Myopic foveal detachment associated with pachychoroid characteristics.

PURPOSE: To describe myopic nontractional foveal detachment associated with pachychoroid diseases. METHODS: This retrospective study included 15 myopic eyes which had nontractional serous foveal detachment. The eyes were divided into myopic central serous chorioretinopathy (CSC) group (n = 8) and a myopic pachychoroid neovascularization (PNV) group (n = 7) according to the presence of type 1 choroidal neovascularization on multimodal imaging. The findings of multimodal imaging and treatment response were described. RESULTS: In myopic CSC group, pachychoroid features such as pachyvessels, choroidal vascular hyperpermeability and punctate hyperfluorescent spots were noted in 8 eyes (100%), 8 eyes (100%), 5 eyes (62.5%) respectively. The above features were noted in 7 eyes (100%), 5 eyes (83.3%), 5 eyes (83.3%), respectively, in the myopic PNV group. Five of 8 eyes in myopic CSC and all 7 eyes received treatment including anti-vascular endothelial growth factor injection and/or photodynamic therapy. However, only five eyes had a complete response. CONCLUSIONS: The pachychoroid phenotype may coexist with high myopia and lead to myopic nontractional serous foveal detachment. Our series suggest that the response to treatment for these conditions would be limited.

Clinical characteristics and treatment outcomes of diffuse large B-cell lymphoma involving the eye and ocular adnexa in East Asia.

PURPOSE: To investigate the clinical features and outcomes of diffuse large B-cell lymphoma (DLBCL) involving the eye and ocular adnexa in an East Asian population and emphasize the importance of prompt biopsy and treatment in unusually progressive ocular adnexal DLBCL for better visual outcomes. METHODS: Retrospective case series of 38 patients diagnosed with DLBCL involving the eye and ocular adnexa between 1995 and 2018 at a single tertiary institution. RESULTS: There were 38 patients (22 men, 16 women), 22 (57.9%) of which had ocular adnexal lymphoma (OAL) and 16 (42.1%), vitreoretinal lymphoma (VRL). The OAL group showed higher rates of unilateral involvement (p = 0.01) and localized disease presentation (p = 0.01). Thirteen (59.1%) of 22 OAL patients were primary diseases and 9 (40.9%) were secondary. Between primary and secondary OAL groups, there was no statistical difference in clinical characteristics such as age, gender and laterality (p = 0.47, p = 0.19 and p = 0.66, respectively). All secondary OAL cases were either disseminated or relapsed by definition and only two cases (15%) of primary OAL showed disseminated presentation (p < 0.01). Six (37.3%) of 22 OAL patients showed a rapid decrease in visual acuity within 15 days and the visual recovery was irreversible in 3 of them. CONCLUSION: OA-DLBCL has a grave prognosis and its visual outcomes largely depend on the timing of diagnosis and treatment. When a high-grade lymphoma is suspected, prompt biopsy and treatment should be performed to ensure optimal visual, clinical and survival outcomes.

Characteristics of secondary epiretinal membrane due to peripheral break.

This study aimed to investigate morphological differences between idiopathic epiretinal membrane (ERM) and secondary ERM due to peripheral break (SEPB) and to identify clinical characteristics in eyes with SEPB to facilitate peripheral retinal examination. The retrospective cross-sectional study involved 93 consecutive eyes in 91 patients who underwent ERM removal surgery. Eyes were divided into two groups: the macular pucker group and the idiopathic ERM group. En-face Optical Coherence Tomography (OCT) images, fundus photographs, severity of metamorphopsia (M-score) and clinical characteristics of each group were compared. ERM extent and eccentricity (ratio of the shortest and longest distances from the foveal center to the boundary) were obtained through en-face OCT imaging. Fundus photographs were used to judge whether the membrane was turbid or not. Patients with SEPB were younger than patients with idiopathic ERM (61.3 ± 7.5 vs. 66.6 ± 8.3 years; p < 0.05). Preoperative M-score and myopic refractive error, axial length were also significantly higher in the macular pucker group than in the idiopathic ERM group (all p < 0.05). There was no difference in ERM extent between the two groups. The incidence of ERM eccentricity was 23 of the 34 eyes (67.6%) in the SEPB group and 26 of the 59 eyes (44.1%) in the idiopathic ERM group (p < 0.05). The incidence of turbid ERM was 18 of the 34 eyes (52.9%) in the SEPB group and 10 of the 59 eyes (16.9%) in the idiopathic ERM group (p < 0.01). The SEPB group, compared with the idiopathic ERM group, tended to have eccentric, turbid ERM at a younger age and with more severe metamorphopsia and myopic refractive error.

Clinical outcomes of topography-guided femtosecond laser-assisted in situ keratomileusis after multifocal intraocular lens implantation.

This retrospective study is to evaluate refractive and visual outcomes of topography-guided femtosecond laser-assisted in situ keratomileusis (TGL) for correcting corneal high-order aberrations (HoA) after multifocal intraocular lens (mIOL) implantation. Twenty-eight eyes of 28 patients with both corrected distance visual acuity (CDVA) under 20/25 and subjective visual discomfort at 3 months after mIOL implantation were included in the study. TGL was performed to correct corneal HoA. Visual acuity, manifest refraction, and corneal HoA were measured 3 months after TGL. CDVA was improved in 22 (78.57%) of 28 eyes after TGL. Uncorrected distance visual acuity (0.12 ± 0.16 logMAR) and uncorrected near visual acuity (0.081 ± 0.16 logMAR) were better than those before TGL (P < 0.001). Residual refractive astigmatism showed no difference compared to that before TGL. Root mean square (RMS) of HoA (P = 0.012), spherical aberration (P = 0.013), and RMS of coma (P = 0.001) were reduced relative to those before TGL. Amount of improvement in CDVA was correlated with amount of reduced coma RMS (R = 0.524; P = 0.005) and spherical aberration (R = 0.443; P = 0.021). TGL showed to improve both refractive and visual outcomes in patients with mIOL implantation by correcting corneal HoA.

Deep Learning-Based Prediction of Refractive Error Using Photorefraction Images Captured by a Smartphone: Model Development and Validation Study.

BACKGROUND: Accurately predicting refractive error in children is crucial for detecting amblyopia, which can lead to permanent visual impairment, but is potentially curable if detected early. Various tools have been adopted to more easily screen a large number of patients for amblyopia risk. OBJECTIVE: For efficient screening, easy access to screening tools and an accurate prediction algorithm are the most important factors. In this study, we developed an automated deep learning-based system to predict the range of refractive error in children (mean age 4.32 years, SD 1.87 years) using 305 eccentric photorefraction images captured with a smartphone. METHODS: Photorefraction images were divided into seven classes according to their spherical values as measured by cycloplegic refraction. RESULTS: The trained deep learning model had an overall accuracy of 81.6%, with the following accuracies for each refractive error class: 80.0% for ≤-5.0 diopters (D), 77.8% for >-5.0 D and ≤-3.0 D, 82.0% for >-3.0 D and ≤-0.5 D, 83.3% for >-0.5 D and <+0.5 D, 82.8% for ≥+0.5 D and <+3.0 D, 79.3% for ≥+3.0 D and <+5.0 D, and 75.0% for ≥+5.0 D. These results indicate that our deep learning-based system performed sufficiently accurately. CONCLUSIONS: This study demonstrated the potential of precise smartphone-based prediction systems for refractive error using deep learning and further yielded a robust collection of pediatric photorefraction images.

Clinical Course and Risk Factors for Visual Field Progression in Normal-Tension Glaucoma With Myopia Without Glaucoma Medications.

PURPOSE: To investigate the natural clinical course and the risk factors of visual field (VF) progression in untreated normal-tension glaucoma (NTG) with myopia with a minimum 3-year follow-up. DESIGN: Retrospective cohort study. METHODS: Kaplan-Meier survival analysis and log-rank test were used to compare survival experiences between the groups. The hazard ratios (HRs) for the associations between potential risk factors and glaucomatous progression were determined using Cox proportional hazards model. RESULTS: The average follow-up period for the included 97 patients was 71.1 ± 29.7 months and 32 eyes showed progression during the observation period. In NTG with myopia, Kaplan-Meier survival curve showed progression cases in 10.3% at 36 months and 24.8% at 60 months. When age and disc tilt direction were classified into 2 groups, a higher cumulative probability of progression was observed in those aged ≤50 years than >50 years (P = .001) and in those with disc tilt direction <45 degrees than disc tilt direction ≥45 degrees (P = .002). In Cox proportional hazards model, younger age, presence of disc hemorrhage, and more temporally tilted disc or parapapillary atrophy were associated with progression. CONCLUSIONS: NTG with myopia seems to have a slow progression rate even without glaucoma medications. Only 10.3% and 24.8% of patients showed VF progression at 3 years and 5 years of follow-up in untreated NTG with myopia. To predict VF progression in untreated NTG with myopia, it seems that age and disc morphology should be considered.

Predictive factors associated with axial length growth and myopia progression in orthokeratology.

PURPOSE: To investigate the factors affecting axial length (AXL) growth and myopia progression in orthokeratology. METHODS: This prospective, observational study enrolled 28 new orthokeratology lens wearers from a contact lens clinic between March 2016 and March 2017. Among them, 32 eyes of 17 wearers who completed one year of follow-up were finally analyzed. All participants underwent central (C) and peripheral (nasal 30° [N30] and temporal 30° [T30]) AXL measurements as well as central and peripheral refraction, ocular aberrations, and corneal topography at baseline and every posttreatment visit. A generalized estimating equation (GEE) was used to assess the associations between AXL change and all independent variables in both eyes. RESULTS: The mean central AXL was 24.21 ± 0.60 mm and the mean baseline central spherical equivalent refractive error (SER) was -2.43 ± 0.97 diopters (D). Among all parameters that were significantly associated with AXL change in univariable GEE analyses, the baseline difference in AXL between C and N30 (ß = -0.213, p < 0.001), baseline SER (ß = -0.040, p < 0.033), posttreatment coma (ß = -0.291, p < 0.031), third-order higher-order aberrations (HOAs) (ß = -0.482, p < 0.001), and changes in second-order aberrations (ß = 0.025, p = 0.027) at one year of follow-up were identified as significant factors in multivariable GEE analysis. CONCLUSIONS: The inhibition of AXL elongation and myopia progression in orthokeratology lens wear is significantly associated with the peripheral myopization and asymmetric optical changes mostly induced by third-order HOAs.

Effects of Pigment Location in Tinted Contact Lenses on the Ocular Surface.

PURPOSE: To evaluate the effects of the location of pigments in decorative tinted soft contact lenses on the ocular surface. METHODS: Thirty test subjects were enrolled in this study. All subjects wore the following types of contact lenses, classified according to the location of the pigment layer, in one eye in three different testing sessions: conventional clear lenses, tinted lenses with a pigment layer embedded in the lens matrix, and tinted lenses with an exposed pigment layer on the surface. Tear samples were collected, the ocular surface status was evaluated, and subjective symptoms were surveyed after lens wear for 8 hours. RESULTS: The tinted lenses with surface pigments resulted in a greater increase in epidermal growth factor and interleukin-8 levels compared with the clear lenses and tinted lenses with embedded pigments (p < 0.050). Ocular surface parameters and subjective symptom scores were significantly different among three lens types (p < 0.050), with the clear lenses showing superior results compared with the two tinted lenses (p < 0.050). The tinted lenses with exposed pigments resulted in a greater degree of conjunctival redness and ocular surface staining and poorer symptom scores compared with the tinted lens with embedded pigments (p < 0.050). CONCLUSIONS: Our results suggest that the presence of surface pigments in tinted contact lenses increases ocular inflammation and results in a poorer ocular surface status and greater discomfort compared with clear lenses and tinted lenses with an embedded pigment layer.

Evaluation of pigment location in tinted soft contact lenses.

PURPOSE: The purpose of this study was to investigate efficient methods to evaluate the pigment layer location of tinted soft contact lenses and to assess various lens products on the market using those methods. METHODS: Two types of tinted soft contact lenses with known pigment location embedded or back surface were manufactured and examined. Light microscopy (LM), focused ion beam milling and scanning electron microscopy (FIB-SEM), and Fourier-domain optical coherence tomography (FD-OCT) were used to examine the pigment layer. Lens surface roughness was also measured using atomic force microscopy. In the second part of the experiment, pigment location and surface roughness of a clear lens (Lens A) and eight commercially-available tinted soft contact lenses (Lens B-I) were evaluated using FIB-SEM and FD-OCT. RESULTS: Pigment location could be reliably determined with FIB-SEM and FD-OCT. With LM, 40% of the lens sections were broken or deformed during slide preparation. The pigment particles in Lens B were buried below the front surface and there were no significant differences of roughness between the front and back surfaces. However, all tinted lenses with surface pigment had significant difference of roughness between front and back surfaces at the pigmented area. CONCLUSION: The FIB-SEM and FD-OCT could reliably locate the pigment layer of tinted soft contact lenses. In addition, lens surface roughness was influenced by pigment layer location.

Efficacy of combined orbital radiation and systemic steroids in the management of Graves' orbitopathy.

PURPOSE: To compare the efficacy and safety of combination therapy with orbital irradiation and systemic steroids versus steroid monotherapy in the management of active Graves' orbitopathy (GO). METHODS: The clinical charts of 127 patients with active inflammation due to GO who received intravenous steroid pulse therapy as a first-line treatment with or without orbital radiotherapy between 2010 and 2014 were reviewed. Patients were divided into two treatment groups: 1) combined orbital radiotherapy and steroid pulse therapy (SRT group) and 2) steroid pulse therapy only (ST group). Primary outcome measures included clinical activity score (CAS); NOSPECS classification; ocular motility impairment; and exophthalmos at 1, 3, 6, and 12 months after treatment. The secondary outcome measure was the change in orbital, extraocular muscle (EOM), and fat volume after treatment measured by orbit computed tomography. RESULTS: Sixty-eight patients were included in the SRT group, and 59 patients were in the ST group. In both treatments, CAS and NOSPECS were significantly reduced. In the comparison of the degree of change from baseline between the groups, the SRT group demonstrated more improvement in NOSPECS and scores of ocular motility. Orbital, EOM, and fat volume significantly decreased in the SRT group; however, only fat volume was reduced in the ST group. Compressive optic neuropathy after treatment developed in 0 % of the SRT group and 3.4 % (2/59) of the ST group. Reactivation of inflammation occurred in 11.8 % (8/68) of the SRT group and 28.8 % (17/59) of the ST group. CONCLUSIONS: Orbital radiotherapy in combination with steroid treatment significantly improved ocular motility by reducing EOM volume in patients with active GO.

Implications of enlarged infraorbital nerve in idiopathic orbital inflammatory disease.

PURPOSE: To investigate the clinical characteristics of idiopathic orbital inflammatory (IOI) disease with infraorbital nerve (ION) enlargement. DESIGN: Retrospective, comparative case series. PARTICIPANTS: Consecutive patients who were diagnosed with IOI between January 2009 and December 2013 were identified. The study included patients whose medical and radiological data at diagnosis were available and whose follow-up period was more than 12 months after treatment. The patients were divided into two groups according to accompaniment of ION enlargement and were compared. MAIN OUTCOME MEASURES: clinical manifestation, radiology and treatment outcome. RESULTS: Among 89 patients with IOI, 12 (13.5%) were identified to have ION enlargement. The ION-enlarged group showed a higher percentage of the patients with diffuse inflammation (66.7%, p<0.001). 91.7% of the ION-enlarged group showed inferiorly located inflammation. Patients with ION enlargement showed a significantly higher incidence rate of proptosis (p=0.013), pain (p=0.004) and altered sensation (p<0.001). The recurrence rate was significantly higher in the ION-enlarged group (83.3%) than in the other group (33.8%) (p=0.001). Repetitive inflammation (recurrence ≥3) with steroid dependency was found only in 19.5% patients without ION enlargement but in 66.7% patients with ION enlargement. CONCLUSIONS: Patients with ION-enlarged IOI showed distinct clinical and radiological characteristics. As IOI accompanied by ION enlargement showed significantly higher steroid dependency and recurrence rate, a more careful follow-up of patients during steroid tapering might be helpful to prevent recurrence of IOI.

Effect of the pigment-free optical zone diameter of decorative tinted soft contact lenses on visual function.

AIMS: We investigated changes in visual function after wearing decorative tinted soft contact lenses with different pigment-free optical zone diameters. METHODS: A prospective study was performed in 30 eyes of 30 healthy volunteers. Best-corrected visual acuity (BCVA), ocular higher-order aberrations (HOAs), modulation transfer function (MTF), Strehl ratio and contrast sensitivity were evaluated after wearing clear lens and tinted lenses with different pigment-free optical zone diameters (4, 5 and 6 mm). RESULTS: BCVA decreased from 0.00 logMAR after wearing a clear lens to 0.04±0.04 logMAR after wearing 4 mm optical zone lens (p<0.001). As the optical zone diameter decreased, ocular aberrations were induced. Total HOAs, coma aberration and secondary astigmatism showed significant difference between clear lens and 5 or 4 mm optical zone lenses (p<0.050). Spherical aberration and trefoil showed significant difference between clear lens and 4 mm optical zone lens (p<0.050). The results for Strehl ratio revealed poorer optical quality for both 5 and 4 mm optical zone lens (both p=0.002). The entire ocular MTF was significantly different, corresponding to the decreased optical zone diameter. The HOAs showed a correlation with the blocked pupil covered by the tinted part (r=0.435, p<0.001). In photopic and mesopic conditions, the contrast sensitivity decreased significantly with the reduced pigment-free optical zone diameters. CONCLUSION: Decorative tinted contact lenses significantly increased ocular aberrations and decreased optical quality and contrast sensitivity, as the pigment-free optical zone diameter decreased. Therefore, consumers of tinted lenses should be informed about the possible disturbance in visual function. TRIAL REGISTRATION NUMBER: NCT02537275.

Comparison of Measurements and Clinical Outcomes After Wavefront-Guided LASEK Between iDesign and WaveScan.

PURPOSE: To compare the measurements of refractive errors and ocular aberrations obtained using iDesign and WaveScan (Abbott Medical Optics, Inc., Santa Ana, CA), and to compare surgical outcomes of wavefront-guided LASEK using ablation profiles based on both aberrometers. METHODS: Ninety myopic eyes of 45 normal patients were evaluated using both the iDesign and WaveScan to measure spherical and cylindrical errors, spherical equivalents, and Zernike coefficients of ocular aberrations. Wavefront-guided LASEK was performed in a different group of 59 eyes of 30 patients divided into two groups, the iDesign and Wavescan groups. The clinical outcomes between the two groups including uncorrected visual acuity, refractive errors, contrast sensitivity, and ocular aberration were compared at 1, 3, and 6 months postoperatively. RESULTS: The iDesign produced significantly higher myopic values for refractive errors than the WaveScan, as well as significantly lower levels of total higher order, third, fourth, and fifth order root mean square values and Zernike coefficients of vertical coma and spherical aberration. At postoperative 1, 3, and 6 months, there were no statistically significant differences between the two groups in terms of uncorrected visual acuity and remaining refractive errors. The percentages of patients with spherical equivalents within ±1.00 and ±0.50 diopters of emmetropia were 100% (29 eyes) and 75.9% (22 eyes), respectively, in the iDesign group and 96.7% (29 eyes) and 70.0% (21 eyes), respectively, in the WaveScan group. Mesopic contrast sensitivity values were significantly higher, and the change in root mean square values for spherical aberration was significantly lower in the iDesign group. CONCLUSIONS: There were significant differences between the iDesign and the WaveScan in the measurements of refraction and ocular aberrations. Wavefront-guided LASEK based on an ablation profile from the iDesign demonstrated comparable refractive predictability with the WaveScan group, resulting in minimal physician adjustment and superior postoperative visual quality.

Restorative benefits of transplanting human mesenchymal stromal cells overexpressing arginine decarboxylase genes after spinal cord injury.

BACKGROUND AIMS: Mesenchymal stromal cells (MSCs) promote functional recovery in central nervous system (CNS) injury. Neuroprotective effects of MSCs are being tested in clinical trials for the treatment of CNS injury; however, the underlying mechanisms remain unclear. Arginine decarboxylase (ADC) is a rate-limiting enzyme of agmatine synthesis and is known to exist in the CNS of mammals. The present study investigated whether transplantation of ADC-overexpressing human MSCs (ADC-hMSCs) after spinal cord injury (SCI) could increase the production of neurotrophic factors and promote cell survival, differentiation, axonal regeneration and the restoration of functional recovery. METHODS: Retroviral human ADC was constructed with the use of an LXSN vector. After compression injury in thoracic level 9, PKH26-labeled ADC-hMSCs were transplanted into the dorsolateral funiculus 1 mm rostral and caudal to the lesion site. The tissues were sampled at 2, 4 and 10 weeks after SCI. RESULTS: Behavioral analysis revealed that locomotor functions of the ADC-hMSC group were significantly restored. Histological analysis showed that the fibrotic scar volume was smaller in the ADC-hMSC-injected group than in any other group. Brain-derived neurotrophic factor level was significantly higher in the ADC-hMSC-injected group than in any other group throughout 10 weeks. Terminal deoxynucleotidyl transferase-mediated nick-end labeling assay showed decreased cell death, and co-localization analysis showed significant increase in the number of neurons and oligodendrocytes originating from transplanted hMSCs when they had been transduced with the ADC gene. CONCLUSIONS: The results suggested that ADC-hMSCs are a more suitable candidate than hMSCs for stem cell therapy after SCI.