Clinical Characteristics of Eyes Showing a Discrete Margin of Different Retinal Reflectivity.

BACKGROUND AND OBJECTIVE: To evaluate the clinical characteristics of discrete margins of different retinal reflectivity (DMDRR) in ultra-widefield fundus photography. PATIENTS AND METHODS: This DMDRR comprises a discrete border, with differing patterns of reflectivity on either side. Spectral-domain optical coherence tomography was performed on both the macula and the margin. The incidences of epiretinal membrane (ERM) and peripheral retinal pathologies of patients with a DMDRR (n = 36) were compared with a control group (n = 41). RESULTS: An ellipsoid zone (EZ) defect at the DMDRR was detected in 34 eyes (92.2%), and vitreous traction was detected in 20 eyes (55.6%). A significantly higher proportion of eyes in the DMDRR group had an ERM, retinal hole, and cystic retinal tuft compared with the control group (P = .022, P = .010, and P < .001, respectively). CONCLUSIONS: The DMDRR indicates EZ disruption that may originate from vitreous traction. Meticulous observation for vitreoretinal interface diseases is mandatory for these patients. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:273-280.].

The Structural and Comparative Analysis of Intravitreal Dexamethasone Implant (Ozurdex) and Anti-VEGF Injection in Branched Retinal Vein Occlusion Patients by Optical Coherence Tomography Angiography Images Quantitation.

Background and Objective: To evaluate and compare the structural changes of retinal vasculature after intravitreal dexamethasone implant (Ozurdex) insertion and antivascular endothelial growth factor (anti-VEGF) injection in patients with branched retinal vein occlusion (BRVO) using optical coherence tomography angiography (OCTA).Study Design/Materials and Methods: We retrospectively analyzed 39 patients with unilateral BRVO. Subjects were divided into two groups according to treatment agent: Ozurdex (n = 18) and anti-VEGF (n = 21). Swept Source (SS) OCT and OCTA were performed and images were analyzed quantitatively using ImageJ (National Institutes of Health) software. Intravitreal implant and anti-VEGF injections were performed following a prn regimen. The specific anti-VEGF agent used was chosen among bevacizumab, ranibizumab and aflibercept.Results: Of the 39 patients (mean ± SD age, 70.0 ± 8.9 years [range, 48-89 years]; 20 men [51.0%]) with unilateral BRVO, in an independent two-sample t test, there was greater vascular reperfusion of the choriocapillaris slab in the intravitreal Ozurdex implant group than in the anti-VEGF group using the angiography mode (P = .013). Increased number of particles was more prominent in intravitreal anti-VEGF injection group than intravitreal Ozurdex implant group in outer retina slab of En-face mode (P = .039). There was no statistically significant difference between the 2 treatment groups in relation to the Early Treatment Diabetic Retinopathy Study (ETDRS) density map and other angiography slabs; and the superficial, deep, and outer retina.Conclusions: Results of a quantitative analysis of OCTA images using ImageJ software suggest that the intravitreal Ozurdex implant induced increased retinal vascular perfusion compared with anti-VEGF injection for the treatment of BRVO.

Prevalence of epiretinal membrane in the phakic eyes based on spectral-domain optical coherence tomography.

The prevalence of epiretinal membrane (ERM) and associated factors in the phakic eyes have not been fully elucidated yet. This cross-sectional study included 2,354 phakic eyes without retinal diseases or surgical history. Ocular parameters, such as uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), white-to-white corneal diameter (WTW), mean keratometric value (Km) of total corneal refractive power at 4-mm diameter (TCRP4), astigmatism of TCRP4, total corneal irregular astigmatism (TCIA), pupil diameter, axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), and posterior vitreous detachment (PVD) were compared between ERM group and control group. Additionally, an age-matched control group was selected by individual matching and compared with the ERM group to eliminate the confounders. Multiple logistic regression analysis was performed to evaluate the factors associated with the presence of ERM. Among 2,354 eyes, 429 eyes (18.2%) had ERM based on spectral-domain optical coherence tomography. The ERM group showed higher prevalence of PVD, worse CDVA, higher astigmatism of TCRP4, higher TCIA, smaller pupil size, longer AXL, and thicker LT than control group (P < 0.001, P < 0.001, P = 0.011, P < 0.001, P = 0.023, P < 0.001, and P < 0.001, respectively). Only PVD, CDVA, SE, astigmatism of TCRP4, TCIA, and AXL maintained the significance when compared with the age-matched control group (P < 0.001, P = 0.026, P < 0.001, P = 0.001, P = 0.003, and P < 0.001, respectively). Multivariate logistic regression analysis showed that age, PVD, CDVA, and TCIA were independently associated with the presence of ERM (P < 0.001, P < 0.001, P = 0.011, and P = 0.002). The prevalence of ERM detected using SD-OCT was 18.2% in the middle aged phakic population. Eyes with TCIA, in addition to older age and PVD, were more likely to have ERM.

Risk Factors for Onset or Progression of Posterior Vitreous Detachment at the Vitreomacular Interface after Cataract Surgery.

PURPOSE: To study the incidence and risk factors for onset or progression of posterior vitreous detachment (PVD) at the vitreomacular interface (VMI) after cataract surgery. DESIGN: Retrospective case series. PARTICIPANTS: Patients with a history of phacoemulsification from April 2018 through April 2019 at the Keye Eye Center, Seoul, Korea, and postoperative monitoring for more than 2 months. METHODS: Cox proportional hazard ratios for the onset or development of PVD after cataract surgery in the presence of selected risk factors and demographic data were calculated. To evaluate the ocular risk factors, various ocular metrics, including spherical equivalent (SE), axial length (AL), anterior chamber depth, lens thickness, central subfield thickness, PVD status at macula and optic nerve head (ONH), peripapillary retinal nerve fiber layer thickness, and ONH parameters from OCT scans, were used for the analysis. MAIN OUTCOME MEASURES: Onset or development of PVD at the VMI. RESULTS: Among 988 eyes without PVD at baseline, 174 eyes (17.6%) showed changes in the VMI. Univariate analysis showed that age, SE, AL, PVD status at macula and ONH, and average and vertical cup-to-disc ratios (CDRs) were associated significantly with PVD onset or development (P = 0.046, P = 0.004, P = 0.040, P < 0.001, P < 0.001, P = 0.008, and P = 0.042, respectively). In a multivariate analysis, PVD status at the macula and ONH and smaller CDR were associated with PVD onset or progression after cataract surgery after adjustment for age, SE, and AL (P < 0.001, P < 0.001, and P = 0.005, respectively). CONCLUSIONS: The risk of PVD onset or progression was dependent on PVD status and the CDR detected on OCT scans, not on age or AL, in a large patient cohort. Patients who show risk factors on OCT should be monitored carefully during the postoperative period.

Analysis of choroidal thickness and vascularity in patients with unilateral polypoidal choroidal vasculopathy.

PURPOSE: This study aimed to analyze the choroidal characteristics in eyes with polypoidal choroidal vasculopathy (PCV, affected eyes) and unaffected fellow eyes, and investigated the longitudinal changes in the choroidal structure of fellow eyes in patients with unilateral PCV. METHODS: We retrospectively reviewed the medical records of 55 treatment-naïve patients with unilateral PCV. The choroidal thickness and vascularity between PCV affected eyes, unaffected fellow eyes, and normal control eyes were compared. Structural changes in the choroid of the fellow eyes were reviewed during follow-up. RESULTS: PCV eyes had thicker subfoveal choroidal thickness (SFCT) (p < 0.001), greater ratio of Haller layer to SFCT (p < 0.001), and lower choroidal vascularity index (p = 0.023), compared to controls. In unaffected fellow eyes, the ratio of the Haller layer to SFCT was greater (p < 0.001) than in controls. During a 58.91-month mean follow-up, nine (16%) fellow eyes developed new PCV. These eyes showed a greater ratio of Haller layer to SFCT at baseline (p < 0.001) compared to the other fellow eyes. We also observed a numerical change in the choroidal vascularity index during follow-up of fellow eyes that developed new PCV. CONCLUSION: The dilation of the Haller layer was prominent in PCV eyes and fellow eyes, compared to normal controls. In the fellow eyes that developed new PCV lesions, there were changes in the choroidal vascularity during follow-up.

Comparative study of tacrolimus and bevacizumab on corneal neovascularization in rabbits.

PURPOSE: To compare the antiangiogenic effects of tacrolimus and bevacizumab on corneal neovascularization (CNV) in rabbits. METHODS: Neovascularization was induced in 32 eyes of 16 rabbits by placing a suture in the corneal stroma. Seven days after suture placement, all rabbits were divided into 4 groups and were treated subconjunctivally with bevacizumab (AVA_sub) 0.05 mL (5 mg/0.05 mL), tacrolimus (TAC_sub) 0.05 mL (0.25 mg/0.05 mL), balanced salt solution (0.05 mL was subconjunctivally injected in 1 eye of each rabbit and applied by eye drops in the other eyes, control group), and tacrolimus eye drops (TAC_drop) (5 mg/5 mL applied 4 times daily). Digital photographs were obtained and surface area of CNV was measured 7 days after subconjunctival injections. Corneal specimens were analyzed histopathologically and were used to measure the concentration of vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), interleukin-1 beta (IL-1ß), and monocyte chemoattractant protein 1 mRNA by reverse transcription polymerase chain reaction. RESULTS: In digital photographs, the neovascularized area was decreased in all treatment groups (AVA_sub, 0.58; TAC_sub, 0.60; TAC_drop, 0.68) compared with the control group (balanced salt solution, 0.81). Histological examination showed markedly regressed new vessels in treatment groups, and immunohistochemical staining revealed weakly stained anti-VEGF and anti-F4/80 antibodies in treatment groups. In semiquantitative reverse transcription polymerase chain reaction, concentration of VEGF (AVA_sub, 0.24; TAC_drop, 0.18), TNF-α (AVA_sub, 0.19; TAC_sub, 0.24; TAC_drop 0.15), and IL-1ß (AVA_sub, 0.19; TAC_sub, 0.33; TAC_drop, 0.18) mRNA were significantly lower in treatment groups than in the control group (VEGF, 0.47; TNF-α, 0.44; IL-1ß, 0.87) (P < 0.05). CONCLUSIONS: Topical and subconjunctival tacrolimus application may be useful in reducing CNV and have comparable effects to subconjunctival bevacizumab injection.

A case of congenital orbital fibroepithelial polyp.

Fibroepithelial polyp (FEP) is a benign tumor of mesodermal origin, composed of varying amounts of stroma covered by epithelium. The skin and the genitourinary tract are the most common sites of FEP. Uncommon locations of FEP include the inferior turbinate of the nasal cavity, bronchi, and the pharynx. To date, there has been no report of orbital FEP. The authors describe a patient with congenital orbital FEP arising from the lateral canthal area. This congenital FEP was completely excised successfully through an anterior orbitotomy without any complications, with no evidence of recurrence after 25 months.