Central Retinal Thickness Variability as a Predictive Factor for Visual Acuity After Dexamethasone Implant in Retinal Vein Occlusion.

BACKGROUND AND OBJECTIVE: Investigate central retinal thickness (CRT) variability and changes in best-corrected visual acuity (BCVA) after 12 months in patients with retinal vein occlusion (RVO) treated with dexamethasone intravitreal implants. PATIENTS AND METHODS: Post hoc analyses of two randomized trials in patients with macular edema associated with branch or central RVO treated with a 0.7-mg dexamethasone implant. Central retinal thickness standard deviation (CRT-SD) and central retinal thickness amplitude (CRT-A) were measures of variability. Analyses included multinomial and simple linear regression. RESULTS: In 400 patients, CRT-SD and CRT-A were significantly associated with central RVO, second dexamethasone implant, and baseline CRT. Baseline BCVA was associated with CRT-A. CRT-SD and CRT-A were significantly correlated with a 12-month change in BCVA (effect sizes of -0.032 and -0.013 letters/µm; P < 0.001). Patients in the highest CRT-SD quartile gained significantly fewer letters (+1.88 letters; 95% CI: -0.46 to 4.23). CONCLUSION: Greater CRT variability was associated with smaller BCVA improvements in patients with RVO treated with dexamethasone implants. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Should We Stop Treating Patients With Eplerenone for Chronic CSCR? Commentary on the VICI Trial.

The VICI trial reported by Lotery et al. is a recent placebo-controlled, randomized trial that examined the efficacy of eplerenone treatment for chronic central serous chorioretinopathy (CSCR) in 104 patients. The study found no significant difference in best-corrected visual acuity (BCVA) between the eplerenone-treated and placebo groups, prompting the VICI investigators to conclude that eplerenone should not be prescribed to treat CSCR. Limitations of the study include the patients' high baseline BCVA, use of a functional outcome like BCVA as the primary endpoint instead of an anatomical outcome, failure to account for rebound effect, and measuring subretinal fluid (SRF) thickness instead of the more informative SRF volume. Based on these reasons and evidence from multiple case series and prospective studies over the past 7 years, it is the opinion of the authors of this editorial that the VICI investigators' conclusion to stop prescribing eplerenone for CSCR is too severe. Future clinical trials should continue to explore the potential for eplerenone as long-term maintenance treatment in chronic CSCR. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:308-310.].

Urinary incontinence and chronic conditions in the US population age 50 years and older.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence is common among older adults with chronic conditions. The purpose of this study is to examine the association of urinary incontinence with chronic conditions in the US population. METHODS: We used data from the 2001-2014 National Health and Nutrition Examination Survey; 7226 women and 7239 men age > 50 years answered questions regarding urinary symptoms. The analysis accounted for the complex survey design, and prevalence reflects estimates within the non-institutionalized US population. RESULTS: The mean age was 64.2 years [standard error (SE) 0.2] among women and 62.9 (SE 0.1) years among men. Bothersome stress, urgency and mixed incontinence were reported by 6.7% (SE 0.4), 4.8% (SE 0.4) and 19.3% (SE 0.59) of women, respectively, and 0.6% (SE 0.1), 3.5% (SE 0.2) and 1.9% (SE 0.2) of men, respectively. Among chronic conditions, heart failure was associated with higher prevalence of mixed incontinence in women and urgency incontinence in men. Among women, heart failure was associated with significantly increased odds of bothersome mixed incontinence (OR 2.35; 95% CI 1.62, 3.42) and lower odds of stress (OR 0.50; 95% CI 0.3, 0.9) or urgency incontinence (OR 0.43; 95% CI 0.19, 0.98) after adjustment for covariates. Among men, heart failure was associated with higher odds of stress (OR 1.99; 95% CI 0.39, 10.22), urgency (1.65; 95% CI 0.91, 2.99) and mixed incontinence (OR 1.54; 95% CI 0.91, 2.62) but associations were not statistically significant. CONCLUSIONS: Heart failure is associated with higher odds of bothersome incontinence, especially among women.