal dysfunction and hepatic congestion. In addition, RARS is independently associated with mortality. Consequently, RARS may be useful for the risk-stratification of patients with HF.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
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Affiliation(s)
- J Stassen
- Leiden University Medical Center , Leiden , The Netherlands
| | - X Galloo
- Leiden University Medical Center , Leiden , The Netherlands
| | - K Hirasawa
- Leiden University Medical Center , Leiden , The Netherlands
| | - P Van Der Bijl
- Leiden University Medical Center , Leiden , The Netherlands
| | - N A Marsan
- Leiden University Medical Center , Leiden , The Netherlands
| | - J J B Bax
- Leiden University Medical Center , Leiden , The Netherlands
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Myagmardorj RIN, Nabeta T, Hirasawa K, Singh G, Van Der Kley F, De Weger A, Ajmone Marsan N, J Bax J, Delgado V. Association between chronic obstructive pulmonary disease and all-cause mortality after aortic valve replacement for aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Chronic obstructive pulmonary disease (COPD) and aortic stenosis (AS) are the most common diseases in aging population that their prevalence and percental change in mortality increase over the years. In severe AS, aortic valve replacement (AVR) is the only treatment that has demonstrated to improve survival, however the presence of comorbidities increases the operative risk and influences negatively on the outcomes after AVR. Therefore, the definition of COPD varies across the studies and is not always based on the use of pulmonary functional tests. Accordingly, the aim of the present study is to evaluate the association between pulmonary functional parameters and all-cause mortality after AVR in a large cohort of patients with severe AS.
Methods
Total of 400 patients (78.0 year-old, 56.7% men) with severe AS and documented preoperative pulmonary functional test (PFT) were retrospectively analyzed. Demographic and clinical characteristics were collected from electronic medical records while echocardiography was performed and measured according to the recommendations. PFTs were performed prior to AVR and categories defined in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database: normal pulmonary function was defined by an FEV1 >75% of predicted; mild COPD if FEV1 was 60–75% of predicted; moderate COPD if FEV1 was 50–59% of predicted and severe COPD when FEV1 <50% of predicted.
Results
Mild, moderate and severe COPD were documented in 75 (19%), 31 (8%) and 22 (5%) while the remaining 68% had normal PFTs. Patients with moderate and severe COPD had significantly larger LV mass and LV end-systolic volume whereas LV ejection fraction was significantly lower. The FVC, FEV1, Tiffeneau index, VC, PEF, and IC were the worst among patients with moderate and severe COPD (per definition) (p<0.0001). Over a median follow-up of 32 months, 92 (23%) patients died. The survival rates were significantly lower in patients with moderate and severe COPD (Log rank p=0.003, Figure 1). In multivariable Cox regression analysis, some clinical factors and COPD were independently associated with all-cause mortality (table 1). Remarkably, any grade of COPD was associated with 2-fold increased risk of all cause-mortality (HR 1.933; 95% CI 1.166–3.204; p=0.011 for mild COPD and HR 2.028; 95% CI 1.154–3.564; p=0.014 for moderate/ severe COPD, separately).
Conclusion
Patients with moderate and severe COPD had higher LV hypertrophy and reduced LV ejection fraction while PFT parameters were the worst among these patients. The survival rates were significantly lower in patients with moderate and severe COPD compared with patients without COPD. In addition to other clinical factors, any grade of COPD was associated with 2-fold increased risk of all cause-mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - T Nabeta
- Leiden University Medical Center , Leiden , The Netherlands
| | - K Hirasawa
- Leiden University Medical Center , Leiden , The Netherlands
| | - G Singh
- Leiden University Medical Center , Leiden , The Netherlands
| | - F Van Der Kley
- Leiden University Medical Center , Leiden , The Netherlands
| | - A De Weger
- Leiden University Medical Center , Leiden , The Netherlands
| | | | - J J Bax
- Leiden University Medical Center , Leiden , The Netherlands
| | - V Delgado
- Leiden University Medical Center , Leiden , The Netherlands
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11
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Stassen J, Galloo X, Hirasawa K, Van Der Bijl P, Marsan NA, Bax JJ. Evolution of functional mitral regurgitation and left atrial function in patients receiving cardiac resynchronization therapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left atrial (LA) function is a strong prognostic marker in patients with heart failure and patients with functional mitral regurgitation (MR). Although cardiac resynchronization therapy (CRT) has shown to improve MR severity, the interaction between a reduction in MR severity and an improvement in LA function, as well as their association with outcomes, has not been investigated.
Purpose
To investigate the association between a reduction in MR severity and an improvement in LA function, as well as their association with outcomes.
Methods
LA reservoir strain (RS) was evaluated with speckle tracking echocardiography in patients with moderate and severe functional MR. MR improvement was defined as at least 1 grade improvement in MR severity at 6 months after CRT implantation. The association between MR improvement and change in LARS was evaluated using multivariable logistic regression analysis. Patients were dividing into 3 groups: MR non-improvers; MR improvers with no LARS improvement; and MR improvers with LARS improvement. The primary endpoint was all-cause mortality.
Results
A total of 340 patients (mean age 66±10 years, 73% male) were included, of whom 200 (59%) showed MR improvement after CRT implantation. On multivariable analysis, an improvement in MR was independently associated with an improvement in LARS (OR 1.008; 95% CI 1.003–1.013; p=0.002) (Table 1). MR improvers showing LARS improvement had the lowest mortality rate, whereas outcomes were not significantly different between MR non-improvers and MR improvers showing no LARS improvement (p=0.236) (Figure 1).
Conclusion
In patients with HF and significant functional MR, an improvement in MR after CRT implantation is independently associated with an improvement in LARS, which in turn, is associated with better survival.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
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Affiliation(s)
- J Stassen
- Leiden University Medical Center , Leiden , The Netherlands
| | - X Galloo
- Leiden University Medical Center , Leiden , The Netherlands
| | - K Hirasawa
- Leiden University Medical Center , Leiden , The Netherlands
| | - P Van Der Bijl
- Leiden University Medical Center , Leiden , The Netherlands
| | - N A Marsan
- Leiden University Medical Center , Leiden , The Netherlands
| | - J J Bax
- Leiden University Medical Center , Leiden , The Netherlands
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12
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Laenens D, Stassen J, Galloo X, Ewe SH, Singh GK, Amanullah MR, Hirasawa K, Sia CH, Butcher SC, Chew NWS, Kong WKF, Poh KK, Ding ZP, Ajmone Marsan N, Bax JJ. The impact of atrial fibrillation on prognosis in aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and increasing with age. Various studies have focused on the complex relationship between these entities that frequently coexist. AS might induce adverse cardiac remodelling, which is associated with poor prognosis in severe AS. Left atrial remodelling, especially left atrial enlargement, is also an important risk factor for AF.
Purpose
To evaluate the additive prognostic value of AF besides markers of left atrial and left ventricular remodelling in patients with AS, irrespective of severity of AS and left ventricular ejection fraction (LVEF).
Methods
Patients with moderate and severe AS were selected and history of AF was assessed. Subgroups were defined according to LVEF (reduced (<50%) vs. preserved (≥50%)) and severity of AS (moderate vs. severe). The endpoint was all-cause mortality. Unadjusted Kaplan-Meier survival curves were plotted. Four multivariable Cox regression models were constructed.
Results
In total, 2849 patients with moderate and severe AS (mean age 72±12 years, 54.7% men) were evaluated of whom 686 (24.1%) had a history of AF. Regarding the defined subgroups, 1091 (38.3%) patients had severe AS and 2207 (77.5%) patients had preserved LVEF. During a median follow-up time of 60 months (interquartile range 30 to 97), 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared with 36.8% in patients with sinus rhythm (SR) (Figure 1) (p<0.001). In subgroup analysis, patients with AF and severe AS, moderate AS or preserved LVEF had worse survival than those who maintained SR (p=0.015, p<0.001 and p<0.001 respectively). On univariable (HR: 1.42; 95% CI: 1.25 to 1.62; p<0.001) and multivariable Cox regression analysis (HR: 1.19; 95% CI: 1.02 to 1.38; p=0.026) adjusting for age, body mass index, hypertension, diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease, kidney function, New York Heart Association class, aortic valve replacement as a time-dependent covariate, left ventricular mass index, left ventricular end-diastolic volume index, LVEF, mean aortic valve gradient, tricuspid annular plane systolic excursion, AF is independently associated with mortality (Table 1; model 1). However, when correcting for LAVI, E/e' or both, AF is no longer independently associated with all-cause mortality (Table 1; model 2–4).
Conclusion
Patients with moderate or severe AS and AF have a significantly higher 10-year mortality rate than patients with SR. This finding is irrespective of AS severity and also apparent in the subgroup with preserved LVEF. Nonetheless, when correcting for markers of diastolic dysfunction, AF is not independently associated with outcome in patients with moderate or severe AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Laenens
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
| | - J Stassen
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
| | - X Galloo
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
| | - S H Ewe
- National Heart Centre Singapore , Singapore , Singapore
| | - G K Singh
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
| | - M R Amanullah
- National Heart Centre Singapore , Singapore , Singapore
| | - K Hirasawa
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
| | - C H Sia
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - S C Butcher
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
| | - N W S Chew
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - Z P Ding
- National Heart Centre Singapore , Singapore , Singapore
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
| | - J J Bax
- Leiden University Medical Center, Cardiology , Leiden , The Netherlands
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13
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Stassen J, Ewe S, Singh GK, Amanullah MR, Hirasawa K, Butcher S, Sin KYK, Ding ZP, Sia CH, Chew NWS, Kong WKF, Poh KK, Delgado V, Marsan NA, Bax JJB. Prevalence and prognostic implications of discordant grading and flow-gradient patterns in moderate aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prognostic implications of discordant grading in severe aortic stenosis (AS) are well known. However, the prevalence of different flow-gradient patterns and their prognostic implications in moderate AS are unknown.
Purpose
To investigate the occurrence and prognostic implications of different flow-gradient patterns in patients with moderate AS.
Methods
Patients with moderate AS (aortic valve area 1.0–1.5 cm2) were divided in 4 groups, based on transvalvular mean gradient (MG), stroke volume index (SVi) and left ventricular ejection fraction (LVEF): concordant moderate AS (MG ≥20 mmHg); normal-flow, low-gradient discordant moderate AS (MG <20 mmHg, SVi ≥35 ml/m2); “classical” low-flow, low-gradient discordant moderate AS (MG <20 mmHg, SVi <35 ml/m2 and LVEF <50%) and “paradoxical” low-flow, low-gradient discordant moderate AS (MG <20 mmHg, SVi <35 ml/m2 and LVEF ≥50%). The primary endpoint was all-cause mortality.
Results
Of 1974 patients (age 73±10 years, 51% men) with moderate AS, 788 (40%) had discordant grading. Patients with discordant grading showed significantly higher mortality rates than patients with concordant grading (p<0.001), even in the subgroup of patients having preserved LVEF (p=0.028) or preserved SVi (p=0.002). Of the patients with discordant grading, 71% had normal-flow, low-gradient moderate AS, 14% had “classical” low-flow, low-gradient moderate AS, and 14% had “paradoxical” low-flow, low-gradient moderate AS (Figure 1). Patients with normal-flow, low-gradient moderate AS, “classical” low-flow, low-gradient moderate AS, and “paradoxical” low-flow, low-gradient moderate AS had worse survival rates than patients with concordant grading (p<0.001) (Figure 2). On multivariable analysis “paradoxical” low-flow, low-gradient (HR: 1.533; 95% CI: 1.133–2.075; p=0.006) and “classical” low-flow, low-gradient (HR: 1.926; 95% CI: 1.442–2.572; p<0.001) but not normal-flow, low-gradient moderate AS were independently associated with all-cause mortality.
Conclusion
Discordant grading is frequently (40%) observed in patients with moderate AS. Low-flow, low-gradient patterns account for an important proportion of the discordant cases and are associated with increased mortality. These findings underline the need for better phenotyping patients with discordant moderate AS.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
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Affiliation(s)
- J Stassen
- Leiden University Medical Center , Leiden , The Netherlands
| | - S Ewe
- National Heart Centre Singapore, Cardiology , Singapore , Singapore
| | - G K Singh
- Leiden University Medical Center , Leiden , The Netherlands
| | - M R Amanullah
- National Heart Centre Singapore, Cardiology , Singapore , Singapore
| | - K Hirasawa
- Leiden University Medical Center , Leiden , The Netherlands
| | - S Butcher
- Leiden University Medical Center , Leiden , The Netherlands
| | - K Y K Sin
- National Heart Centre Singapore, Cardiology , Singapore , Singapore
| | - Z P Ding
- National Heart Centre Singapore, Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre , Singapore , Singapore
| | - N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - V Delgado
- Leiden University Medical Center , Leiden , The Netherlands
| | - N A Marsan
- Leiden University Medical Center , Leiden , The Netherlands
| | - J J B Bax
- Leiden University Medical Center , Leiden , The Netherlands
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14
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Hirasawa K, Yamaguchi J, Nagano K, Kanno J, Kasahara M, Shoji N. Structure–Function Relationships and Glaucoma Detection with Magnification Correction of OCT Angiography. Ophthalmology Science 2022; 2:100120. [PMID: 36249704 PMCID: PMC9562297 DOI: 10.1016/j.xops.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
Purpose To investigate the effects of adjusting the ocular magnification during OCT-based angiography imaging on structure–function relationships and glaucoma detection. Design Cross-sectional study. Participants A total of 96 healthy control participants and 90 patients with open-angle glaucoma were included. Methods One eye of each patient in the control group and the patient group was evaluated. The layers comprising the macula vascular density (VD) and circumpapillary VD were derived from swept-source OCT angiography imaging. The mean sensitivity (MS) of the standard automated perimetry was measured using the Humphrey 24-2 test. Structure–function relationships were evaluated with simple and partial correlation coefficients. A receiver operating characteristic analysis was performed to evaluate the diagnostic accuracy for glaucoma using the area under the receiver operating characteristic curve (AUC). Ocular magnification was adjusted using Littmann’s formula modified by Bennett. Main Outcome Measures The association between the axial length and VD, structure–function relationships, and glaucoma detection with and without magnification correction. Results The superficial layer of the macular region was not significantly correlated to the axial length without magnification correction (r = 0.0011; P = 0.99); however, it was negatively correlated to the axial length with magnification correction (r = –0.22; P = 0.028). Regarding the nerve head layer in the circumpapillary region, a negative correlation to the axial length without magnification correction was observed (r = –0.22; P = 0.031); however, this significant correlation disappeared with magnification correction. The superficial layer of the macula and the nerve head layer of the circumpapillary region were significantly correlated to Humphrey 24-2 MS values without magnification correction (r = 0.22 and r = 0.32, respectively); however, these correlations did not improve after magnification correction (r = 0.20 and r = 0.33, respectively). Glaucoma diagnostic accuracy in the superficial layer (AUC, 0.63) and nerve head layer (AUC, 0.70) without magnification correction did not improve after magnification correction (AUC, 0.62 and 0.69, respectively). Conclusions Adjustment of the ocular magnification is important for accurate VD measurements; however, it may not significantly impact structure–function relationships and glaucoma detection.
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15
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Hirasawa K, Murata H, Shimada S, Matsuno M, Shoji N, Asaoka R. Faster algorithms to measure visual field using the variational Bayes linear regression model in glaucoma: comparison with SITA-Fast. Br J Ophthalmol 2022:bjophthalmol-2021-320523. [PMID: 35232725 DOI: 10.1136/bjophthalmol-2021-320523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/29/2022] [Indexed: 11/03/2022]
Abstract
AIMS To compare the visual field (VF) test results measured with the Swedish Interactive Threshold Algorithm Fast (SITA-Fast) and newly developed variational Bayes linear regression visual field (VBLR-VF) Fast or VBLR-VF Fast+. METHOD Of 65 patients with glaucoma, 31 eyes of 31 patients performed VBLR-VF Fast and SITA-Fast, and 34 eyes of 34 patients performed VBLR-VF Fast+ and SITA-Fast on the same day and iterated the same procedures within 6 months using the 24-2 test grid in the current prospective study. Global index (mean deviation and pattern SD), pointwise retinal sensitivity, test duration and reliability index (fixation loss, false positive and false negative) were compared between SITA-Fast and VBLR-VF Fast or VBLR-VF Fast+. RESULTS Global indices were not significantly different between SITA-Fast and VBLR-VF Fast or VBLR-VF Fast+. There was no significant difference in the pointwise retinal sensitivity between the SITA-Fast and VBLR-VF Fast algorithms at the first visit, while the VBLR-VF Fast algorithm was approximately 1 dB higher compared to the SITA-Fast algorithm at the second visit. Test duration was reduced by approximately 30 s (10%) with VBLR-VF Fast and by approximately 80 s (30%) with VBLR-VF Fast+ compared with to SITA-Fast (p<0.05). Most cases showed good reliability index values; however, a marginal but significant difference was observed between the VBLR-VF and SITA-Fast algorithms. CONCLUSION Both VBLR-VF Fast and VBLR-VF Fast+ considerably reduced the test durations. Although there was a marginal difference in the pointwise retinal sensitivities, global indices were almost interchangeable between the VBLR-VF Fast and SITA-Fast.
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Affiliation(s)
- Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Mei Matsuno
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan .,Seirei Christopher University, Hamamatsu, Japan.,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Nanovision Research Division, Research Institute of Electronics, Shizuoka University, Hamamatsu, Japan.,The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Japan
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16
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Stassen J, Ewe SH, Butcher SC, Ammanullah MR, Hirasawa K, Singh GK, Ding ZP, Pio SM, Chew NWS, Sia CH, Kong WKF, Poh KK, Marsan NA, Delgado V, Bax JJ. Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) diastolic dysfunction (DDF) has shown to carry an unfavorable prognosis in severe AS, the prognostic value of LV DDF in MAS has not been investigated.
Purpose
To investigate the prognostic impact of LV DDF in patients with MAS and preserved LV ejection fraction (EF).
Methods
LV diastolic function was evaluated in patients with MAS (aortic valve area >1.0 and ≤1.5cm2) and preserved LVEF (≥50%) using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR).
Results
Of 1247 patients (age 74 ± 10 years, 47% men) with MAS and preserved LVEF, 396 (32%) had normal diastolic function, 316 (25%) had indeterminate diastolic function and 535 (43%) had DDF. Patients with DDF were more likely to be female, had more comorbidities (hypertension, atrial fibrillation, chronic kidney disease) and were more symptomatic (NYHA ≥2) than patients with normal diastolic function. Patients with DDF also had smaller aortic valve area and higher peak aortic velocities than patients with normal/indeterminate diastolic function. During a median follow-up of 53 (26 – 81) months, 484 (39%) patients died. For the composite endpoint, 770 patients (62%) underwent AVR (n = 376) or died (n = 394) during a median follow-up of 37 (IQR 15 – 62) months. Patients with DDF had significantly lower survival rates (p <0.001) and event-free survival rates (p = 0.015) compared to patients with normal/indeterminate diastolic function (Figure 1). On multivariable analysis, DDF was independently associated with all-cause mortality (HR: 1.368; 95% CI: 1.085 – 1.725; p = 0.008) and the composite endpoint of all-cause mortality and AVR (HR: 1.241; 95% CI: 1.035 – 1.488; p = 0.020) (Figure 2).
Conclusion
LV DDF is associated with worse outcomes in patients with MAS. Assessment of LV diastolic function may contribute significantly to risk stratification of patients with MAS. Abstract Figure. Abstract Figure.
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Affiliation(s)
- J Stassen
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SH Ewe
- National Heart Centre Singapore, Singapore, Singapore
| | - SC Butcher
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - MR Ammanullah
- National Heart Centre Singapore, Singapore, Singapore
| | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - GK Singh
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - ZP Ding
- National Heart Centre Singapore, Singapore, Singapore
| | - SM Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - NWS Chew
- National University Heart Centre, Singapore, Singapore
| | - CH Sia
- National University Heart Centre, Singapore, Singapore
| | - WKF Kong
- National University Heart Centre, Singapore, Singapore
| | - KK Poh
- National University Heart Centre, Singapore, Singapore
| | - NA Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - JJ Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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17
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Stassen J, Pio SM, Ewe SH, Singh GK, Hirasawa K, Butcher SC, Marsan NA, Delgado V, Bax JJ. Prognostic value of left ventricular global longitudinal strain in patients with moderate aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Impaired left ventricular (LV) global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis, but its prognostic value in patients with moderate aortic stenosis (MAS) is largely unknown.
Purpose
To investigate the prognostic implications of LV GLS in patients with MAS and preserved LV ejection fraction (EF).
Methods
LV GLS was evaluated by speckle tracking echocardiography in 621 patients (age 71 ± 12 years, 59% men) with MAS (aortic valve area 1.0 – 1.5cm2) and preserved LVEF (≥50%). Impaired LV GLS was defined as an LV GLS value <16%, based on spline curve analysis (i.e. where the hazard ratio for all-cause mortality was ≥1). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement.
Results
Patients with LV GLS <16% (n = 282) were significantly older, more likely to be male and had more comorbidities (diabetes mellitus, atrial fibrillation, more impaired renal function) compared to patients with LV GLS ≥16% (n = 339). In terms of echocardiographic data, patients with LV GLS <16% had larger LV volumes, lower LVEF and higher E/e’. During a median follow-up of 53 (27 – 102) months, 199 (32%) patients died. For the composite endpoint, 409 patients (66%) underwent AVR (n = 290) or died (n = 119) during a median follow-up of 29 (IQR 14 – 54) months. Patients with LV GLS <16% experienced significantly lower survival rates (p < 0.001) and event-free survival rates (p = 0.001) compared to patients with LV GLS ≥16% (Figure 1). On multivariable analysis, LV GLS was independently associated with all-cause mortality (HR 2.442; 95% CI: 1.762 – 3.384; p < 0.001) and the composite endpoint of all-cause mortality and aortic valve replacement (HR 1.862; 95% CI: 1.498 – 2.315; p = 0.040) (Figure 2).
Conclusions
In patients with MAS and preserved LVEF, reduced LV GLS is associated with an increased risk of all-cause mortality and the composite endpoint of all-cause mortality and AVR. Assessment of LV GLS may be useful in the risk stratification of these patients. Abstract Figure. Kaplan-Meier curves Abstract Figure. Cox regression analysis
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Affiliation(s)
- J Stassen
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SM Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SH Ewe
- National Heart Centre Singapore, Singapore, Singapore
| | - GK Singh
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SC Butcher
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - NA Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - JJ Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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18
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Stassen J, Ewe SH, Hirasawa K, Butcher SC, Singh GK, Ammanullah RA, Ding ZP, Pio SM, Chew NWS, Sia CH, Kong WKF, Poh KK, Marsan NA, Delgado V, Bax JJ. Left ventricular remodeling patterns in patients with moderate aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) adverse remodeling is associated with worse outcomes in patients with severe AS, the prognostic significance of different patterns of LV remodeling in MAS has not been investigated.
Purpose
To investigate the association between different patterns of LV remodeling on outcomes in patients with MAS.
Methods
Patients with MAS (aortic valve area >1.0 and ≤1.5cm2) were stratified into 4 groups according to the pattern of LV remodeling: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) or eccentric hypertrophy (EH). Clinical outcomes were defined as all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR).
Results
Of 1931 patients (age 73 ± 10 years, 52% men) with MAS, 344 (18%) had NG, 469 (24%) CR, 698 (36%) CH and 420 (22%) EH. Patients with CH were more likely to be female, had more hypertension, were more symptomatic (NYHA ≥III) and had more pronounced LV diastolic dysfunction, whereas patients with EH had more coronary artery disease, were more symptomatic (NYHA ≥III) and had lower LV ejection fraction than patients with NG. Patients with CH had higher aortic mean pressure gradients and peak aortic jet velocities than patients with NG. During a median follow-up of 51 (IQR 25 - 83) months, 833 (43%) patients died. For the composite endpoint, 1286 (67%) patients underwent AVR (n = 613) or died (n = 673) during a median follow-up of 35 (IQR 14 - 60) months. Patients with CH and EH had significantly lower survival rates (p < 0.001; Figure 1) and event-free survival rates (p = 0.004) compared to patients with NG/CR. On multivariable analysis, CH was independently associated with all-cause mortality (HR:1.267; 95% CI:1.024 – 1.568; p = 0.029), whereas both CH (HR:1.293; 95% CI:1.090 – 1.533; p = 0.003) and EH (HR:1.222; 95% CI:1.013 – 1.474; p = 0.036) were associated with the composite endpoint of AVR and all-cause mortality (Figure 2).
Conclusions
In patients with MAS, different patterns of LV remodeling are observed with CH being independently associated with an increased risk of all-cause mortality. Risk stratification according to the different patterns of LV remodeling may help to identify patients with MAS who are at increased risk of adverse events and may benefit from closer follow-up. Abstract Figure. Kaplan-Meier curves Abstract Figure. Cox regression analysis
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Affiliation(s)
- J Stassen
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SH Ewe
- National Heart Centre Singapore, Singapore, Singapore
| | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SC Butcher
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - GK Singh
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - RA Ammanullah
- National Heart Centre Singapore, Singapore, Singapore
| | - ZP Ding
- National Heart Centre Singapore, Singapore, Singapore
| | - SM Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - NWS Chew
- National University Heart Centre, Singapore, Singapore
| | - CH Sia
- National University Heart Centre, Singapore, Singapore
| | - WKF Kong
- National University Heart Centre, Singapore, Singapore
| | - KK Poh
- National University Heart Centre, Singapore, Singapore
| | - NA Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - JJ Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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19
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Kuneman JH, Singh GK, Milhorini Pio S, Hirasawa K, Ajmone Marsan N, Knuuti J, Delgado V, Bax JJ. Sex differences in left ventricular remodeling in patients with severe aortic valve stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Women with severe aortic valve stenosis (AS) have better long-term outcomes after transcatheter aortic valve implantation (TAVI) but worse survival after surgical aortic valve replacement compared to men. Whether this is related to sex differences in left ventricular (LV) remodeling is unknown.
Purpose
To examine sex differences in LV remodeling and outcomes in patients with severe AS undergoing TAVI.
Methods
Patients with severe AS who underwent TAVI between 2007 and 2018 with a pre-procedural multidetector row computed tomography (MDCT) scan were included. LV volumes, mass and function were analyzed with MDCT. Patients were classified into 4 LV remodeling patterns based on LV mass index and LV mass-to-volume ratio: 1) normal geometry, 2) concentric remodeling, 3) concentric hypertrophy and 4) eccentric hypertrophy. The primary endpoint was all-cause mortality after TAVI.
Results
A total of 289 patients (age 80±6 years, 54% male) were included. Women showed smaller LV volumes and mass compared to men. Concentric hypertrophy (50%) was the most frequent pattern of LV remodeling followed by eccentric hypertrophy (33%), normal geometry (13%) and concentric remodeling (4%). Concentric remodeling was more frequently observed in men compared to women (91% vs. 9% respectively, p=0.011). However, no sex differences were observed in the remaining LV remodeling patterns (Figure 1). During a median follow-up of 3.8 (IQR 2.2–5.1) years after TAVI, 87 patients died. Women demonstrated better outcome after TAVI compared to men (log-rank χ2=4.29, p=0.038). The survival benefit of women over men was mainly present among patients with concentric hypertrophy (log-rank χ2=4.91, p=0.027, Figure 2).
Conclusion
LV concentric and eccentric hypertrophy are similarly observed in men and women with severe AS. Women demonstrated better outcome after TAVI as compared to men, particularly among those with LV concentric hypertrophy. However, the outcome benefit of females after TAVI seems not to be related to sex-differences in LV remodeling.
Funding Acknowledgement
Type of funding sources: None. Distribution of sex in LV remodelingAll-cause mortality after TAVI
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Affiliation(s)
- J H Kuneman
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - G K Singh
- Leiden University Medical Center, Leiden, Netherlands (The)
| | | | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | | | - J Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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20
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Chimed S, Van Der Bijl P, Lustosa R, Hirasawa K, Yedidya I, Fortuni F, Montero J, Marsan N, Delgado V, Bax J. Right ventricular remodeling and prognostic relevance after ST-segment elevation myocardial infarction in patients treated with primary percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) often involves changes in right ventricular (RV) function and size over time. However, the prognostic implications of RV remodeling after STEMI are unknown. The aim of current study was to characterize RV remodeling in post-STEMI patients and to investigate it's prognostic relevance.
Methods
RV remodeling in post-STEMI patients who underwent primary percutaneous coronary intervention (PCI) was defined by RV end-systolic area (RV ESA) change at 6 months after STEMI, compared to baseline. The optimal threshold of RV ESA change (≥40%) to define RV remodeling was derived from spline curve analysis (Figure 1A). The primary endpoint was the composite of all-cause mortality and heart failure (HF) hospitalization. Long term outcomes were compared between patients with and without RV remodeling by means of a log rank test.
Results
A total of 2280 patients were analyzed (mean age 60±11 years, 76% male) and RV remodeling was present in 320 patients (14%). After a median follow-up of 75 months (interquartile range 50–106 months), the composite endpoint of all-cause mortality and HF hospitalization occurred in 292 patients (13%). After adjustment for various risk factors, including tricuspid annular plane systolic excursion (TAPSE), post-STEMI RV remodeling was independently associated with a higher risk of all-cause mortality and HF hospitalization (HR=1.37, 95% CI 1.00–1.87, p=0.049. Finally, patients with RV remodeling were had a significantly lower event-free survival rate compared with patients without RV remodeling during follow-up (log-rank test p=0.009) (Figure 1B).
Conclusion
RV post-infarct remodeling is associated with mortality and HF hospitalization, independent of RV systolic function.
Funding Acknowledgement
Type of funding sources: None. Figure 1. A) Spline and B) Kaplan-Meier curve
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Affiliation(s)
- S Chimed
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - P Van Der Bijl
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - R Lustosa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - I Yedidya
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - F Fortuni
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J.M Montero
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - N.A Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J.J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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21
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Hirasawa K, Singh GK, Kuneman JH, Ajmone Marsan N, Delgado V, Bax JJ. Impact of left atrial strain assessed with feature-tracking computed tomography on long-term mortality after transcatheter aortic valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) induces left atrial (LA) remodeling through the increase of left ventricular (LV) filling pressure. Peak left atrial longitudinal strain (PALS) has been proposed as a prognostic marker in patients with AS. Novel feature-tracking (FT) software allows to assess LA strain from multidetector computed tomography (MDCT) dataset.
Purpose
To investigate the association between PALS using FT MDCT and moratlity in patients who underwent transcatheter aortic valve implantation (TAVI).
Methods
A total of 369 Patients (mean 80±7 years, 51% male) who underwent preprocedual MDCT before TAVI and had suitable data for measureing PALS using dedicated FT software were included. Patients were classified into 4 groups according to PALS quartiles; PALS more than 19.3% (Q1), 19.3% or less to more than 15.0% (Q2), 15.0% or less to more than 9.1% (Q3), and 9.1% or less (Q4). The primary outcome was all-caurse mortality.
Results
During median follow-up of 45 [22 - 68] months, 124 patients (34%) were died. On multivariable Cox regression analysis, PALS is an independently associated with all-cause mortality (HR: 0.958 [95% CI: 0.925–0.993], P=0.006). Kaplan-Meier analysis showed the worse outcome of the quatile with more impaired PALS (Logrank P<0.001). Compared to Q1, Q3 and Q4 had higher risk of mortality after TAVI (HR: 2.475 [95% CI: 1.411–4.340] for Q3, HR: 3.253 [95% CI: 1.878–5.633] for Q4).
Conclusion
In this retrospective study, PALS measured with FT MDCT was strongly associated with all-cause mortality after TAVI. LA functial assessment using MDCT may have a importan role for risk stratification in patients referred to TAVI.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant 2018 K-M curve according to PALS quartiles
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Affiliation(s)
- K Hirasawa
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - G K Singh
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - J H Kuneman
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | | | - V Delgado
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - J J Bax
- Leiden University Medical Centre, Leiden, Netherlands (The)
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22
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Hirasawa K, Fortuni F, Rosendael PJ, Ajmone Marsan N, Delgado V, Bax JJ. Impact of tricuspid annular shape on late worsening tricuspid regurgitation after transcatheter aortic implantation: insight from multidetector row computed tomography assessment. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Worsening of tricuspid regurgitation (TR) in patients undergoing transcatheter aortic valve implantation (TAVI) is associated with adverse clinical outcomes. The geometrical factors that determine the occurrence of significant TR after TAVI are uncertain. Multi-detector row computed tomography (MDCT) may provide additional geometrical insights in the pathophysiology of worsening TR after TAVI.
Purpose
To investigate the impact of right atrial and tricuspid annular (TA) geometryassessed by MDCT on the occurrence of significant TR (≥ moderate) at 1-year after TAVI.
Methods
Patients without significant TR who had undergone a full-beat MDCT prior to TAVI were included. Right and left atrial and ventricular volumes and TA parameters including the anterior-posterior (AP) and septal-lateral (SL) diameters, area and circularity (AP/SL ratio) were measured and correlated to the occurrence of significant TR at 1-year after TAVI.
Results
A total of 205 patients (80±7 years, 51% male) who underwent TAVI for severe aortic stenosiswere included. Moderate or severe TR at 1-year follow-up occurred in 59 patients (29%). Patients who developed significant TR were more likely to have atrial fibrillation and lower left ventricular (LV) volumes, but larger right and left atrial volumes and TA dimensions at baseline. After adjusting for atrial fibrillation and LV and right atrial volumes, larger end-diastolic TA SL diameter (odds-ratio 1.182 95% CI 1.047–1.334, P=0.007) and more circular TA shape were independently associated with the occurrence of significant TR.
Conclusion
In patients without significant TR prior to TAVI, TA dilation and loss of the elliptical shape of the TA at baseline are associated with of the occurrence of significant TR 1-year after TAVI.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant 2018 Representative cases
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Affiliation(s)
- K Hirasawa
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - F Fortuni
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - P J Rosendael
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | | | - V Delgado
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - J J Bax
- Leiden University Medical Centre, Leiden, Netherlands (The)
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23
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Omoto T, Murata H, Fujino Y, Matsuura M, Fujishiro T, Hirasawa K, Yamashita T, Kanamoto T, Miki A, Ikeda Y, Mori K, Tanito M, Inoue K, Yamagami J, Asaoka R. Relationship Between Macular Ganglion Cell Thickness and Ocular Elongation as Measured by Axial Length and Retinal Artery Position. Invest Ophthalmol Vis Sci 2021; 61:16. [PMID: 32915981 PMCID: PMC7488627 DOI: 10.1167/iovs.61.11.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose We recently reported on the usefulness of retinal artery trajectory in estimating the magnitude of retinal stretch due to myopia. The purpose of the present study was to elucidate the relationship between the peripapillary retinal artery angle (PRAA) and thickness of the macular ganglion cell–inner plexiform layer (GCIPL). Methods This r included 138 healthy eyes of 79 subjects older than 20 years of age without any known eye disease. GCIPL thickness was separated into eight sectors according to quadrant and eccentricity from the fovea. The PRAA was calculated as the angle between the superior and inferior retinal arteries. Relationships between whole GCIPL thickness (average and sectorial) and the values of PRAA and axial length (AL) were investigated using a linear mixed model. Results Average GCIPL thickness in the whole scanned area decreased significantly with narrowing of the PRAA with and without adjusting for AL. Sectorized macular GCIPL thickness also decreased significantly, with narrowing of the PRAA in seven out of the eight with the adjustment of AL, the exception being the inferior peripheral temporal sector. Conclusions Macular GCIPL thickness decreased significantly with narrowing of the PRAA on average and in seven out of eight sectors.
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Affiliation(s)
- Takashi Omoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Department of Ophthalmology, JR Tokyo General Hospital, Shibuya-ku, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Department of Ophthalmology, Shimane University Faculty of Medicine, Matsue-shi, Shimane, Japan.,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan
| | - Masato Matsuura
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takashi Fujishiro
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, School of Medicine, Kitasato University, Minami-ku, Sagamihara-shi Kanagawa, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Takashi Kanamoto
- Department of Ophthalmology, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima, Japan
| | - Atsuya Miki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan
| | - Yoko Ikeda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kajii-cho, Kamigyo-ku, Kyoto, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kajii-cho, Kamigyo-ku, Kyoto, Japan.,Oike-Ikeda Eye Clinic, Kyoto, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Matsue-shi, Shimane, Japan
| | - Kenji Inoue
- Inouye Eye Hospital, Chiyoda-ku, Tokyo, Japan
| | - Junkichi Yamagami
- Department of Ophthalmology, JR Tokyo General Hospital, Shibuya-ku, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Hamamatsu, Japan.,Seirei Christopher University, Shizuoka, Hamamatsu, Japan
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24
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Murata H, Asaoka R, Fujino Y, Matsuura M, Hirasawa K, Shimada S, Shoji N. Comparing the usefulness of a new algorithm to measure visual field using the variational Bayes linear regression in glaucoma patients, in comparison to the Swedish interactive thresholding algorithm. Br J Ophthalmol 2021; 106:660-666. [PMID: 33441321 PMCID: PMC9046736 DOI: 10.1136/bjophthalmol-2020-318304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
Background/aims We previously reported that the visual field (VF) prediction model using the variational Bayes linear regression (VBLR) is useful for accurately predicting VF progression in glaucoma (Invest Ophthalmol Vis Sci. 2014, 2018). We constructed a VF measurement algorithm using VBLR, and the purpose of this study was to investigate its usefulness. Method 122 eyes of 73 patients with open-angle glaucoma were included in the current study. VF measurement was performed using the currently proposed VBLR programme with AP-7700 perimetry (KOWA). VF measurements were also conducted using the Swedish interactive thresholding algorithm (SITA) standard programme with Humphrey field analyser. VF measurements were performed using the 24–2 test grid. Visual sensitivities, test–retest reproducibility and measurement duration were compared between the two algorithms. Result Mean mean deviation (MD) values with SITA standard were −7.9 and −8.7 dB (first and second measurements), whereas those with VBLR-VF were −8.2 and −8.0 dB, respectively. There were no significant differences across these values. The correlation coefficient of MD values between the 2 algorithms was 0.97 or 0.98. Test–retest reproducibility did not differ between the two algorithms. Mean measurement duration with SITA standard was 6 min and 02 s or 6 min and 00 s (first or second measurement), whereas a significantly shorter duration was associated with VBLR-VF (5 min and 23 s or 5 min and 30 s). Conclusion VBLR-VF reduced test duration while maintaining the same accuracy as the SITA-standard.
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Affiliation(s)
- Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan .,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Seirei Christopher University, Hamamatsu, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.,Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | | | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
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25
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Hirasawa K, Smith CA, West ME, Sharpe GP, Shuba LM, Rafuse PE, Nicolela MT, Vianna JR, Chauhan BC. Discrepancy in Loss of Macular Perfusion Density and Ganglion Cell Layer Thickness in Early Glaucoma. Am J Ophthalmol 2021; 221:39-47. [PMID: 32828878 DOI: 10.1016/j.ajo.2020.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To identify characteristics of patients with early open-angle glaucoma exhibiting greater macular perfusion density (PD) loss compared with macular ganglion cell layer (GCL) thickness loss. DESIGN Cross-sectional study. METHODS Optical coherence tomography (OCT) imaging of the optic nerve head and macula was conducted in patients and healthy control subjects. Minimum rim width, retinal nerve fiber layer and GCL thickness, and PD from OCT angiography were derived. Only high-quality images were included. For direct comparison, raw PD and GCL thickness values in patients were converted to relative age-corrected loss values based on data from controls. Demographic and ocular variables related to greater PD loss compared with GCL thickness loss were identified with multivariate logistic regression. RESULTS Data from 89 patients (median mean deviation with the 24-2 and 10-2 tests, Humphrey Field Analyzer: -1.96 dB and -1.49 dB, respectively) and 54 controls were analyzed. Sixty-three (71%) patients had relatively more GCL thickness loss, whereas 26 (29%) had relatively more PD loss. More PD loss was associated with lower OCT and OCT-angiography signal strength (odds ratio [95% confidence interval], 0.64 [0.40, 0.96] and 0.60 [0.38, 0.86], per dB, respectively), thicker retinal nerve fiber layer thickness (1.08 [1.01, 1.16] per μm), and female sex (6.57 [1.25, 48.79]). CONCLUSION Less than one-third of patients with early glaucoma had more loss of perfusion compared with conventional structural loss in the macula. Even within a range of high-quality images, lower signal strength may be at least partially responsible for apparent perfusion loss.
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Affiliation(s)
- Kazunori Hirasawa
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Corey A Smith
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael E West
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Glen P Sharpe
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Lesya M Shuba
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Paul E Rafuse
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Marcelo T Nicolela
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jayme R Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
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26
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Azuma K, Hirasawa K, Araki F, Shiraya T, Yashiro S, Kato S, Nagahara M, Ueta T. Fovea-Sparing as Opposed to Total Peeling of Internal Limiting Membrane for Myopic Foveoschisis: A Systematic Review and Meta-analysis. Ophthalmol Retina 2020; 5:670-679. [PMID: 33307217 DOI: 10.1016/j.oret.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
TOPIC The effectiveness of fovea-sparing (FS) peeling of internal limiting membrane (ILM) to treat myopic foveoschisis (MF) has not been understood fully. The present meta-analysis aimed to compare postoperative visual and anatomic outcomes between FS peeling and total peeling (TP) of ILM in pars plana vitrectomy for the treatment of MF. CLINICAL RELEVANCE Postoperative macular hole (MH) development is not uncommon and is a serious complication after surgery for MF, with poor visual prognosis. Fovea-sparing peeling of ILM is expected to reduce the risk of postoperative MH; however, no statistically significant evidence exists to prove this hypothesis. In addition, its effect on postoperative visual acuity has not been clear. METHODS MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were reviewed systematically, and studies that compared FS with total ILM peeling in MF surgery were retrieved. The protocol was registered in International Prospective Register of Systematic Reviews (identifier, CRD42020201675). Primary outcome measures were the postoperative best-corrected visual acuity (BCVA) and frequency of postoperative MH development. Certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS Eight studies with 300 eyes from 289 patients were included. All studies were nonrandomized and observational. The postoperative BCVA was significantly better in eyes treated with FS (mean difference [MD], -0.15 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.24 to -0.05 logMAR; P = 0.002). The risk of postoperative MH was significantly lower in the FS group (odds ratio, 0.19; 95% CI, 0.06-0.56; P = 0.003). No significant difference was found in postoperative central foveal thickness (MD, 12.59 μm; 95% CI, -2.8 to 28.0 μm; P = 0.11). The certainty of evidence regarding lower frequency of postoperative MH after FS peeling was considered moderate, whereas the certainty regarding better postoperative BCVA after FS peeling was judged to be low. DISCUSSION Fovea-sparing peeling may contribute to better visual acuity outcome and lower risk of postoperative MH development in eyes with MF.
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Affiliation(s)
- Kunihiro Azuma
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Orthoptics and Visual Science, School of Allied Health Science, Kitasato University, Kanagawa, Japan
| | - Fumiyuki Araki
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyasu Shiraya
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shigeko Yashiro
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kato
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Nagahara
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan.
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Hirasawa K, Matsuura M, Fujino Y, Yanagisawa M, Kanamoto T, Inoue K, Nagumo M, Yamagami J, Yamashita T, Murata H, Asaoka R. Comparing Structure-Function Relationships Based on Drasdo's and Sjöstrand's Retinal Ganglion Cell Displacement Models. Invest Ophthalmol Vis Sci 2020; 61:10. [PMID: 32293667 PMCID: PMC7401427 DOI: 10.1167/iovs.61.4.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare structure-function relationships based on the Drasdo and Sjöstrand retinal ganglion cell displacement models. Methods Single eyes from 305 patients with glaucoma and 55 heathy participants were included in this multicenter, cross-sectional study. The ganglion cell and inner plexiform layer (GCIPL) thickness was measured using spectral domain optical coherence tomography. Visual field measurements were performed using the Humphrey 10-2 test. All A-scan pixels (128 × 512 pixels) were allocated to the closest 10-2 location with both displacement models using degree and millimeter scales. Structure-function relationships were investigated between GCIPL thickness and corresponding visual sensitivity in nonlong (160 eyes) and long (200 eyes) axial length (AL) groups. Results In both the nonlong and long AL groups, compared with the no-displacement model, both the Drasdo and the Sjöstrand models showed that the structure-function relationship around the fovea improved (P < 0.05). The magnitude of improvement in the area was either comparable between the model or was larger for the Drasdo model than the Sjöstrand model (P < 0.05). Meanwhile, structure-function relationships outside the innermost retinal region that were based on the Drasdo and Sjöstrand models were comparable to or were even worse than (in the case of the Drasdo model) those obtained using the no-displacement model. Conclusions Structure-function relationships evaluated based on both the Drasdo and Sjöstrand models significantly improved around the fovea, particularly when using the Drasdo model. This was not the case in other areas.
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Aoki S, Murata H, Nakakura S, Nakao Y, Matsuura M, Hirasawa K, Tokumo K, Kiuchi Y, Asaoka R. Comment on Cataract Surgery and Rate of Visual Field Progression in Primary Open-Angle Glaucoma. Am J Ophthalmol 2020; 209:216-217. [PMID: 31706641 DOI: 10.1016/j.ajo.2019.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 11/15/2022]
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Goukon H, Hirasawa K, Kasahara M, Matsumura K, Shoji N. Comparison of Humphrey Field Analyzer and imo visual field test results in patients with glaucoma and pseudo-fixation loss. PLoS One 2019; 14:e0224711. [PMID: 31697732 PMCID: PMC6837373 DOI: 10.1371/journal.pone.0224711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 10/19/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this cross-sectional study was to evaluate the results of a visual field (VF) test for patients with glaucoma and pseudo-fixation loss. These patients exhibit fixation loss (FL) rates >20% with the Humphrey Field Analyzer (HFA); however, actual fixation stabilizes when a head-mounted perimeter (imo) is used. This device is able to adjust the stimulus presentation point by tracking eye movements. We subjected 54 eyes of 54 patients with glaucoma and pseudo-FL to the HFA 30–2 or 24–2 Swedish Interactive Threshold Algorithm -Standard protocol. All patients also underwent the imo 30–2 or 24–2 Ambient Interactive Zipper Estimated Sequential Testing protocol after HFA measurement. We compared HFA and imo reliability indices [including false-positive (FP) responses, false-negative (FN) responses, and FL rate], global indices [including mean deviation (MD), visual field index (VFI), and pattern standard deviation (PSD)], and retinal sensitivity for each test point. There were no significant differences in MD, VFI, and PSD between HFA and imo, and these measures were strongly correlated (r > 0.96, p < 0.01). There were no significant differences in FP and FN between both devices, while FL measured with HFA (27.5%) was significantly reduced when measured with imo (13.2%) (p < 0.01). There was no correlation in FL and FN between both devices, and a weak correlation for FP (r = 0.29, p = 0.04). At each test point, retinal sensitivity averaged 1.7 dB higher with HFA, compared with imo (p < 0.01). There was no significant variability in global indices in patients with pseudo-FL. The FP response rate might have influenced measures of FL in patients with glaucoma and pseudo-FL.
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Affiliation(s)
- Hiroyasu Goukon
- Graduate School of Medical Science, Kitasato University, Kanagawa, Japan
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
- Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of ophthalmology, London, United Kingdom
| | - Masayuki Kasahara
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kazuhiro Matsumura
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
- * E-mail:
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30
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Yanagisawa M, Murata H, Matsuura M, Fujino Y, Hirasawa K, Asaoka R. Investigating the structure-function relationship using Goldmann V standard automated perimetry where glaucomatous damage is advanced. Ophthalmic Physiol Opt 2019; 39:441-450. [PMID: 31595548 DOI: 10.1111/opo.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate if the structure-function relationship between circumpapillary retinal nerve fibre layer (cpRNFL) thickness and visual field (VF) thresholds is stronger when using the Goldmann V target rather than the Goldman III target where glaucomatous damage is advanced. METHODS Optical coherence tomography (OCT) and VF (Humphrey Field Analyzer 24-2 or 30-2) measurements with Goldmann III (SITA standard) and V (full-threshold) targets were carried out in 51 eyes of 51 patients with primary open angle glaucoma. The relationship between cpRNFL thicknesses in supero- and infero-temporal sectors, and VF sensitivity with the Goldmann III or V target was investigated. RESULT Visual field sensitivities (dB) both with the Goldmann III target and Goldmann V target showed a floor effect in the structure-function relationship against cpRNFL thickness, at approximately 60 μm. There was no significant relationship between visual field sensitivity measured with the Goldmann V target (dB scale: p = 0.12, 1/Lambert scale: p = 0.40; linear mixed models) and cpRNFL thickness, when corresponding visual field sensitivity, measured with the Goldmann III target, was <20 dB. CONCLUSION There was no improvement in the structure-function relationship using the Goldmann V target (full-threshold), compared to using the Goldmann III target (SITA standard), where glaucomatous damage was advanced.
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Affiliation(s)
- Mieko Yanagisawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
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Hirasawa K, Izumo M, Umemoto T, Suzuki K, Harada T, Akashi YJ. P304Prognostic significance of transvalvular flow rate during exercise in asymptomatic patients with aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The optimal management of asymptomatic aortic stenosis (AS) remains controversial. The aim of this study is to investigate the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with AS.
Purpose
To investigate the additive value of ESE in asymptomatic patients with AS.
Methods and results
We retrospectively enrolled 109 consecutive patients (mean age 73±13 years, 55 men) with AS (aortic valve area ≤1.5cm2) who underwent ESE. Of these, 10 patients referred for aortic valve replacement without symptoms were excluded; finally, 99 conservatively managed patients were enrolled. During the mean follow-up period of 14±11 months, 23 patients (23%) suffered from AS related events. Although no differences in mean pressure gradient at rest and during exercise were found between the patients with and without adverse events, transvalvular flow rate during exercise (Ex-FR) was lower in patients with adverse events than those without adverse events (236±55 ml/sec vs 274±64 ml/sec, P=0.01). Using multivariate Cox regression analysis, low Ex-FR (<270 ml/sec) was an independent predictor for adverse events in patients with asymptomatic AS (hazard ratio: 3.53, P<0.01). The Kaplan–Meier analysis showed that Ex-FR was clearly stratified the event-free survival (Figure, log-rank P<0.01).
K-M curve according to Ex-FR
Conclusion
These results suggested that Ex-FR measured by ESE should play crucial roles in risk stratification in asymptomatic patients with AS.
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Affiliation(s)
- K Hirasawa
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - M Izumo
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - T Umemoto
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - K Suzuki
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - T Harada
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - Y J Akashi
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
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Hirasawa K, Izumo M, Mizukoshi K, Suzuki T, Sato Y, Watanabe M, Kamijima R, Ohara H, Harada T, Akashi YJ. P1493Prognostic significance of right ventricular function during exercise in patients with non-obstructive hypertrophic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is a heterogeneous condition that may present crucial complication including life-threatening arrhythmia and sudden cardiac death. However, the risk stratification of HCM without left ventricular outflow tract (LVOT) obstruction had not been fully elucidated. Moreover, although recent studies have revealed the right ventricle (RV) involvement of HCM, the prognostic importance of RV function during exercise is unclear.
Purpose
To investigate the prognostic significance of RV function in patients with non-obstructive HCM using exercise stress echocardiography (ESE).
Methods and results
This study conducted on 100 HCM patients (age 62.9±13.6 years, 63% men) with preserved left ventricular ejection fraction who underwent ESE using semi-supine bicycle ergometer. Ten patients with significant LVOT obstruction (≥30mmHg) were excluded and 9 were also excluded because of the inadequate imaging quality or insufficiency of data. Among remaining 81 non-obstructive HCM patients, 9 patients suffered from HCM related cardiac events including cardiac death, unexpected hospitalization, life-threatening arrhythmias, and new-onset of syncope during the mean follow up period of 2.6±1.6 years. A multivariate Cox Hazard analysis revealed that low tricuspid annular plane systolic excursion during exercise (Ex-TAPSE, cut-off: 24mm) was an independent predictor of cardiac events. (hazard ratio: 18.66, 95% confidence interval: 3.66–338.46, P<0.001) The estimated cumulative cardiac event free survival using the Kaplan-Meier method was significantly lower in patients with reduced Ex-TAPSE (<24mm) than those with preserved Ex-TAPSE (Log-rank, P<0.01).
K-M curve according to Ex-TAPSE
Conclusion
Ex-TAPSE had a strong predictive value of clinical outcomes in non-obstructive HCM patients. Right ventricular function during exercise may have crucial role in the risk stratification of non-obstructive HCM.
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Affiliation(s)
- K Hirasawa
- Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan
| | - M Izumo
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - K Mizukoshi
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - T Suzuki
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - Y Sato
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - M Watanabe
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - R Kamijima
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - H Ohara
- Ebara Hospital, Division of Cardiology, Tokyo, Japan
| | - T Harada
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
| | - Y J Akashi
- St. Marianna University, Division of Cardiology, Department of Internal Medicine, Kawasaki, Japan
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Nakamura T, Yonetsu T, Nakao M, Nakagama S, Niida T, Matsuda Y, Hirasawa K, Hatano Y, Sasaoka T, Umemoto T, Lee T. P5622Clinical significance of late-acquired malapposition observed by serial optical coherence tomography after second-generation drug eluting stents. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies have demonstrated that the presence of late-acquired stent malapposition after stent implantation may be a risk of late and very late stent thrombosis and myocardial infarction, which is however still controversial.
Purpose
We sought to investigate the incidence and prognosis of late acquired stent malapposion after second-generation drug eluting stents (2G-DES) implantation.
Methods
A total of 199 lesions in 139 patients who underwent optical coherence tomography (OCT) at both immediately after implantation (Baseline) and 6–12 months after 2G-DES implantation (follow-up) were investigated. We excluded lesions with stent failure before follow-up examination. We evaluated presence or absence of malapposed strut at 1mm interval of OCT images and stents with one or more cross-sections with >30% malapposed strut was defined as stents with malapposition (MP), otherwise well-apposed (WA). We divided the lesions into 4 groups according to the presence of malapposition at baseline and follow-up; WA and WA, persistent well-apposed; MP and WA, resoloved malapposition; WA and MP, late acquired malapposition (LAMP); and MP and MP, persistent malapposition. We compared the target lesion failure (TLF) rate after follow-up examination among 4 groups with Kaplan–Meier analysis.
Results
Median follow-up period was 469 (IQR 71–1416) days. follow-up OCT examination was performed at median 9 months (IQR 7.6–10.5). There were no significant differences in patient's and procedural characteristics among the 4 groups. TLF rate in LAMP group was 12.0% and Kaplan–Meier analysis showed no significant differences among the 4 groups in TLF rate.
TLF-free suvival curves (Kaplan-Meier)
Conclusion
LAMP was observed by OCT at 6–12 months in 12.0% of lesions after 2G-DES implantation, which was not associated with TLF at 5 years.
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Affiliation(s)
- T Nakamura
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - T Yonetsu
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - M Nakao
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - S Nakagama
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - T Niida
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - Y Matsuda
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - K Hirasawa
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - Y Hatano
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - T Sasaoka
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - T Umemoto
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
| | - T Lee
- Tokyo Medical and Dental University, Bunkyo-ku Tokyo, Japan
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Asaoka R, Murata H, Hirasawa K, Fujino Y, Matsuura M, Miki A, Kanamoto T, Ikeda Y, Mori K, Iwase A, Shoji N, Inoue K, Yamagami J, Araie M. Using Deep Learning and Transfer Learning to Accurately Diagnose Early-Onset Glaucoma From Macular Optical Coherence Tomography Images. Am J Ophthalmol 2019; 198:136-145. [PMID: 30316669 DOI: 10.1016/j.ajo.2018.10.007] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE We sought to construct and evaluate a deep learning (DL) model to diagnose early glaucoma from spectral-domain optical coherence tomography (OCT) images. DESIGN Artificial intelligence diagnostic tool development, evaluation, and comparison. METHODS This multi-institution study included pretraining data of 4316 OCT images (RS3000) from 1371 eyes with open angle glaucoma (OAG) regardless of the stage of glaucoma and 193 normal eyes. Training data included OCT-1000/2000 images from 94 eyes of 94 patients with early OAG (mean deviation > -5.0 dB) and 84 eyes of 84 normal subjects. Testing data included OCT-1000/2000 from 114 eyes of 114 patients with early OAG (mean deviation > -5.0 dB) and 82 eyes of 82 normal subjects. A DL (convolutional neural network) classifier was trained using a pretraining dataset, followed by a second round of training using an independent training dataset. The DL model input features were the 8 × 8 grid macular retinal nerve fiber layer thickness and ganglion cell complex layer thickness from spectral-domain OCT. Diagnostic accuracy was investigated in the testing dataset. For comparison, diagnostic accuracy was also evaluated using the random forests and support vector machine models. The primary outcome measure was the area under the receiver operating characteristic curve (AROC). RESULTS The AROC with the DL model was 93.7%. The AROC significantly decreased to between 76.6% and 78.8% without the pretraining process. Significantly smaller AROCs were obtained with random forests and support vector machine models (82.0% and 67.4%, respectively). CONCLUSION A DL model for glaucoma using spectral-domain OCT offers a substantive increase in diagnostic performance.
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Murata H, Zangwill LM, Fujino Y, Matsuura M, Miki A, Hirasawa K, Tanito M, Mizoue S, Mori K, Suzuki K, Yamashita T, Kashiwagi K, Shoji N, Asaoka R. Validating Variational Bayes Linear Regression Method With Multi-Central Datasets. Invest Ophthalmol Vis Sci 2019; 59:1897-1904. [PMID: 29677350 PMCID: PMC5886131 DOI: 10.1167/iovs.17-22907] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To validate the prediction accuracy of variational Bayes linear regression (VBLR) with two datasets external to the training dataset. Method The training dataset consisted of 7268 eyes of 4278 subjects from the University of Tokyo Hospital. The Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG) dataset consisted of 271 eyes of 177 patients, and the Diagnostic Innovations in Glaucoma Study (DIGS) dataset includes 248 eyes of 173 patients, which were used for validation. Prediction accuracy was compared between the VBLR and ordinary least squared linear regression (OLSLR). First, OLSLR and VBLR were carried out using total deviation (TD) values at each of the 52 test points from the second to fourth visual fields (VFs) (VF2–4) to 2nd to 10th VF (VF2–10) of each patient in JAMDIG and DIGS datasets, and the TD values of the 11th VF test were predicted every time. The predictive accuracy of each method was compared through the root mean squared error (RMSE) statistic. Results OLSLR RMSEs with the JAMDIG and DIGS datasets were between 31 and 4.3 dB, and between 19.5 and 3.9 dB. On the other hand, VBLR RMSEs with JAMDIG and DIGS datasets were between 5.0 and 3.7, and between 4.6 and 3.6 dB. There was statistically significant difference between VBLR and OLSLR for both datasets at every series (VF2–4 to VF2–10) (P < 0.01 for all tests). However, there was no statistically significant difference in VBLR RMSEs between JAMDIG and DIGS datasets at any series of VFs (VF2–2 to VF2–10) (P > 0.05). Conclusions VBLR outperformed OLSLR to predict future VF progression, and the VBLR has a potential to be a helpful tool at clinical settings.
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Affiliation(s)
- Hiroshi Murata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Linda M Zangwill
- Shiley Eye Institute Hamilton Glaucoma Center, University of California, San Diego, La Jolla, California, United States
| | - Yuri Fujino
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Atsuya Miki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Hirasawa
- Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, United Kingdom.,Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Shiro Mizoue
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuyoshi Suzuki
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Nobuyuki Shoji
- Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Hirasawa K, Yamashita T, Fujino Y, Matsuura M, Yanagisawa M, Kii Y, Sakamoto T, Murata H, Asaoka R. Relationship between the Vertical Asymmetry of the Posterior Pole of the Eye and the Visual Field Damage in Glaucomatous Eyes. Ophthalmol Glaucoma 2019; 2:28-35. [PMID: 32672554 DOI: 10.1016/j.ogla.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/01/2018] [Accepted: 11/09/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE This study investigated the relationship between the shape of the posterior pole of the eye and the vertical asymmetry of visual field (VF) damage in glaucomatous eyes. DESIGN Cross-sectional study. PARTICIPANTS A total of 83 eyes of 43 patients with open-angle glaucoma. METHODS The VF was measured using the Humphrey 24-2 or 30-2 Swedish Interactive Thresholding Algorithm (SITA) standard. The vertical asymmetry of VF damage was defined as the difference between the mean total deviation (mTD) values of the superior and inferior hemi-retinas. This difference was calculated for the hemifield, central, middle, and peripheral areas. A vertical cross-sectional image of the macula was obtained, and the magnitudes of superior and inferior retinal tilt (RT) were calculated as the difference between the lower margins of the retinal pigment epithelium (RPE) at the fovea and at a location 2 mm superior or inferior to the RPE. The RT asymmetry was defined as the difference between the inferior and superior RT. Data were analyzed using a multivariate linear mixed model. MAIN OUTCOME MEASURES The relationship between mTD asymmetry (hemifield, central, middle, and peripheral) and both RT asymmetry and other factors (intraocular pressure, axial length, corneal radius, age, gender, mean deviation, refraction, and visual acuity) was assessed. RESULTS The inferior RT was significantly larger than the superior RT (P < 0.001). Hemifield mTD asymmetry was related to RT asymmetry (P = 0.017). These relationships were significant in the middle (P = 0.029) and peripheral areas (P = 0.023), but not in the central area (P = 0.40). Other factors were not related to mTD asymmetry. CONCLUSIONS Vertical asymmetry of the posterior pole was related to the vertical asymmetry of glaucomatous VF damage.
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Affiliation(s)
- Kazunori Hirasawa
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan; Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuri Fujino
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Ophthalmology, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Mieko Yanagisawa
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yuya Kii
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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37
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Takahashi M, Goseki T, Ishikawa H, Hiroyasu G, Hirasawa K, Shoji N. Compressive Lesions of the Optic Chiasm: Subjective Symptoms and Visual Field Diagnostic Criteria. Neuroophthalmology 2018; 42:343-348. [PMID: 30524487 DOI: 10.1080/01658107.2018.1438477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 09/30/2022]
Abstract
We investigated the diagnostic ability of a new criterion (simple temporal depression) for compressive lesions of the optic chiasm. The subjects were 124 eyes with compressive lesions of the optic chiasm. The controls were 84 eyes. The Humphrey (Carl Zeiss) visual field test was used for visual field testing. The simple temporal depression index was calculated as the ratio of the sums of the thresholds for one line on the nasal side and temporal side of the vertical meridian. The result of new index was 87% sensitivity and 99% specificity. This result suggested that our new criterion will assist the diagnosis in the future.
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Affiliation(s)
- Mikiko Takahashi
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Toshiaki Goseki
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan
| | - Hitoshi Ishikawa
- Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan.,Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Goukon Hiroyasu
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, United Kingdom
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Japan
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Hirasawa K, Kobayashi K, Shibamoto A, Tobari H, Fukuda Y, Shoji N. Variability in monocular and binocular fixation during standard automated perimetry. PLoS One 2018; 13:e0207517. [PMID: 30462706 PMCID: PMC6248984 DOI: 10.1371/journal.pone.0207517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 11/01/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this cross-sectional study was to use standard automated perimetry to compare fixation variability among the dominant eye fixation, non-dominant eye fixation, and binocular fixation conditions. Thirty-five eyes of 35 healthy young participants underwent standard automated perimetry (Humphrey 24–2 SITA-Standard) in dominant eye fixation, non-dominant eye fixation, and binocular fixation conditions. Fixation variability during foveal threshold and visual field measurement, which was recorded using a wearable eye-tracking glass and calculated using the bivariate contour ellipse area (deg2), was compared among the three fixation conditions. Further, the association of bivariate contour ellipse area with ocular position and fusional amplitude during binocular fixation was analysed. There were no significant differences in bivariate contour ellipse area during foveal threshold measurement among the dominant eye fixation (1.75 deg2), non-dominant eye fixation (1.45 deg2), and binocular fixation (1.62 deg2) conditions. In contrast, the bivariate contour ellipse area during visual field measurement in binocular fixation (2.85 deg2) was significantly lower than the bivariate contour ellipse area in dominant eye fixation (4.62 deg2; p = 0.0227) and non-dominant eye fixation (5.24 deg2; p = 0.0006) conditions. There was no significant difference in bivariate contour ellipse area during visual field measurement between dominant eye fixation and non-dominant eye fixation conditions. There was no significant correlation between bivariate contour ellipse area and either ocular position or fusional amplitude during both foveal threshold and visual field measurements. Thus, fixation variability might be improved in binocular fixation conditions during a long-duration test, such as visual field measurement.
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Affiliation(s)
- Kazunori Hirasawa
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
- Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, United Kingdom
| | - Kaoru Kobayashi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Asuka Shibamoto
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Houmi Tobari
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia
| | - Yuki Fukuda
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
- * E-mail:
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Hirasawa K, Nakakura S, Nakao Y, Fujino Y, Matsuura M, Murata H, Kiuchi Y, Asaoka R. Changes in Corneal Biomechanics and Intraocular Pressure Following Cataract Surgery. Am J Ophthalmol 2018; 195:26-35. [PMID: 30071213 DOI: 10.1016/j.ajo.2018.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the effects of cataract surgery on corneal biomechanics and intraocular pressure (IOP) measured with the updated Corvis ST tonometer (CST). DESIGN Prospective, interventional case series study. METHODS This study included 39 eyes of 39 cataract patients. CST measurements were performed at presurgery (Pre) as well as 1 week (1W), 1 month (1M), and 3 months (3M) postsurgery. The following CST parameters were recorded: deformation amplitude max (DA max), DA ratio max 1 mm and 2 mm, integrated radius, stiffness parameter at applanation 1 (SP A1), Ambrosio relational thickness to the horizontal profile (ARTh), Corvis biomechanical index (CBI), central corneal thickness (CCT), noncorrected intraocular pressure (IOPnct), and biomechanically corrected IOP (bIOP). IOP was also measured with Goldmann applanation tonometry and the noncontact tonometer CT-90A. All measurements were compared at each period using the linear mixed model, with and without adjustment for bIOP and CCT. RESULTS All IOP measurements decreased over time (P < .01). CCT was increased at 1W and 3M (P < .01), whereas ARTh was decreased at 1W and 1M (P < .01), but returned to its Pre level at 3M. DA max and Integrated radius were increased at 3M (P < .01), whereas SP A1 was decreased at 3M (P < .01). CBI was increased at 1W (P < .01), but returned to its Pre level at 1M. CONCLUSIONS IOP and Corneal biomechanical properties are changed after cataract surgery. In particular, SP A1 decreases while DA max and integrated radius increase, even at 3M, suggesting a less stiff cornea.
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Matsuura M, Murata H, Fujino Y, Hirasawa K, Yanagisawa M, Asaoka R. Reply. Am J Ophthalmol 2018; 190:201-202. [PMID: 29627064 DOI: 10.1016/j.ajo.2018.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/10/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
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Matsuura M, Murata H, Fujino Y, Hirasawa K, Yanagisawa M, Asaoka R. Evaluating the Usefulness of MP-3 Microperimetry in Glaucoma Patients. Am J Ophthalmol 2018; 187:1-9. [PMID: 29248331 DOI: 10.1016/j.ajo.2017.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the current study was to evaluate the test-retest reproducibility and structure-function relationship of the MP-3 microperimeter, compared against the Humphrey Field Analyzer (HFA). METHODS Design: Reliability and validity study. SETTING Institutional, or clinical practice. STUDY POPULATION Thirty eyes of 30 primary open-angle glaucoma patients were enrolled. OBSERVATION PROCEDURES Visual fields (VF) were measured twice with the MP-3 and HFA instruments, using the 10-2 test grid pattern in both perimeters. Ganglion cell complex (GCC) thickness was measured using optical coherence tomography (OCT). Test-retest reproducibility was assessed using the mean absolute deviation (MAD) measure at all 68 VF test points, and also the intraclass correlation coefficient (ICC) of the repeated VF sensitivities. The structure-function relationship between VF sensitivities (measured with MP-3 or HFA) and GCC thickness (adjusted for the retinal ganglion cell displacement) was analyzed using linear mixed modeling. MAIN OUTCOME MEASURE Reproducibility and structure-function relationship. RESULTS The average measurement duration with the HFA 10-2 was 7 minutes and 6 seconds (7m06s) ± 0m49s (mean ± standard deviation). A significantly (P < .001, paired Wilcoxon test) longer measurement duration was observed for the MP-3 test: 10m29s ± 2m55s. There were no significant differences in MAD and ICC values between HFA (MAD; 0.83 ± 0.69 dB and ICC: 0.89 ± 0.69, mean ± standard deviation) and MP-3 (MAD: 0.65 ± 0.67 dB and ICC: 0.89 ± 0.69). MP-3 VF sensitivities had a stronger structure-function relationship with GCC thickness compared to HFA. CONCLUSIONS The MP-3 microperimeter has a similar test-retest reproducibility to the HFA but a better structure-function relationship.
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Affiliation(s)
- Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan; Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Kanagawa, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Kanagawa, Japan; Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan; Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, United Kingdom
| | - Mieko Yanagisawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.
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Yanagisawa M, Murata H, Matsuura M, Fujino Y, Hirasawa K, Asaoka R. Goldmann V Standard Automated Perimetry Underestimates Central Visual Sensitivity in Glaucomatous Eyes with Increased Axial Length. Transl Vis Sci Technol 2017; 6:13. [PMID: 29082108 PMCID: PMC5656222 DOI: 10.1167/tvst.6.5.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/23/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To investigate the effect of axial length (AL) on the structure-function relationship between retinal nerve fiber layer (RNFL) thickness measurements and visual field (VF) sensitivity measured with Goldmann III and V. METHOD There were 85 eyes of 85 patients with primary open angle glaucoma included in the current study. Optical coherence tomography and VF (Humphrey Field Analyzer 24-2 or 30-2) measurements with Goldmann III and V targets were carried out in all patients. The optic disc and the VF were divided into six clusters and the relationship between circumpapillary RNFL (cpRNFL) thickness and VF sensitivity (with Goldmann III or V), age, and AL were investigated in each cluster. RESULT Visual sensitivity with Goldmann III (19.3 ± 11.7 dB, mean ± standard deviation) was significantly lower than that with Goldmann V (24.6 ± 11.0 dB, P < 0.001, linear mixed model). Visual sensitivities with both Goldmann III and V were significantly correlated with cpRNFL thickness in all clusters. Visual sensitivity decreased with increasing AL in the nasal retinal area for both targets, however, this phenomenon was only observed with the Goldmann V target in the temporal area. CONCLUSION Visual sensitivity measured with the size V target decreases with increasing AL in the temporal area, which corresponds to the papillomacular bundle. In the nasal retinal area, visual sensitivity decreases with the increase of AL for both Goldmann III and Goldmann V. TRANSLATIONAL RELEVANCE Careful consideration is needed when measuring visual sensitivity using Goldmann V target in glaucomatous eyes with increased AL.
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Affiliation(s)
- Mieko Yanagisawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan.,Moorfields Eye Hospital NHS Foundation Trust and University College London, Institute of Ophthalmology, London, UK
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
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Hirasawa K, Shoji N. Influence of corneal power on circumpapillary retinal nerve fiber layer and optic nerve head measurements by spectral-domain optical coherence tomography. Int J Ophthalmol 2017; 10:1385-1391. [PMID: 28944197 DOI: 10.18240/ijo.2017.09.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/24/2017] [Indexed: 12/21/2022] Open
Abstract
AIM To evaluate the influence of corneal power on circumpapillary retinal nerve fiber layer (cpRNFL) and optic nerve head (ONH) measurements by spectral-domain optical coherence tomography (SD-OCT). METHODS Twenty-five eyes of 25 healthy participants (mean age 23.6±3.6y) were imaged by SD-OCT using horizontal raster scans. Disposable soft contact lenses of different powers (from -11 to +5 diopters including 0 diopter) were worn to induce 2-diopter changes in corneal power. Differences in the cpRNFL and ONH measurements per diopter of change in corneal power were analyzed. RESULTS As corneal power increased by 1 diopter, total and quadrant cpRNFL thicknesses, except for the nasal sector, decreased by --0.19 to -0.32 µm (P<0.01). Furthermore, the disc, cup, and rim areas decreased by -0.017, -0.007, and -0.015 mm2, respectively (P<0.001); the cup and rim volumes decreased by -0.0013 and -0.006 mm3, respectively (P<0.01); and the vertical and horizontal disc diameters decreased by -0.006 and -0.007 mm, respectively (P<0.001). CONCLUSION For more precise OCT imaging, the ocular magnification should be corrected by considering both the axial length and corneal power. However, the effect of corneal power changes on cpRNFL thickness and ONH topography are small when compare with those of the axial length.
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Affiliation(s)
- Kazunori Hirasawa
- Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa 252-0373, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of medicine, Kitasato University, Sagamihara, Kanagawa 252-0373, Japan
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Hirasawa K, Matsuura M, Murata H, Nakakura S, Nakao Y, Kiuchi Y, Asaoka R. Association between Corneal Biomechanical Properties with Ocular Response Analyzer and Also CorvisST Tonometry, and Glaucomatous Visual Field Severity. Transl Vis Sci Technol 2017. [PMID: 28626602 PMCID: PMC5472364 DOI: 10.1167/tvst.6.3.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association between corneal biomechanical properties measured with the Ocular Response Analyzer (ORA) and also CorvisST (CST) tonometry, and glaucomatous visual field (VF) severity. Methods One hundred forty-six eyes of 91 patients with primary open-angle glaucoma who performed Humphrey Field Analyzer 30-2 or 24-2 SITA-Standard, ORA, and CST within 180 days were included in this multicentral, observational cross-sectional study. The association between ORA parameters (corneal hysteresis [CH] and corneal resistant factor [CRF]), CST parameters (A1 and A2 time, A1 and A2 length, A1 and A2 velocity, A1 and A2 deformation amplitude, highest deformation amplitude, highest concavity time, peak distance, and radius), and other basic parameters (age, intraocular pressure with Goldmann applanation tonometry, central corneal thickness, and axial length) against mean total deviation (mTD) were analyzed using a linear mixed-model and model selection with corrected Akaike Information Criterion (AICc). Results The optimal model of VF severity included ORA's CH as well as a number of CST parameters, including A1 length, A2 time, radius, and highest concavity deformation amplitude (AICc: 971.7). The possibility this model describes visual field severity more accurately than the optimal model without CST parameters was 99.98%. Conclusion Glaucomatous VF severity was best described by both ORA and CST parameters. Eyes with corneas that experience sharp and deep indentation at the maximum deformation, wide indentation at the first applanation, and early second applanation in the CST measurement are more likely to show advanced VF severity. Translational Relevance CorvisST tonometry parameters are related to VF severity in glaucoma patients.
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Affiliation(s)
- Kazunori Hirasawa
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, Japan
| | - Yoshitaka Nakao
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Takahashi N, Hirasawa K, Hoshina M, Kasahara M, Matsumura K, Shoji N. Diagnostic Ability and Repeatability of a New Supra-Threshold Glaucoma Screening Program in Standard Automated Perimetry. Transl Vis Sci Technol 2017; 6:7. [PMID: 28553561 PMCID: PMC5444500 DOI: 10.1167/tvst.6.3.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/17/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose We assess the diagnostic ability and repeatability of a new suprathreshold glaucoma screening test (GST) comprising 28 test points and a 1-of-3 sampling strategy at 95% of the normal limit for standard automated perimetry (SAP) in early to advanced glaucoma. Methods This prospective cross-sectional study included 96 eyes of patients with early, moderate, or advanced glaucoma and 37 eyes of normal controls. Participants were evaluated by the G-Dynamic threshold test once and the GST twice, in random order, using the Octopus 600 perimeter. The diagnostic ability of GST was assessed by comparison with the G-Dynamic threshold obtained by receiver operating characteristic analysis. Repeatability was assessed by κ statistics for agreement on glaucoma diagnosis and each test point. Results Although the G-Dynamic test exhibited significantly higher areas under the curve (AUC) than the GST1st (P = 0.009) in early glaucoma, there were no significant differences in any other AUCs between the two methods. The κ values for repeatability of glaucoma diagnosis and each test point were 0.747 to 1.0 and 0.537 to 1.0, respectively. The duration of the GST in the control and early glaucoma groups was less than a minute, while that in the moderate and advanced glaucoma groups was within 1.5 minutes. Conclusion The diagnostic ability of the new suprathreshold GST for early to advanced glaucoma was high, with moderate to strong repeatability and short test duration. Translational Relevance There currently are no prominent suprathreshold screening strategies using SAP. The GST would be an effective clinical method for glaucoma screening.
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Affiliation(s)
- Natsumi Takahashi
- Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan
| | - Kazunori Hirasawa
- Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Miki Hoshina
- Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan
| | - Masayuki Kasahara
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kazuhiro Matsumura
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
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Aoki S, Murata H, Fujino Y, Matsuura M, Miki A, Tanito M, Mizoue S, Mori K, Suzuki K, Yamashita T, Kashiwagi K, Hirasawa K, Shoji N, Asaoka R. Investigating the usefulness of a cluster-based trend analysis to detect visual field progression in patients with open-angle glaucoma. Br J Ophthalmol 2017; 101:1658-1665. [PMID: 28450381 DOI: 10.1136/bjophthalmol-2016-310069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/16/2017] [Accepted: 03/24/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To investigate the usefulness of the Octopus (Haag-Streit) EyeSuite's cluster trend analysis in glaucoma. METHODS Ten visual fields (VFs) with the Humphrey Field Analyzer (Carl Zeiss Meditec), spanning 7.7 years on average were obtained from 728 eyes of 475 primary open angle glaucoma patients. Mean total deviation (mTD) trend analysis and EyeSuite's cluster trend analysis were performed on various series of VFs (from 1st to 10th: VF1-10 to 6th to 10th: VF6-10). The results of the cluster-based trend analysis, based on different lengths of VF series, were compared against mTD trend analysis. RESULT Cluster-based trend analysis and mTD trend analysis results were significantly associated in all clusters and with all lengths of VF series. Between 21.2% and 45.9% (depending on VF series length and location) of clusters were deemed to progress when the mTD trend analysis suggested no progression. On the other hand, 4.8% of eyes were observed to progress using the mTD trend analysis when cluster trend analysis suggested no progression in any two (or more) clusters. CONCLUSION Whole field trend analysis can miss local VF progression. Cluster trend analysis appears as robust as mTD trend analysis and useful to assess both sectorial and whole field progression. Cluster-based trend analyses, in particular the definition of two or more progressing cluster, may help clinicians to detect glaucomatous progression in a timelier manner than using a whole field trend analysis, without significantly compromising specificity.
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Affiliation(s)
- Shuichiro Aoki
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, Tokyo Hospital, Tokyo, Japan
| | | | - Atsuya Miki
- Department of Ophthalmology, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shiro Mizoue
- Department of Ophthalmology, Minami-matsuyama Hospital, Matsuyama-shi, Ehime, Japan.,Department of Ophthalmology, Ehime University School of Medicine, Toon-shi, Ehime, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuyoshi Suzuki
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Rehabilitation, Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Hirasawa K, Takahashi N, Satou T, Kasahara M, Matsumura K, Shoji N. Comparison of Size Modulation Standard Automated Perimetry and Conventional Standard Automated Perimetry with a 10-2 Test Program in Glaucoma Patients. Curr Eye Res 2017; 42:1160-1168. [PMID: 28441081 DOI: 10.1080/02713683.2017.1293114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This prospective observational study compared the performance of size modulation standard automated perimetry with the Octopus 600 10-2 test program, with stimulus size modulation during testing, based on stimulus intensity and conventional standard automated perimetry, with that of the Humphrey 10-2 test program in glaucoma patients. METHODS Eighty-seven eyes of 87 glaucoma patients underwent size modulation standard automated perimetry with Dynamic strategy and conventional standard automated perimetry using the SITA standard strategy. The main outcome measures were global indices, point-wise threshold, visual defect size and depth, reliability indices, and test duration; these were compared between size modulation standard automated perimetry and conventional standard automated perimetry. RESULTS Global indices and point-wise threshold values between size modulation standard automated perimetry and conventional standard automated perimetry were moderately to strongly correlated (p < 0.01). However, the correlation coefficient of point-wise threshold value for the central zone was significantly lower than that for the peripheral zone (χ2 > 33.40, p < 0.01). Better mean defect and point-wise threshold values were obtained with size modulation standard automated perimetry than with conventional standard automated perimetry, but the visual-field defect size was smaller (p < 0.01) and depth shallower (p < 0.01) on size modulation-standard automated perimetry than on conventional standard automated perimetry. The reliability indices, particularly the false-negative response, of size modulation standard automated perimetry were worse than those of conventional standard automated perimetry (p < 0.01). The test duration was 6.5% shorter with size modulation standard automated perimetry than with conventional standard automated perimetry (p = 0.02). CONCLUSIONS Global indices and the point-wise threshold value of the two testing modalities correlated well. However, the potential of a large stimulus presented at an area with a decreased sensitivity with size modulation standard automated perimetry could underestimate the actual threshold in the 10-2 test protocol, as compared with conventional standard automated perimetry.
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Affiliation(s)
- Kazunori Hirasawa
- a Department of Orthoptics and Visual Science , School of Allied Health Sciences, Kitasato University , Kanagawa , Japan
| | - Natsumi Takahashi
- b Department of Ophthalmology , Kitasato University Hospital , Kanagawa , Japan
| | - Tsukasa Satou
- c Department of Orthoptics and Visual Sciences , International University of Health and Welfare School of Health Sciences , Tochigi , Japan
| | - Masayuki Kasahara
- d Department of Ophthalmology , School of Medicine, Kitasato University , Kanagawa , Japan
| | - Kazuhiro Matsumura
- d Department of Ophthalmology , School of Medicine, Kitasato University , Kanagawa , Japan
| | - Nobuyuki Shoji
- d Department of Ophthalmology , School of Medicine, Kitasato University , Kanagawa , Japan
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Kofahi HM, Taylor NGA, Hirasawa K, Grant MD, Russell RS. Hepatitis C Virus Infection of Cultured Human Hepatoma Cells Causes Apoptosis and Pyroptosis in Both Infected and Bystander Cells. Sci Rep 2016; 6:37433. [PMID: 27974850 PMCID: PMC5156923 DOI: 10.1038/srep37433] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/24/2016] [Indexed: 12/16/2022] Open
Abstract
Individuals infected with hepatitis C virus (HCV) are at high risk of developing progressive liver disease, including cirrhosis and hepatocellular carcinoma (HCC). How HCV infection causes liver destruction has been of significant interest for many years, and apoptosis has been proposed as one operative mechanism. In this study, we employed a tissue culture-adapted strain of HCV (JFH1T) to test effects of HCV infection on induction of programmed cell death (PCD) in Huh-7.5 cells. We found that HCV infection reduced the proliferation rate and induced caspase-3-mediated apoptosis in the infected cell population. However, in addition to apoptosis, we also observed infected cells undergoing caspase-1-mediated pyroptosis, which was induced by NLRP3 inflammasome activation. By co-culturing HCV-infected Huh-7.5 cells with an HCV-non-permissive cell line, we also demonstrated induction of both apoptosis and pyroptosis in uninfected cells. Bystander apoptosis, but not bystander pyroptosis, required cell-cell contact between infected and bystander cells. In summary, these findings provide new information on mechanisms of cell death in response to HCV infection. The observation that both apoptosis and pyroptosis can be induced in bystander cells extends our understanding of HCV-induced pathogenesis in the liver.
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Affiliation(s)
- H M Kofahi
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland A1B 3V6, Canada
| | - N G A Taylor
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland A1B 3V6, Canada
| | - K Hirasawa
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland A1B 3V6, Canada
| | - M D Grant
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland A1B 3V6, Canada
| | - R S Russell
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland A1B 3V6, Canada
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Asaoka R, Murata H, Fujino Y, Hirasawa K, Tanito M, Mizoue S, Mori K, Suzuki K, Yamashita T, Kashiwagi K, Miki A, Shoji N. Effects of ocular and systemic factors on the progression of glaucomatous visual field damage in various sectors. Br J Ophthalmol 2016; 101:1071-1075. [PMID: 27941050 DOI: 10.1136/bjophthalmol-2016-309643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/28/2016] [Accepted: 11/19/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM To investigate the effects of ocular and systemic risk factors for glaucomatous progression in different sectors of the visual field (VF). METHOD 409 eyes from 268 patients with 10 reliable VFs from the Japanese Archive of Multicentral Databases in Glaucoma (JAMDIG) were investigated. VFs were divided into six sectors (mean total deviation (mTD)s20+, mTDs10-20 and mTDs0-10, >20°, 10-20° and <10° in the superior hemifield, respectively; and mTDi20+, mTDi10-20 and mTDi0-10, >20°, 10-20° and <10° in the inferior hemifield, respectively). The relationship between sectorial progression rate and eight variables (age, mTD at baseline VF, average intraocular pressure (IOP), SD of IOP, systemic hypertension, migraine, family history of glaucoma and smoking status) was investigated. RESULT The mTD progression rate was -0.21 dB/year. Older age was related to progression of mTDs20+, mTDs10-20, mTDi20+ and mTDi10-20. Mean IOP was not related to progression in any VF sector; however, a larger SD of IOP was related to progression of mTDs20+, mTDi0-10, mTDi10-20 and mTDi20+. Smoking status was related to progression in all inferior VF sectors (mTDi0-10, mTDi10-20 and mTDi20+). CONCLUSIONS Smoking status is related to glaucomatous VF progression in all sectors of the inferior hemifield.
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Affiliation(s)
- Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan.,Division of Ophthalmology, Matsue Red Cross Hospital, Shimane, Japan
| | - Shiro Mizoue
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuyoshi Suzuki
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Atsuya Miki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuyuki Shoji
- Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
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50
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Igarashi N, Matsuura M, Hashimoto Y, Hirasawa K, Murata H, Inoue T, Ryo O, Aihara M, Asaoka R. Assessing Visual Fields in Patients with Retinitis Pigmentosa Using a Novel Microperimeter with Eye Tracking: The MP-3. PLoS One 2016; 11:e0166666. [PMID: 27893769 PMCID: PMC5125600 DOI: 10.1371/journal.pone.0166666] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of the current study is to investigate the test-retest reproducibility of visual fields (VFs) measured with the MP-3 microperimeter, in patients with retinitis pigmentosa (RP). METHOD VFs were twice measured with the MP-3 and also the Humphrey Field Analyzer, using the 10-2 test grid pattern in both perimeters, in 30 eyes (15 right and 15 left eyes) of 18 RP patients (11 males and 7 females). Test-retest reproducibility was assessed using the mean absolute deviation (MAD) measure at all 68 points in the test grid. Reproducibility was also evaluated using the intraclass correlation coefficient (ICC) of VF sensitivities. RESULT The mean sensitivity measured in the HFA 10-2 was significantly higher than that measured in the MP-3 in both the first and second VF tests (p <0.0001, linear mixed model). The MAD was 2.4±0.6 [1.1 to 3.6] dB for MP-3 and 2.4±0.9 [1.1 to 5.1] dB for HFA 10-2, which was not significantly different (p = 0.76, linear mixed model). The ICC value associated with the MP-3 VFs was 0.81±0.13 [0.49 to 0.98], which was significantly larger than that observed for the HFA 10-2 VFs: 0.77±0.19 [0.20 to 0.94] (p = 0.043, linear mixed model). CONCLUSION The MP-3 microperimeter appears to be useful to evaluate central visual function in RP eyes, exhibiting test-retest reproducibility that is equal to, or better than, that observed in HFA 10-2 VFs.
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Affiliation(s)
- Nozomi Igarashi
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Obata Ryo
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- * E-mail:
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