SUBRETINAL FLUID ASSOCIATED WITH DRUSENOID PIGMENT EPITHELIAL DETACHMENT.

PURPOSE: To analyze the clinical characteristics of drusenoid pigment epithelial detachment (PED) with subretinal fluid (SRF) and to evaluate the impact of SRF on the long-term visual and anatomical outcomes. METHODS: Forty-seven eyes with drusenoid PED (47 patients) who completed >24 months of follow-up were retrospectively analyzed. Intergroup comparisons of the visual and anatomical outcomes with and without SRF were made. RESULTS: The mean duration of follow-up was 32.9 ± 18.7 months. The group with drusenoid PED with SRF (14 eyes) showed significantly higher PED height (468 ± 130 µ m vs. 313 ± 88 µ m, P < 0.001), larger PED diameter (2,328 ± 953 µ m vs. 1,227 ± 882 µ m, P < 0.001), and larger PED volume (1.88 ± 1.73 mm 3 vs. 1.12 ± 1.35 mm 3 , P = 0.021) than that in the group with drusenoid PED without SRF (33 eyes) at baseline. No significant intergroup difference was found regarding the best-corrected visual acuity at the final visit. In addition, the incidence of complete retinal pigment epithelial and outer retinal atrophy (cRORA; 21.4%) and the development of macular neovascularization (MNV; 7.1%) for the group with drusenoid PED with SRF showed no difference compared with those (39.4% for cRORA development and 9.1% for MNV development) with drusenoid PED without SRF. CONCLUSION: The size, height, and volume of drusenoid PED were associated with the development of SRF. The SRF in drusenoid PED did not affect the visual prognosis or the development of macular atrophy during long-term follow-up.

Anterior segment characteristics in normal and keratoconus eyes evaluated with a new type of swept-source optical coherence tomography.

PURPOSE: This study aimed to evaluate and compare the discriminating ability of corneal elevation maps generated using a swept-source optical coherence tomography (SS-OCT) (SS-OCT ANTERION, Heidelberg Engineering, Heidelberg, Germany), which was estimated with different reference surfaces, to distinguish normal corneas from those with keratoconus and keratoconus suspect. METHODS: A total of 126 eyes of patients, which comprised 43, 37, and 46 keratoconus, keratoconus suspects, and normal controls, respectively, were included in this study. The anterior and posterior elevations at the thinnest point under the best-fit sphere (BFS) and toric-ellipsoid (BFT), respectively, and other corneal parameters were measured using the SS-OCT. In addition, the receiver operating characteristic (ROC) curve analysis and cut-off value were calculated to evaluate the diagnostic ability of the corneal elevation values in differentiating keratoconus and keratoconus suspects from normal eyes. RESULTS: The mean total keratometric and corneal elevation values were significantly higher in the keratoconus group than in the other groups. Pachymetric parameters exhibited the lowest values for keratoconus. In addition, ROC curve analyses showed a high accuracy of the thinnest point anterior and posterior BFT for both keratoconus and keratoconus suspects and normal controls (area under the ROC were 0.969 and 0.961, respectively). Furthermore, the optimal cut-off point of the posterior elevation at the thinnest point under BFT was 16.44 µm (sensitivity and specificity of 86% and 98%, respectively) for differentiating keratoconus from normal and keratoconus suspect eyes. CONCLUSIONS: The elevation map using the BFS and BFT references measured with the anterior segment SS-OCT is considered an effective indicator for keratoconus diagnosis. Therefore, the anterior segment SS-OCT can effectively differentiate keratoconus from suspected keratoconus and normal corneas by measuring parameters such as posterior and anterior elevations, pachymetry, and keratometry.

Neovascular age-related macular degeneration without exudative recurrence over 24 months after initial remission.

We investigated the characteristics of neovascular age-related macular degeneration (AMD), which rarely recurs after initial remission. This study retrospectively analyzed 392 neovascular AMD patients treated with anti-vascular endothelial growth factor (VEGF). All patients received three monthly loading doses of anti-VEGF injections, followed by a pro re nata (as needed) regimen for 24 months. The baseline characteristics associated with the odds of having no recurrence within 24 months were evaluated using multivariate modeling. After the initial three loading injections over 24 months, 58 (14.8%) eyes showed no exudative recurrence and did not require additional anti-VEGF injections. These patients without exudative recurrence had significantly better best-corrected visual acuity (P = 0.003) and lower central subfoveal thickness (P = 0.035) at 24 months than those with exudative recurrence. Additionally, the incidence of macular atrophy was significantly lower in the former than in the latter (8.6% vs. 21.9%; P = 0.020). Multivariate analysis revealed that younger age (odds ratio [OR], 0.901; P = 0.033), smaller lesion size (OR, 0.589; P = 0.016), and absence of fibrovascular pigment epithelial detachment (PED) (OR, 1.349; P = 0.028) were associated with higher odds of no recurrence during follow-up. Approximately 15% of the neovascular AMD patients showed no exudative recurrence after initial remission during the 24-month follow-up. The infrequent recurrence after initial remission correlated with younger age, smaller lesion size, and absence of fibrovascular PED.

Short-Term Outcomes of Switching to Ranibizumab in Polypoidal Choroidal Vasculopathy Resistant to Aflibercept Therapy.

BACKGROUND: To evaluate the short-term outcomes of switching to ranibizumab in aflibercept-resistant polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective study included 18 eyes diagnosed with aflibercept-resistant PCV. All patients were treated with two to four consecutive ranibizumab injections at 4-5-week intervals. The best-corrected visual acuity (BCVA), and central retinal thickness (CRT) values before and after switching to ranibizumab were compared. The proportion of eyes showing ≥100 µm decrease in retinal thickness and/or complete resolution of fluid after switching was identified. RESULTS: The mean number of aflibercept injections before switching was 5.7 ± 3.3. After switching, a mean of 2.8 ± 0.6 consecutive ranibizumab injections was performed. The mean logarithm of minimal angle of resolution (logMAR) BCVA was 0.41 ± 0.26 (Snellen equivalents = 20/51) before switching, and 0.40 ± 0.30 (20/50) after switching (p = 0.574). The mean CRT was 422.2 ± 152.4 µm before switching, and 400.7 ± 182.0 µm after switching (p = 0.236). A decrease in CRT of ≥100 µm, and/or complete resolution of fluid was noted in three eyes (16.7%). CONCLUSIONS: Switching to ranibizumab in aflibercept-resistant polypoidal choroidal vasculopathy was not effective in most patients, suggesting the need for further investigation to seek more effective treatment options for this condition.

Comparison Between an Intraocular Lens With Extended Depth of Focus (Tecnis Symfony ZXR00) and a New Monofocal Intraocular Lens With Enhanced Intermediate Vision (Tecnis Eyhance ICB00).

PURPOSE: This study compared the extended depth of focus (EDOF) intraocular lens (IOL) (ZXR00; Tecnis Symfony, Johnson & Johnson Vision, Santa Ana, CA, US) to a novel, higher-order aspheric monofocal IOL (ICB00; Tecnis Eyhance, Johnson & Johnson Vision, Santa Ana, CA, US) which uses the same platform and material. METHODS: Medical records of patients undergoing cataract surgery with ZXR00 or ICB00 implantation between March 2020 and January 2021 and with the data available for the 3-month visit were reviewed. The uncorrected near, intermediate, and distance visual acuity (VA); corrected distance VA; and optical quality parameters were the main outcome measures. RESULTS: Among the 174 enrolled patients, 72 and 102 received the ZXR00 and ICB00, respectively. The average patient ages were 59.6 ±â€Š10.6 (range: 49 to 70) and 65.2 ±â€Š8.2 (range: 45 to 82) years in the ZXR00 and ICB00 groups, respectively, with significantly older patients in the ICB00 group. The other baseline parameters were not different for the 2 groups. Compared to the ICB00 group, the ZXR00 group showed markedly superior near VA (P < 0.05) at 3 months postoperatively. In terms of optical quality, ICB00 was, statistically, significantly superior to ZXR00. CONCLUSIONS: The ZXR00 showed remarkable near vision and defocus curve smoothness, while the ICB00 achieved better optical quality. The 2 IOLs had comparable distance and intermediate vision.

Relationship between the partial blink rate and ocular surface parameters.

PURPOSE: To elucidate the relationship between partial blink rate (PBR) and ocular surface parameters. METHODS: We conducted a retrospective cross-sectional study of the patients who visited the Kim's Eye Hospital between March 2020 and July 2020. Blinking dynamics, tear film lipid layer thickness (LLT), non-invasive tear film break- up time (NITBUT), tear meniscus height (TMH), and meibomian gland (MG) dropout rate were assessed using the IDRA® Ocular surface analyzer (SBM SISTEMI, Inc., Torino, Italy) (IDRA). Dry eye symptoms were quantified by the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores. RESULTS: A total of 47 non-Sjögren dry eye patients (47 right eyes, mean age = 56.8 ± 14.5 [20-75] years, 66% female) were enrolled. Among the ocular surface parameters, PBR had strong correlations with MG dropout rate (r = 0.811; p < 0.01) and moderate correlations with SPEED scores (r = 0.596; p < 0.01). MG dropout rate and age had moderate correlations with SPEED scores (r = 0.416; p = 0.04 and r = 0.322; p = 0.03, respectively). Comparisons by sex revealed no significant difference in characteristics, except for the TMH value. The TMH of female patients (0.17 ± 0.07) was significantly higher than that of males (0.14 ± 0.04; p = 0.04). LLT showed no significant correlation with the other variables. CONCLUSION: PBR and MG dropout rates measured with IDRA were significantly correlated to dry eye symptoms.

Optical properties and 14C ages of stream DOM from agricultural and forest watersheds during storms.

Forest and agricultural land use affects the concentration and composition of dissolved organic carbon (DOC) in streams and rivers. To elucidate the impacts of forest and agricultural land use on stream DOC during storm events, we investigated DOC concentration ([DOC]), optical properties of dissolved organic matter (DOM), and Δ14C-DOC in both forest- and agriculture-dominated headwater streams in South Korea in the summer of 2012. One forested and five agricultural streams were investigated. During storms, the peak [DOC] of forest stream increased to 5.8 mg L-1, approximately two times larger than that of the most agricultural stream (3.2 mg L-1), demonstrating the weaker storm responses of the [DOC] of agricultural streams to hydrological change. Five PARAFAC components were identified, including three terrestrial humic-like substances (C1, C2, C3), one microbial humic substance (C4), and one microbial protein-like substances (C5). The mean (C4+C5)/(C1+C2+C3) of all storm events at the most agricultural stream was 1.5 times larger than that of the most forested stream, suggesting that more protein-like DOM is exported from agricultural watersheds. Whereas a forest stream was primarily composed of terrestrially derived and 14C-enriched modern DOC, the 14C-age of the most agricultural stream was up to ∼1000 years old. The results suggest that agricultural practices could decrease the old organic carbon pools from soils. However, how quickly the aged DOC can be degraded to CO2 in streams is unknown, warranting future investigation on lability of the aged DOC and their effects on CO2 evasion from rivers and estuaries downstream.

Ocular surface analysis: A comparison between the LipiView® II and IDRA®.

PURPOSE: To compare the lipid layer thickness (LLT), meibomian gland (MG) dropouts, and blinking pattern determined by the analysis of images acquired from the LipiView® II (LVII) and the IDRA® Ocular surface analyzer. METHODS: A cross-sectional single-visit observational study was conducted. The LLT (minimum, maximum, and average), percentages of MG dropouts, and partial blink rates (PBR) were taken from both eyes of 47 participants using LVII and IDRA. Both devices were used to image the inferior eyelid of each participant in a random order. RESULTS: Forty-seven participants (mean age 56.77 ± 14.47 (21-79) years, 66% female) completed the study. There was no significant difference in LLT between the two devices. A significant difference in percentages of MG dropouts was obtained between the LVII (36.51 ± 17.53) and the IDRA (45.36 ± 21.87), p = 0.003). There was also a significant difference in PBR between the LVII (0.51 ± 0.37) and the IDRA (0.23 ± 0.27), p < 0.001). CONCLUSION: No significant difference in LLT was obtained between LVII and IDRA. IDRA had a significantly lesser percentage of MG dropout and a higher PBR compared to LVII. These results indicate that these devices should not be used interchangeably for the evaluation of MG dropouts and PBR.