Tractional Retinal Detachment in Eyes with Vitreous Hemorrhage and Proliferative Diabetic Retinopathy and Posterior Vitreous Detachment in Fellow Eye.

PURPOSE: To predict the presence of tractional retinal detachment (TRD) in eyes with dense vitreous hemorrhage (VH) and proliferative diabetic retinopathy (PDR) by evaluating the status of posterior vitreous detachment (PVD) in fellow eyes using optical coherence tomography (OCT). METHODS: A total of 44 eyes from 22 patients who underwent vitrectomy due to dense VH with PDR were enrolled. Using OCT, the PVD status in the fellow eye was divided into two groups (incomplete and complete PVD). The incomplete PVD group included eyes without PVD and eyes with partial PVD. B-scan ultrasonography was performed on eyes with dense VH to evaluate the presence of TRD. Both OCT and B-scan images were reviewed by four ophthalmologists (two novices and two experienced), and the interobserver agreement was evaluated. RESULTS: There was a difference in the interobserver agreement regarding the presence of TRD in eyes with dense VH evaluated by B scan between novice and experienced ophthalmologists (novice, κ = 0.421 vs. experienced, κ = 0.814), although there was no difference between novice and experienced ophthalmologists in the interobserver agreement regarding the status of PVD in the fellow eye evaluated by OCT (novice, κ = 1.000 vs. experienced, κ = 1.000). All observed TRD during vitrectomy occurred in eyes with incomplete PVD in the fellow eye. Logistic regression analysis revealed a statistically significant relation between TRD and the age of the patient (odds ratio [OR], 0.874; p = 0.047), and between TRD and incomplete PVD in the fellow eye evaluated by OCT (OR, 13.904; p = 0.042). CONCLUSIONS: Evaluation of the PVD status in the fellow eye using OCT may be a useful predictor for detecting the presence of TRD in eyes with dense VH and PDR.

Novel area-based optic nerve head parameter to distinguish glaucoma from non-glaucomatous retinal nerve fiber layer defect in branch retinal vein occlusion.

PURPOSE: The purpose of this study was to assess the diagnostic ability of the new area-based parameter retinal nerve fiber layer to disc ratio (RDR) for discriminating between glaucoma and non-glaucomatous retinal nerve fiber layer defects (RNFLDs). METHODS: This retrospective cross-sectional study included 42 branch retinal vein occlusion (BRVO) eyes with RNFLD, 42 open-angle glaucoma (OAG) eyes, and 42 healthy control eyes that were matched with optic disc size. The RDR, peripapillary retinal nerve fiber layer thickness (pRNFLT), Bruch's membrane opening-minimum rim width (BMO-MRW), and Bruch's membrane opening-minimum rim area (BMO-MRA) were analyzed. The areas under the receiver operating characteristic curves (AUCs) were calculated for each parameter. RESULTS: The OAG and BRVO groups had similar global pRNFLT (87.57 ± 7.07 µm and 89.71 ± 12.21 µm, respectively), but these were thinner than those of the healthy group (102.71 ± 8.95 µm, p < 0.001 and p < 0.001, respectively). RDR was lowest in the BRVO group (0.755 ± 0.121, p < 0.001) and highest in the OAG group (1.111 ± 0.145, p < 0.001). Global BMO-MRW was significantly lower in the OAG group (194.36 ± 23.09 µm) than in the BRVO (269.69 ± 42.77 µm, p < 0.001) and healthy (273.48 ± 30.92 µm, p < 0.001) groups. Total BMO-MRA of the OAG group (0.88 ± 0.12 mm2) was significantly lower than that of the BRVO (1.32 ± 0.19 mm2, p < 0.001) and healthy (1.30 ± 0.21 mm2, p < 0.001) groups. AUC for discriminating between the OAG and BRVO was 0.986 for total BMO-MRA and 0.970 for RDR (p = 0.192). CONCLUSION: In clinical practice, RDR may perform well as a parameter to distinguish between glaucoma and non-glaucomatous RNFLD.

Aqueous humor inflammatory cytokine levels and choroidal thickness in patients with macular edema associated with branch retinal vein occlusion.

PURPOSE: We aimed to investigate the association between subfoveal choroidal thickness (SCT) and the level of aqueous humor (AH) inflammatory cytokines in patients with macular edema (ME) associated with branch retinal vein occlusion (BRVO). METHODS: Twenty-eight eyes of 28 BRVO ME patients who underwent intravitreal injection treatment (ranibizumab, bevacizumab, or dexamethasone implant) were prospectively recruited. The concentrations of vascular endothelial growth factor (VEGF)-A and inflammatory cytokines were measured from AH samples. We analyzed clinical factors associated with visual gain or the degree of central macular thickness (CMT) decrease and the association between SCT and inflammatory cytokine levels. RESULTS: On multiple linear regression analysis, the AH interleukin (IL)-8 level was significantly associated with visual gain and CMT reduction at 6 months. Age, systemic hypertension, and AH monocyte chemo-attractant protein 1 level showed a significant association with baseline SCT, and VEGF-A showed a significant association with baseline SCT ratio (BRVO eye SCT/fellow eye SCT). Those with thick SCT showed a higher level of AH soluble VEGF receptors 2 and IL-8 and showed better visual gain and greater CMT reduction at 2 and 6 months compared to the thin SCT group. CONCLUSIONS: The level of AH inflammatory cytokines was significantly associated with the ischemic status of the retina, treatment outcomes, and SCT in BRVO ME patients. Thick baseline SCT might be a predictive sign for better treatment outcomes in BRVO ME patients which are thought to be related to a higher level of intraocular inflammatory cytokines in these patients.

INTRAOCULAR AND INTEROCULAR DIFFERENCES IN PARAFOVEAL VASCULAR DENSITY IN DIABETIC PATIENTS WITHOUT DIABETIC RETINOPATHY.

PURPOSE: To evaluate the associations among optical coherence tomography angiography-measured vascular density (VD), intraocular and interocular VD differences, and clinical factors in diabetic patients without diabetic retinopathy. METHODS: We retrospectively reviewed 94 Type 2 diabetic patients without diabetic retinopathy who had undergone optical coherence tomography angiography. Vascular density and vessel skeleton density were measured in a 3-mm central zone in the total capillary plexus, superficial capillary plexus, deep capillary plexus (DCP), and choriocapillaris layers. Intraocular VD difference was determined between the superior and inferior zones, while interocular VD difference was determined between both eyes of the patient. Associations between optical coherence tomography angiography parameters and clinical factors were evaluated. RESULTS: Vascular density and intraocular and interocular VD differences were significantly associated with signal strength of the image, which was related with age and lens opacity. In multivariate analysis, diabetes duration was negatively associated with skeleton density in total capillary plexus and superficial capillary plexus layers, and positively associated with intraocular VD difference in superficial capillary plexus layer. Estimated glomerular filtration rate was negatively associated with intraocular skeleton density difference in total capillary plexus layer, interocular VD, and skeleton density differences in total capillary plexus layer. CONCLUSION: Intraocular and interocular VD difference may be an easy and sensitive way to detect subtle early microvascular changes in diabetic patients.

Author Correction: Inter-ocular and inter-visit differences in ocular biometry and refractive outcomes after cataract surgery.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Inter-ocular and inter-visit differences in ocular biometry and refractive outcomes after cataract surgery.

This study aimed to determine whether inter-ocular differences in axial length (AL), corneal power (K), and adjusted emmetropic intraocular lens power (EIOLP) and inter-visit differences in these ocular biometric values, measured on different days, are related to refractive outcomes after cataract surgery. We retrospectively reviewed 279 patients who underwent phacoemulsification. Patients underwent ocular biometry twice (1-4 weeks before and on the day of surgery). Patients were divided into three groups: group S (similar inter-ocular biometry in different measurements; n = 201), group P (inter-ocular differences persisted in the second measurement; n = 37), and group D (inter-ocular difference diminished in the second measurement; n = 41). Postoperative refractive outcomes (mean absolute errors [MAEs]) were compared among the groups. Postoperative MAE2, based on second measurement with reduced inter-ocular biometry difference, was smaller than that calculated using the first measurement (MAE1) with borderline significance in group D (MAE1, 0.49 ± 0.45 diopters vs. MAE2, 0.41 ± 0.33 diopters, p = 0.062). Postoperative MAE2 was greater in group P compared to the other two groups (p = 0.034). Large inter-ocular biometry differences were associated with poor refractive outcomes after cataract surgery. These results indicate that measurements with smaller inter-ocular differences were associated with better refractive outcomes in cases with inter-visit biometry differences.