Morphological differences of the neuroretinal rim between temporally tilted and non-tilted optic discs in healthy eyes.

This study aimed to compare morphological differences of the neuroretinal rim between the temporally tilted and non-tilted optic discs in healthy eyes. We prospectively enrolled participants aged 20-40 years with temporally tilted or non-tilted optic discs. The optic nerve head parameters were analyzed using spectral domain-optical coherence tomography. The angle between the Bruch's membrane opening (BMO) plane and BMO-minimum rim width (BMO-MRW) was termed "BMO-MRW angle". Peripapillary retinal nerve fiber layer thickness (pRNFLT) and BMO-based parameters were compared between the temporally tilted and non-tilted disc groups. As a result, 55 temporally tilted disc eyes and 38 non-tilted disc eyes were analyzed. Global pRNFLT, global BMO-MRW, and total BMO-minimum rim area (BMO-MRA) were similar between the two groups (p = 0.138, 0.161, and p = 0.410, respectively). In the sectoral analysis, temporally tilted disc group exhibited thicker BMO-MRW in the temporal sector (p = 0.032) and thinner in the nasal superior and nasal sectors (p = 0.025 and p = 0.002, respectively). Temporally tilted disc group showed larger BMO-MRA in the temporal, temporal superior, and temporal inferior sectors (p < 0.001, p < 0.001, and p < 0.016, respectively), alongside a higher BMO-MRW angle in the temporal sector and lower in the nasal superior and nasal sectors. In conclusion, the neuroretinal rim, represented by BMO-MRW and BMO-MRA, showed morphological differences between temporally tilted and non-tilted optic discs in healthy eyes. BMO-MRW and BMO-MRA showed temporalization in the same manner as pRNFLT in the temporally tilted disc eyes. The BMO-MRW angle showed that in temporally tilted disc eyes, optic nerve fibers met the BMO plane steeply in the nasal sector and gently in the temporal sector than in non-tilted disc eyes, suggesting potential stress region of optic nerve fibers in temporally tilted disc eyes.

Factors affecting optical coherence tomography angiography signal strength index in patients receiving intravitreal injection treatment.

PURPOSE: To investigate the clinical factors affecting optical coherence tomography angiography (OCTA) signal strength index (SSI) and its change after intravitreal injection treatment in patients with retinal disorders. METHODS: OCTA data from 186 eyes of 166 patients with various retinal disorders including age-related macular degeneration, diabetic macular edema (DME), and retinal vein occlusions who received intravitreal injections were analyzed. The associations between SSI and clinical factors, including age, best-corrected visual acuity (BCVA), media opacity severity, and central macular thickness (CMT), were evaluated both before and after injection. RESULTS: After injection, BCVA improved and CMT decreased significantly, and SSI increased significantly (p = 0.030). BCVA showed a significant positive correlation with media opacity severity before and after injection and with CMT only before injection. In the multivariate analysis, age, presence of DME, BCVA, and media opacity severity were negatively associated with SSI both before and after injection, while CMT was negatively associated with SSI only before injection. After injection, a negative correlation was found between SSI change and both BCVA and CMT change. CONCLUSION: Our findings suggest that OCTA SSI is influenced by various clinical factors, including age, visual acuity, media opacity severity, and macular thickening, especially in cases of DME. The results also indicate that SSI may decrease in patients with macular disorders due to the presence of macular edema and the associated decrease in visual acuity. Therefore, it is crucial to consider these factors when interpreting OCTA data and ensure an adequate level of SSI.

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.

Insulin syringe for anesthesia in ptosis surgery: a randomized, fellow eye-controlled clinical study.

PURPOSE: Unlike ordinary 30-gauge needles, insulin syringe needles are thinner and shorter and have a comparatively blunt tip. Therefore, insulin syringes may reduce injection discomfort, bleeding, and edema by minimizing tissue damage and vascular penetration. This study aimed to evaluate the potential benefits of using insulin syringes for local anesthesia in ptosis surgery. METHODS: This randomized, fellow eye-controlled study included 60 patients (120 eyelids), conducted at a university-based hospital. An insulin syringe was used on one eyelid, and a conventional 30-gauge needle was used on the other. Patients were instructed to score pain in both eyelids using a visual analog scale (VAS) ranging from 0 (no pain) to 10 (unbearable pain). Ten minutes after the injection, two observers scored degrees of hemorrhage and edema in both eyelids on five- and four-pointing grading scales (0-4 and 0-3) for each value, and the average score between the two observers was calculated and compared. RESULTS: The VAS score was 5.17 in the insulin syringe group and 5.35 in the 30-gauge needle group (p = 0.282). Ten minutes after the anesthesia, the median hemorrhage scores were 1.00 and 1.75 (p = 0.010), and the median eyelid edema scores were 1.25 and 2.00 (p = 0.007) in the insulin syringe and 30-gauge needle groups, respectively (Fig. 1). CONCLUSION: Injecting local anesthesia using an insulin syringe significantly reduces hemorrhage and eyelid edema, but not injection pain, before skin incision. Insulin syringes are useful in patients at high risk of bleeding because they can reduce the penetrative tissue damage caused by needle insertion.

Vogt-Koyanagi-Harada Disease following mRNA-1273 (Moderna) COVID-19 Vaccination.

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease following mRNA-1273 (Moderna) COVID-19 vaccination. METHODS: Retrospective case report. RESULTS: A 50-year-old Korean woman developed bilateral serous retinal detachment 35 days after the first dose of COVID-19 mRNA vaccination (mRNA-1273, Moderna). She experienced adverse effects such as erythema and pain at the injection site, headache, myalgia, and allergy symptoms prior to ocular manifestation. She was diagnosed with Vogt-Koyanagi-Harada (VKH) disease. After treatment with oral prednisolone, the serous retinal detachment resolved and vision improved. CONCLUSION: COVID-19 vaccination might be associated with VKH disease development, and the ingredients of the mRNA vaccine or viral peptide encoded by mRNA may have activated the immunological process and induced VKH disease.

A Decrease in Bruch's Membrane Opening-Minimum Rim Area Precedes Decreased Retinal Nerve Fiber Layer Thickness and Visual Field Loss in Glaucoma.

PRCIS: A decrease in Bruch's membrane opening-minimum rim area, which represents the optic nerve head (ONH), preceded a decrease in the peripapillary retinal nerve fiber layer thickness (RNFLT) and the visual field index (VFI). PURPOSE: This study aimed to investigate the relative comparison between a decrease in BMO-MRA, the peripapillary RNFLT, and the VFI, according to the severity of glaucoma. MATERIALS AND METHODS: This retrospective cross-sectional study included 121 eyes (73 with open-angle glaucoma and 48 normal eyes). The ONH and retinal nerve fiber layer were analyzed using spectral domain optical coherence tomography, and VFI was obtained using the Humphrey Field Analyzer. The tipping points of RNFLT for VFI and BMO-MRA were estimated using broken-stick regression models. Polynomial regression analysis was performed, and the changes in the 3 parameters were expressed as a graph. RESULTS: The tipping point of the RNFLT for the VFI was 88.62 µm [95% confidence interval (CI): 79.59-97.65; P=0.001]. The tipping point of the RNFLT for BMO-MRA was 60.00 µm (95% CI: 48.28-71.72; P=0.220). Above the tipping point, BMO-MRA decreased with a decrease in the RNFLT (slope=0.0135; 95% CI: 0.0115-0.0155; P<0.001); below the tipping point, BMO-MRA did not decrease significantly (slope=0.0002; 95% CI: -0.0177 to 0.0181; P=0.983). Polynomial regression analysis showed that with the progression of glaucoma, BMO-MRA decreased more rapidly, and this preceded a decrease in the RNFLT followed by a decrease in the VFI. CONCLUSION: The ONH parameter, BMO-MRA, showed a faster decrease than RNFLT and VFI in early glaucoma. BMO-MRA may help detect early glaucomatous damage and its progression.