A shared neural ensemble links distinct contextual memories encoded close in time.

Recent studies suggest that a shared neural ensemble may link distinct memories encoded close in time. According to the memory allocation hypothesis, learning triggers a temporary increase in neuronal excitability that biases the representation of a subsequent memory to the neuronal ensemble encoding the first memory, such that recall of one memory increases the likelihood of recalling the other memory. Here we show in mice that the overlap between the hippocampal CA1 ensembles activated by two distinct contexts acquired within a day is higher than when they are separated by a week. Several findings indicate that this overlap of neuronal ensembles links two contextual memories. First, fear paired with one context is transferred to a neutral context when the two contexts are acquired within a day but not across a week. Second, the first memory strengthens the second memory within a day but not across a week. Older mice, known to have lower CA1 excitability, do not show the overlap between ensembles, the transfer of fear between contexts, or the strengthening of the second memory. Finally, in aged mice, increasing cellular excitability and activating a common ensemble of CA1 neurons during two distinct context exposures rescued the deficit in linking memories. Taken together, these findings demonstrate that contextual memories encoded close in time are linked by directing storage into overlapping ensembles. Alteration of these processes by ageing could affect the temporal structure of memories, thus impairing efficient recall of related information.

Organic Supramolecular Zippers with Ultralong Organic Phosphorescence by a Dexter Energy Transfer Mechanism.

Ultralong organic phosphorescence (UOP) materials glow persistently in the dark, which offers new exciting possibilities in the fields of anti-counterfeiting, photoelectric devices and biological imaging. However, the development of single-component UOP materials remains a great challenge. Herein, we develop a single component organic supramolecular zipper system with a lifetime up to 0.77 s. Owing to the introduction of a pyrazole ring into the diphenylsulfone group, the "V" shaped molecules were artfully self-assembled into supramolecular zippers via π-π and C-H⋅⋅⋅π interactions, that is not only of significance in highly efficient generation of triplet excitons but also facilitates a Dexter energy transfer process within supramolecular zippers, that are responsible for alleviating radiative and non-radiative deactivation decay of triplet excitons, to finally boost the UOP. This finding not only gives a new set of guidelines for the design of single-component UOP molecules but also reveals the UOP mechanism from a new perspective.

Organometallic Ir(III) Phosphors Decorated by Carbazole/Diphenylphosphoryl Units for Efficient Solution-Processable OLEDs with Low Efficiency Roll-Offs.

Recently, solution-processable PhOLEDs have been attracting great interest for their low cost and high productivity relative to the vacuum-deposited devices. Similar to vacuum-deposited OLEDs, however, they usually suffer from serious efficiency roll-offs, especially in high brightness. Finding a feasible way and/or designing novel materials to increase efficiencies and reduce roll-offs simultaneously are highly desired. Herein, a new family of solution-processable cyclometalated iridium(III) phosphors with carbazole (Cz) and/or diphenylphosphoryl (Ph2PO) units functionalized main ligands has been designed. Owing to Cz and Ph2PO moieties possessing bulky steric effects, they can suppress the intermolecular strong packing and then decrease TTA effects and emission quenching. Meanwhile, the resulting OLEDs based on the designed phosphors exhibit considerable efficiencies and relatively small efficiency roll-offs. The device based on 4 containing both Cz and Ph2PO units realized a maximum current efficiency of 21.3 cd A-1, accompanied by a small roll-off. By optimization of the configuration of OLEDs, the device performance can be further enhanced, demonstrating their potential for high-performance solution-processable PhOLEDs.

Plasma exchange: an effective add-on treatment of optic neuritis in neuromyelitis optica spectrum disorders.

PURPOSE: To evaluate the efficiency of plasma exchange (PE) add-on on optic neuritis (ON) in neuromyelitis optica spectrum disorders (NMOSD). METHODS: Our ambispective, nonrandomized study was performed in Southwest Hospital, Southwest Eye Hospital, Army Medical University. We studied 31 consecutive NMOSD patients characterized by ON and hospitalized from September 2015 to May 2018. Their clinical features were assessed, and efficiency of PE add-on treatment in ON of NMOSD was evaluated. Correlation was assessed between the effect of steroid pulse therapy (SPT) and the number of ON episodes in NMOSD. RESULTS: All 31 NMOSD patients accepted SPT; 15 patients of them accepted SPT and PE add-on. In these 15 patients, after PE add-on treatment, the patients' visual acuity was further significantly improved (P = 0.000, N = 23), including 3 no light perception (NLP) patients. After the treatment, the visual function recovered quickly in the first 2 months and then gradually slowed down; the visual function remained stable about 6 months later. The correlation coefficient between visual acuity improvement of SPT and the number of ON episodes was - 0.311 (P = 0.030, N = 49). CONCLUSION: One clinical feature of NMOSD can be repeated vision impairment. In NMOSD patients characterized by ON, efficacy of SPT is limited as the number of episodes increased, and PE add-on is more effective. Even though the visual acuity of NMOSD patients decreases to NLP during episodes, there is still a chance to restore vision by PE add-on treatment.

Global profiling of the gene expression and alternative splicing events during hypoxia-regulated chondrogenic differentiation in human cartilage endplate-derived stem cells.

The intervertebral disc (IVD) degeneration is initiated by cartilage endplate (CEP) degeneration and is characterised by reduced chondrification. Cartilage endplate-derived stem cells (CESCs) with chondrogenic differentiation abilities are responsible for the restoration of cartilage. CEP remains in an avascular and hypoxic microenvironment. In this study, we observed that the physiological hypoxia greatly promotes the chondrogenic differentiation of CESCs. This tissue specificity of the differentiation fate of CESCs in response to the hypoxic microenvironment was physiologically significant for the CEP to maintain the chondrification status. To investigate the mechanisms underlying the hypoxia-regulated chondrogenic differentiation of CESCs, we adopted a high-throughput scanning technology to detect the global profiling of gene expression and alternative splicing (AS) event changes during chondrogenic differentiation under hypoxia in CESCs compared to those induced under normoxia. An Affymetrix Human Transcriptome Array 2.0 was used to identify the differentially expressed genes (DEGs) and alternatively spliced genes (ASGs). After RT-PCR validation, GO and KEGG pathway analyses of both the DEGs and ASGs were performed. The enrichment of the GO functional terms and signalling pathways provided referential direction of the mechanism to study the gene expression and AS in the hypoxia-regulated chondrogenesis promotion, which could be helpful in understanding this physiological phenomenon, and it could also be instrumental in finding targets for CEP degeneration therapy.

Deep learning-based algorithm for the detection of idiopathic full thickness macular holes in spectral domain optical coherence tomography.

BACKGROUND: Automated identification of spectral domain optical coherence tomography (SD-OCT) features can improve retina clinic workflow efficiency as they are able to detect pathologic findings. The purpose of this study was to test a deep learning (DL)-based algorithm for the identification of Idiopathic Full Thickness Macular Hole (IFTMH) features and stages of severity in SD-OCT B-scans. METHODS: In this cross-sectional study, subjects solely diagnosed with either IFTMH or Posterior Vitreous Detachment (PVD) were identified excluding secondary causes of macular holes, any concurrent maculopathies, or incomplete records. SD-OCT scans (512 × 128) from all subjects were acquired with CIRRUS™ HD-OCT (ZEISS, Dublin, CA) and reviewed for quality. In order to establish a ground truth classification, each SD-OCT B-scan was labeled by two trained graders and adjudicated by a retina specialist when applicable. Two test sets were built based on different gold-standard classification methods. The sensitivity, specificity and accuracy of the algorithm to identify IFTMH features in SD-OCT B-scans were determined. Spearman's correlation was run to examine if the algorithm's probability score was associated with the severity stages of IFTMH. RESULTS: Six hundred and one SD-OCT cube scans from 601 subjects (299 with IFTMH and 302 with PVD) were used. A total of 76,928 individual SD-OCT B-scans were labeled gradable by the algorithm and yielded an accuracy of 88.5% (test set 1, 33,024 B-scans) and 91.4% (test set 2, 43,904 B-scans) in identifying SD-OCT features of IFTMHs. A Spearman's correlation coefficient of 0.15 was achieved between the algorithm's probability score and the stages of the 299 (47 [15.7%] stage 2, 56 [18.7%] stage 3 and 196 [65.6%] stage 4) IFTMHs cubes studied. CONCLUSIONS: The DL-based algorithm was able to accurately detect IFTMHs features on individual SD-OCT B-scans in both test sets. However, there was a low correlation between the algorithm's probability score and IFTMH severity stages. The algorithm may serve as a clinical decision support tool that assists with the identification of IFTMHs. Further training is necessary for the algorithm to identify stages of IFTMHs.

Visual Acuity in Patients Requiring Intravitreal Injections: Short-Term and Long-Term Effects of Delay in Care.

Purpose: To assess the short-term and long-term effects of a delay in care on visual acuity (VA) in patients requiring intravitreal injections. Methods: This retrospective cohort study comprised patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) receiving intravitreal injections. The visual and anatomic outcomes at the next completed visit and at the 1-year follow-up were studied. Results: Of 1172 patients, 38% had a delay in care (mean 5.7 weeks). Compared with baseline, these patients lost VA (Early Treatment Diabetic Retinopathy Study letters) (mean -2.13 ± 0.49 SE) in the short-term (P = .0003) and had a thicker central subfield. Patients with no delay in care had a net VA gain (0.97 ± 0.39) (P = .0067). There was no difference in VA between 1 year and the baseline in either group. Long term, patients with nAMD in both groups had VA loss (no delay in care: -1.76 ± 0.60; delayed care: -2.44 ± 0.78) (P = .0005 and P = .0114, respectively). Patients with DME and no delay in care maintained gains in vision (4.68 ± 1.86) but those with delayed care did not (1.72 ± 2.24) (P = .0202 and P = .3756, respectively). In both groups, patients with RVO had no significant difference in vision from baseline. Conclusions: In patients requiring intravitreal injections, a delay in care of 5.7 weeks affected vision outcomes in the short term but not the long term.

Blue Light Induces RPE Cell Necroptosis, Which Can Be Inhibited by Minocycline.

Purpose: Damage to and death of the retinal pigment epithelium (RPE) are closely related to retinal degeneration. Blue light is a high-energy light that causes RPE damage and triggers inflammatory responses. This study investigates whether blue light induces RPE necroptosis, explores pharmacologic therapy and specific mechanisms, and provides hints for research on retinal degeneration. Methods: The human RPE cell line ARPE-19 was cultured and subjected to blue light insult in vitro. Annexin V/PI was used to evaluate RPE survival. Minocycline was applied to inhibit the death of RPE. Proteomic measurement was used to analyze protein expression. Inhibitors of necroptosis and apoptosis were applied to assess the death mode. Immunofluorescence of protein markers was detected to analyze the mechanism of cell death. Subcellular structural changes were detected by transmission electron microscopy. Reactive oxygen species (ROS) was tested by DCFH-DA. Mitochondrial membrane potential (Δψm) was detected by JC-1. BALB/c mice received bule light exposure, and RPE flatmounts were stained for verification in vivo. Results: Blue light illumination induced RPE death, and minocycline significantly diminished RPE death. Proteomic measurement showed that minocycline effectively mitigated protein hydrolysis and protein synthesis disorders. Necroptosis inhibitors (Nec-1s, GSK-872) increased the survival of RPE cells, but apoptosis inhibitors (Z-VAD-FMK) did not. After blue light illumination, high-mobility group box-1 (HMGB1) was released from the nucleus, receptor-interacting protein kinase 3 (RIPK3) aggregated, and mixed-lineage kinase domain-like protein (MLKL) increased in the RPE. The application of minocycline alleviated the above phenomena. After blue light illumination, RPE cells exhibited necrotic characteristics accompanied by destruction of cell membranes and vacuole formation, but nuclear membranes remained intact. Minocycline improved the morphology of RPE. Blue light increased ROS and decreased Δψm of RPE, minocycline did not reduce ROS but kept Δψm stable. In vivo, HMGB1 release and RIPK3 aggregation appeared in the RPE of BALB/c mice after blue light illumination, and minocycline alleviated this effect. Conclusions: Blue light exposure causes RPE necroptosis. Minocycline reduces the death of RPE by keeping Δψm stable, inhibiting necroptosis, and preventing HMGB1 release. These results provide new ideas for the pathogenesis and treatment of retinal degeneration.

Hyperoxia Induced Hypomyelination.

We asked whether hyperoxia might induce hypomyelination of the corpus callosum, clinically described as periventricular leukomalacia (PVL) of the severely preterm infant. Mouse pups and their nursing dams were placed in 80% oxygen from P4-P8, then removed to room air until P11. Corpus callosal sections were probed myelin immunofluorescence, tested for myelin basic protein concentration by Western blot, and both glial fibrillary acidic protein levels and apoptosis quantified. Density of corpus callosal capillaries were measured after lectin staining and hypoxia measured by Hypoxyprobe. Numbers of oligodendrocytes were quantified by immunohistochemistry. We next used hypoxiamimesis as a surrogate to hypoxia by comparing cerebral hypoxia inducible factor (HIF) stabilization to hepatic HIF stabilization. Hyperoxia induced hypomyelination and a reduction of corpus callosal capillaries. Hyperoxia decreased numbers of oligodendrocytes with an increase in corpus callosal fibrosis and apoptosis. Cerebral hypoxiamimesis induced hypomyelination whereas hepatic hypoxiamimesis alone increased myelination, oligodendrocyte numbers, and corpus callosal capillary density. Hepatic HIF-1 dependence on myelination was confirmed using the cre/lox hepatic HIF-1 knockout. These findings suggest that hyperoxia can induce hypomyelination through vasoobliteration and subsequent ischemia, adding a potential oxygen induced mechanism to the diverse causes of periventricular leukomalacia of the severely preterm infant. Targeting hepatic HIF-1 alone led to increased myelination.

Performance of a Machine-Learning Computational Image Analysis Algorithm in Retinal Fluid Quantification for Patients With Diabetic Macular Edema and Retinal Vein Occlusions.

BACKGROUND AND OBJECTIVE: The objective is to validate an automated artificial intelligence model in detecting and quantifying fluid in diabetic macular edema (DME) and retinal vein occlusion (RVO) optical coherence tomography images. PATIENTS AND METHODS: DME (n = 100) and RVO (n = 100) images of adult patients were reviewed. The performance of machine-learning (ML) computational image analysis algorithm was evaluated against consensus manual grading. Main outcomes were accuracy and sensitivity for detection and Pearson's correlation coefficients for quantification. RESULTS: The ML algorithm had a high accuracy and sensitivity in both DME (intraretinal fluid [IRF]: 0.92, 0.97; subretinal fluid [SRF]: 0.93, 1.00) and RVO (IRF: 0.94, 0.99; SRF: 0.93, 1.00). It had moderate-high correlation in quantifying fluid in DME (total retinal fluid: 0.88; IRF: 0.88; SRF: 0.97) and RVO (total retinal fluid: 0.83; IRF: 0.76; SRF: 0.64). CONCLUSION: The ML algorithm is highly accurate and sensitive in detecting fluid in DME and RVO optical coherence tomography images and effectively quantifies IRF and SRF in both disease states, particularly in images with low to moderate fluid burden. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:123-131.].

Genomic selection and genetic architecture of agronomic traits during modern rapeseed breeding.

Rapeseed (Brassica napus L.) is an important oil-producing crop for the world. Its adaptation, yield and quality have been considerably improved in recent decades, but the genomic basis underlying successful breeding selection remains unclear. Hence, we conducted a comprehensive genomic assessment of rapeseed in the breeding process based on the whole-genome resequencing of 418 diverse rapeseed accessions. We unraveled the genomic basis for the selection of adaptation and agronomic traits. Genome-wide association studies identified 628 associated loci-related causative candidate genes for 56 agronomically important traits, including plant architecture and yield traits. Furthermore, we uncovered nonsynonymous mutations in plausible candidate genes for agronomic traits with significant differences in allele frequency distributions across the improvement process, including the ribosome recycling factor (BnRRF) gene for seed weight. This study provides insights into the genomic basis for improving rapeseed varieties and a valuable genomic resource for genome-assisted rapeseed breeding.

The Utilization of Phone Communication with Patient Companions During a Pandemic.

Involvement of companions is a critical aspect of patient-centered care. This retrospective cross-sectional study examined patients who were asked, by utilizing electronic medical record (EMR) preset questions (SmartPhrase template), if they wanted another individual called during the assessment and plan portion of an ophthalmology visit. Of 518 patients, 14.5% wanted another individual called. New patients as well as those who needed procedural or surgical intervention were more likely to want a companion called. Adoption of a SmartPhrase template within clinical workflow may be a feasible and effective method to increase communication with companions of physically unaccompanied patients and promote patient-centered care.

The Effect of Delay in Care among Patients Requiring Intravitreal Injections.

PURPOSE: To examine the effect of delay in care on visual acuity (VA) in patients requiring intravitreal injections (IVIs). DESIGN: Retrospective cohort study. PARTICIPANTS: Patients 18 years of age or older with diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), or both; neovascular age-related macular degeneration (nAMD); or retinal vein occlusion (RVO) scheduled to see a retina specialist during the mandated lockdown period (March 14 - May 4, 2020 [the coronavirus disease 2019 period]) and who had received an IVI in the 12 weeks prior. METHODS: Chart review was performed and demographics, diagnoses, procedures, and VA were recorded. MAIN OUTCOME MEASURES: VA in patients who completed, canceled, and no-showed for the scheduled visit. RESULTS: Of the 1041 total patients, 620 (60%) completed the scheduled visit, whereas 376 (36%) canceled and 45 (4%) no-showed. In patients who missed the visit, the average delay in care was 5.34 weeks. In those who missed a visit, VA was assessed at the subsequent visit. Patients who canceled a visit were older, and patients who no-showed had lower baseline vision (mean Early Treatment Diabetic Retinopathy Study letters ± standard error [SE]: no-show, 53.27 ± 3.21 letters; canceled, 60.79 ± 1.11 letters; and completed, 62.81 ± 0.84 letters; P = 0.0101) and were more likely to have DME, PDR, or both (no-show, 13 patients [29%]; canceled, 56 patients [16%]; completed, 81 patients [13%]; P = 0.0456). Patients who missed a visit lost vision as compared with the patients who completed one (no-show, -5.024 ± 1.88 letters; canceled, -1.633 ± 0.65 letters; completed, 0.373 ± 0.50 letters; P = 0.0028). Patients with DME, PDR, or both (-3.48 ± 1.95 letters vs. 2.71 ± 1.75 letters; P = 0.0203), with RVO (-3.22 ± 1.41 letters vs. 0.95 ± 1.23 letters; P = 0.0230), and, to lesser degree, with nAMD (-1.23 ± 0.70 letters vs. -0.24 ± 0.56 letters; P = 0.2679) lost vision compared with patients with same diagnoses who completed the scheduled visit. CONCLUSIONS: In patients requiring IVIs, a delay in care of 5.34 weeks resulted in vision loss. It was seen in all patients, but was more prominent in patients with DME, PDR or both and RVO. Further studies are necessary to examine whether these vision changes persist over a longer duration.

Characterization of Kiosk Usage for Ophthalmic Outpatient Visits.

BACKGROUND AND OBJECTIVES: This study aims to characterize check-in kiosk usage within a multidisciplinary ophthalmic clinic. PATIENTS AND METHODS: Chart review of patients aged 18 or older seen at Cole Eye Institute, Cleveland Clinic, from August 1, 2019, to October 31, 2019. Primary endpoint was percentage of patients who used a check-in kiosk. Secondary endpoints were demographic characteristics and visual acuity (VA) of the two groups. RESULTS: Of 13,752 patients, 3,542 (26%) used a check-in kiosk. Kiosk users were significantly younger than kiosk non-users (median [interquartile range (IQR)]: 63.6 [49.4-72.6] vs. 66.6 [55.0-75.4]; P < .0001), had a lower proportion of Medicaid patients (282 [8%] vs. 930 [10%]; P < .0001), and lived in areas with a greater median income (mean [± standard error]: $58,421 [± 399) vs. $54,992 [±236]; P < .0001). On average, they also had better VA (mean ETDRS [95% confidence interval]: 80.5 [80-80.9] vs. 78.3 [78-78.6]; P < .0001). CONCLUSIONS: Significant demographic and VA differences were observed between kiosk users and non-users and may influence kiosk usage. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:684-690.].

Prevention of Macular Edema in Patients With Diabetic Retinopathy Undergoing Cataract Surgery: The PROMISE Trial.

BACKGROUND AND OBJECTIVE: To determine the safety and efficacy of intravitreal aflibercept injection (IAI) in patients with diabetic retinopathy (DR) in the prevention of macular edema (ME) following cataract surgery. PATIENTS AND METHODS: This phase 2, prospective, interventional, single-masked, randomized trial at a single academic center included 30 patients who were 18 years of age or older with nonproliferative DR and undergoing cataract surgery with phacoemulsification. Patients received 2 mg intravitreal aflibercept (0.05 mL) or sham injection during cataract surgery. Main outcome measures included treatment adverse events (AEs), best-corrected visual acuity (BCVA), and incidence of ME (defined as presence of cystoid abnormalities as detected by optical coherence tomography at any follow-up visit), a 30% or greater increase from preoperative baseline in central subfield macular thickness, or a BCVA decrease of more than 5 ETDRS letters from Day 7 due to retinal thickening. RESULTS: There were similar incidences of AEs between the two groups and no clinically serious ocular AEs in either group. The IAI group had fewer ME events at Day 14 (13% vs. 53%; P = .022), but there was no significant difference in ME events at Day 30 (27% vs. 60%; P = .057), Day 60 (27% vs. 60%; P = .057), or Day 90 (40% vs. 67%; P = .161). Compared to the study group, the control group had a significantly greater increase in central subfield thickness (CST) at Day 30 (50.05 µm vs. 7.95 µm; P = .040) and Day 60 (56.45 µm vs. 3.02 µm; P = .010). However, the difference in CST between groups was no longer significant at Day 90 (50.31 µm vs. 18.48 µm; P = .12). There were no significant differences in BCVA gains between the IAI and sham group at the end of the follow-up period (Day 90, ETDRS letters: 9.88 vs. 8.52; P = .66). CONCLUSIONS: Use of IAI in patients with DR for prevention of ME following cataract surgery showed no significant AEs. Although there were significant differences in ME incidence and retinal thickness at periods of time, there was no clinically meaningful benefit in terms of VA. Further larger trials are needed to validate these findings. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:170-178.].

Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy.

PURPOSE: To evaluate change in best-corrected visual acuity (BCVA) in patients with diabetes and diabetic retinopathy (DR) after cataract extraction (CE). DESIGN: Retrospective cohort study. PARTICIPANTS: Diabetic eyes of patients 18 years of age or older that underwent CE at the Cleveland Clinic from 2012 through 2018. METHODS: Chart review examining visual acuities from patient visits before and after surgery, as well as OCT images. Statistical analysis was carried out using multiple linear regression models. MAIN OUTCOME MEASURES: The primary end point was change in BCVA during the first postoperative year. The secondary end point was the association of central subfield thickness at baseline with change in BCVA. Additional preoperative factors examined were age, race, gender, laterality, insulin use, hemoglobin A1c, creatinine, blood urea nitrogen, and estimated glomerular filtration rate. RESULTS: Diabetic eyes without DR (n = 138) and eyes with mild/moderate nonproliferative DR (NPDR; n = 125), severe NPDR (n = 20), and proliferative DR (PDR; n = 72) were included. A year after surgery, eyes without DR gained a median of 11.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (interquartile range [IQR], 5.0-20.0) from 65.0 (IQR, 58.0-70.0) before surgery, eyes with mild or moderate DR gained 10.0 letters (IQR, 5.0-22.0) from 65.0 (IQR, 58.0-76.0), eyes with severe NPDR gained 20.5 letters (IQR, 8.0-28.5) from 55.0 (IQR, 26.0-65.0), and eyes with PDR gained 15.0 letters (IQR, 6.0-29.5) from 55.0 (IQR, 35.0-61.0). Eyes without DR or mild or moderate NPDR showed significantly greater improvements in VA 1 year after surgery compared with eyes with severe NPDR or PDR when controlling for baseline visual acuity (VA), with eyes with more severe DR showing less expected VA gain (P < 0.001). Length of disease most strongly related to baseline DR severity (ρ = 0.431; P < 0.001). CONCLUSIONS: Cataract surgery is beneficial in most patients with DR without severe concurrent macular pathologic features. However, preoperative VA and the severity of DR can limit visual outcomes.

Macular Atrophy Affecting Visual Outcomes in Patients Undergoing Anti-VEGF Treatment in Routine Clinical Practice.

BACKGROUND AND OBJECTIVE: To explore how baseline macular atrophy (MA) affects visual acuity (VA) in patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) injections for neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS: A retrospective, case control series. Patients were grouped into three cohorts based on baseline spectral-domain optical coherence tomography image findings: foveal MA, nonfoveal MA, and no MA. Outcomes were assessed at 1, 2, and 3 years following anti-VEGF therapy. RESULTS: No differences existed in MA growth between eyes with foveal and nonfoveal MA (0.89 mm2 [95% confidence interval (CI), 0.64-1.14] vs. 0.88 mm2 [95% CI, 0.72-1.05]) after adjusting for baseline lesion sizes at 3 years. Foveal MA patients lost an average of 19.4 ETDRS letters (95% CI, -30.8 to -8.0) after 3 years. Nonfoveal MA patients gained an average of 1.1 ETDRS letters (95% CI, -6.8 to 9.0), and patients without MA averaged a gain of 9.7 ETDRS letters (95% CI, 5.5-14.0). CONCLUSION: In patients with nAMD receiving anti-VEGF in routine clinical practice, presence of baseline foveal MA was associated with significant vision loss. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:68-75.].

Changes in retinal and choriocapillaris density in diabetic patients receiving anti-vascular endothelial growth factor treatment using optical coherence tomography angiography.

BACKGROUND: Optical coherence tomography angiography (OCTA) enables detailed, non-invasive assessment of ocular vasculature. This study uses OCTA imaging to evaluate choriocapillaris and retinal capillary perfusion density (CPD) changes in diabetic retinopathy following anti-vascular endothelial growth factor (VEGF) treatment. METHODS: Records of 38 eyes at a single institution were reviewed, grouped as non-diabetic controls (19 eyes), diabetes mellitus patients with diabetic retinopathy (DR, 19 eyes) and macular edema (DME). DR eyes were imaged at baseline, 6-months and 12-months after anti-VEGF treatment. Quantitative analyses assessed CPD of the choriocapillaris and retinal plexus. RESULTS: DR eyes showed decreased choriocapillaris whole-image CPD (62.6 ± 6.1 vs. 68.4 ± 5.1, p < 0.003), foveal CPD (61.2 ± 7.4 vs. 66.3 ± 9.8, p < 0.014), and parafoveal CPD (61.9 ± 6.6 vs. 68.2 ± 4.8, p < 0.002) at baseline. DR eyes also showed decreased retinal density, including whole-image CPD (46.9 ± 5.1 vs. 50.7 ± 5.6, p < 0.04), foveal CPD (27.6 ± 5.9 vs. 34.1 ± 6.1, p < 0.002), and parafoveal CPD (49.0 ± 5.6 vs. 53.1 ± 6.0, p < 0.011). Following 12 months of anti-VEGF treatment, no changes to retinal or choriocapillaris or CPD were observed. Retinal central subfield thickness decreased (397.1 ± 93.2 µm vs. 294.2 ± 71.5 µm, p < 0.005). Lastly, FAZ area (0.307 ± 0.133 mm2 vs. 0.184 ± 0.058 mm2, p = 0.008) and perimeter (2.415 ± 0.692 mm2 vs. 1.753 ± 0.408 mm2, p = 0.002) were increased in DR eyes at baseline. No changes to FAZ area or perimeter were seen with anti-VEGF treatment in DR eyes. CONCLUSIONS: Compared to control, choriocapillaris and retinal CPD are reduced in DR, while FAZ area and perimeter are increased. No retinal capillary or choriocapillaris CPD changes were observed in DR eyes following anti-VEGF treatment.

Characterization of Patients With Geographic Atrophy in Routine Clinical Practice.

BACKGROUND AND OBJECTIVE: Geographic atrophy (GA) affects millions of patients with age-related macular degeneration (AMD) worldwide, leading to significant, irreversible visual impairment. This study aims to characterize the visual impairment of patients with GA in a routine clinical practice. PATIENTS AND METHODS: This single-center, cross-sectional study used a novel natural language processing to select 1,045 GA cases utilizing the macula examination records from 19,359 patients with AMD. RESULTS: Patients were classified based on the diagnosis of the fellow-eye as follow: 502 in group 1 (GA:GA), 403 in group 2 (GA : choroidal neovascularization), and 234 in group 3 (GA : early / intermediate AMD). Best-corrected visual acuity (BCVA) in the affected eye was 50.3 (± 22.1) letters in group 1, 52.5 (± 21.3) letters in group 2, and 48.5 (± 23.6) letters in group 3 (P < .05). Visual impairment (ineligibility for an unrestricted driver license) was present in 70.5% of group 1, 59.7% of group 2, and 39.6% of group 3. Legal blindness (BCVA < 20 letters in the best-seeing eye) was seen in 2.2% of group 1, 3% of group 2, and 0.8% of group 3. CONCLUSION: Differences in visual impairment between subgroups of patients with GA can be seen in routine clinical practice. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:93-98.].