Artificial Intelligence-Enhanced OCT Biomarkers Analysis in Macula-off Rhegmatogenous Retinal Detachment Patients.

Purpose: To identify optical coherence tomography (OCT) biomarkers for macula-off rhegmatogenous retinal detachment (RRD) with artificial intelligence (AI) and to correlate these biomarkers with functional outcomes. Methods: Patients with macula-off RRD treated with single vitrectomy and gas tamponade were included. OCT volumes, taken at 4 to 6 weeks and 1 year postoperative, were uploaded on an AI-derived platform (Discovery OCT Biomarker Detector; RetinAI AG, Bern, Switzerland), measuring different retinal layer thicknesses, including outer nuclear layer (ONL), photoreceptor and retinal pigmented epithelium (PR + RPE), intraretinal fluid (IRF), subretinal fluid, and biomarker probability detection, including hyperreflective foci (HF). A random forest model assessed the predictive factors for final best-corrected visual acuity (BCVA). Results: Fifty-nine patients (42 male, 17 female) were enrolled. Baseline BCVA was 0.5 logarithmic minimum angle of resolution (logMAR) ± 0.1, significantly improving to 0.3 ± 0.1 logMAR at the final visit (P < 0.001). Average thickness analysis indicated a significant increase after the last follow-up visit for ONL (from 95.16 ± 5.47 µm to 100.8 ± 5.27 µm, P = 0.0007) and PR + RPE thicknesses (60.9 ± 2.6 µm to 66.2 ± 1.8 µm, P = 0.0001). Average occurrence rate of HF was 0.12 ± 0.06 at initial visit and 0.08 ± 0.05 at last follow-up visit (P = 0.0093). Random forest model revealed baseline BCVA as the most critical predictor for final BCVA, followed by ONL thickness, HF, and IRF presence at the initial visit. Conclusions: Increased ONL and PR-RPE thickness associate with better outcomes, while HF presence indicates poorer results, with initial BCVA remaining a primary visual predictor. Translational Relevance: The study underscores the role of novel biomarkers like HF in understanding visual function in macula-off RRD.

Efficacy and safety of treat-and-extend intravitreal brolucizumab in naive and switched patients with macular neovascularization: one-year follow-up study.

BACKGROUND: to analyze, at one year, the efficacy and safety of treat-and-extend (T&E) intravitreal (IV) Brolucizumab in patients affected by macular neovascularization (MNV). Both naïve and previously treated (i.e., switched) patients were included, and the data from the two groups were compared. METHODS: anatomical (i.e., central subfoveal thickness, CST; presence of fluid), functional (i.e., best corrected visual acuity, BCVA) and treatment-related (i.e., number of IV injections within the study period; number of patients reaching a 12-weeks interval between treatments) data from 41 eyes of 41 subjects (20 naïve and 21 switched) were analyzed. Patients were treated with 3 monthly IV injections followed by a T&E regimen based on a disease activity assessment performed at each scheduled IV treatment. RESULTS: significant CST reduction (from 412.1 ± 115.8 to 273.2 ± 61.6; p < 0.05) and BCVA (mean; p) improvement were observed in the naïve group, while in the switched cohort, both parameters were almost stable. In the naïve and switched groups, 55% and 33.5% of patients, respectively, reached a 12-week IV interval at one year, with a mean of 6.55 ± 1 and 7.43 ± 0.68 IV treatments, respectively. One patient with mild anterior uveitis without sequelae was recorded. CONCLUSION: In patients with MNV, IV Brolucizumab injections following a T&E regimen demonstrated great efficacy and a good safety profile, with greater anatomical and functional results in naïve patients. TRIAL REGISTRATION: This study was approved by the Local Ethics Committee (protocol number 155/2020, general registry number n°11486, InterHospital Ethics Committee, San Luigi Gonzaga Hospital, Orbassano, Italy).

Macular Pigment Optical Density as a Measurable Modifiable Clinical Biomarker.

BACKGROUND: Carotenoids are present throughout retina and body its dense deposition leads to an identifiable yellow spot in the macula. Macular pigment optical density (MPOD) measured in the macula is vital to macular well-being and high-resolution visual acuity. MPOD has also been associated with various health and disease states. We sought to review the literature on this topic and summarize MPODs role as a measurable modifiable clinical biomarker, particularly as a measure of the eye's antioxidant capacity in the context of oxidative damage and retinal ischemia. METHODS: A literature review collated the articles relevant to MPOD, carotenoid intake or supplementation, and their influence on various health and disease states. RESULTS: Literature reveals that MPOD can serve as a reliable biomarker for assessing the retinal defense mechanisms against oxidative stress and the deleterious effects of excessive light exposure. Elevated MPOD levels offer robust protection against the onset and progression of age-related macular degeneration (AMD), a prevalent cause of vision impairment among the elderly population. MPOD's implications in diverse ocular conditions, including diabetic retinopathy and glaucoma, have been explored, underscoring the real need for clinical measurement of MPOD. The integration of MPOD measurement into routine eye examinations presents an unparalleled opportunity for early disease detection, precise treatment planning, and longitudinal disease monitoring. CONCLUSIONS: Longitudinal investigations underscore the significance of MPOD in the context of age-related ocular diseases. These studies show promise and elucidate the dynamic nuances of MPOD's status and importance as a measurable, modifiable clinical biomarker.

A comparative study of choroidal structural features in eyes with central macular atrophy related to Stargardt disease and non-exudative age-related macular degeneration.

PURPOSE: To compare choroidal structural features in eyes with central macular atrophy related to Stargardt disease (STGD) and non-exudative age-related macular degeneration (AMD). METHODS: Twenty-five eyes of 25 Stargardt cases and 25 eyes of 25 non-exudative AMD cases were included in this retrospective study. Region Finder software was used to measure atrophic areas on blue-light fundus autofluorescence images centered on the macula. The total choroidal area (TCA), luminal area (LA), and stromal area (SA) were calculated using the ImageJ program and Niblack autolocal thresholding method. The choroidal vascularity index (CVI) was assessed. RESULTS: The mean age was 59.4 ± 10.9 years in the STGD group and 68.1 ± 7.6 years in the non-exudative AMD group (P = 0.002). The mean macular atrophic area was 16.06 ± 10.61 mm2 in STGD and 11.73 ± 7.65 mm2 in non-exudative AMD (P = 0.171). The STGD group had significantly higher mean subfoveal choroidal thickness (184.0 ± 62.6 vs. 131.8 ± 62.4 µm), TCA (0.553 ± 0.201 vs. 0.406 ± 0.189 mm2), LA (0.344 ± 0.150 vs. 0.253 ± 0.124 mm2), and SA values (0.208 ± 0.062 vs. 0.153 ± 0.069 mm2) compared to the non-exudative AMD group (P = 0.004, P = 0.011, P = 0.023, and P = 0.004, respectively). However, CVI values did not differ significantly between the two groups (60.58 ± 7.4 vs. 61.93 ± 5.8%, P = 0.432). According to the results of the ANCOVA test, differences in mean SFCT, TCA, and SA persisted when the data were readjusted for age (P = 0.018, P = 0.035, and P = 0.017, respectively). CONCLUSION: In non-exudative AMD with geographic atrophy, the reductions in the choroidal compartments are more pronounced than those in STGD. However, similar CVI values may suggest that controversy still exists regarding the role of choroidal compartmental changes in the development of atrophy.

The effects of topical latanoprost 0.005% treatment on microvascular changes in the optic nerve head and macula.

PURPOSE: This prospective study aimed to assess the impact of topical latanoprost 0.005% treatment on the microvasculature of the macula and optic nerve head (ONH) in primary open-angle glaucoma (POAG). METHODS: Fifty-seven eyes of 31 subjects were enrolled. ONH whole-image (wiVD), peripapillary (ppVD), and macular vascular density (VD) parameters were measured using optical coherence tomography angiography before treatment, at the 1st month, and at the 3rd month of treatment. RESULTS: There was a significant reduction in IOP post treatment, with a decrease of 17.0 ± 2.3 mmHg in the 1st month and 16.3 ± 2.5 mmHg in the 3rd month (P < 0.001 for both). ONH wiVD and ppVD significantly increased at the post-treatment 1st month (P = 0.001 for both) but decreased by the 3rd month, returning to baseline levels (P < 0.001 for both), indicating a return to pre-treatment levels (P > 0.05 for both). Similarly, macular wiVD and perifoveolar VD (pefVD) increased significantly at the 1st month (P = 0.013 and P < 0.001, respectively) but returned to baseline by the 3rd month (P < 0.001 for both). No significant difference was observed between before-treatment and post-treatment 3rd month regarding the macular wiVD and pefVD (P > 0.05 for both). Deep capillary plexus and foveal avascular zone parameters did not change during follow-up (P > 0.05 for both). CONCLUSION: The initial increase in ONH and peripapillary VD, as well as macular VD, is attributed to the acute reduction in IOP from topical latanoprost 0.005%. However, the diminishment of sustained differences by the 3rd month indicates adaptation of the ONH and retinal microvasculature to decreased IOP through compensatory mechanisms.

OPTICAL COHERENCE TOMOGRAPHY FEATURES ASSOCIATED WITH VITREOMACULAR TRACTION RELEASE AND MACULAR HOLE SIZE PROGRESSION FOLLOWING TREATMENT WITH OCRIPLASMIN.

PURPOSE: To evaluate OCT features for vitreomacular traction (VMT) release and change in macular hole (MH) size after treatment with ocriplasmin. METHODS: Patients who had undergone treatment with ocriplasmin for VMT with or without MH ≤400 µm were included. The main outcomes were VMT release and changes in minimum linear diameter MH size at 4 weeks in MHs that persisted. OCT features evaluated were central retinal thickness, vitreomacular adhesion length, posterior vitreous cortex (PVC) insertion angles 500 µm from the insertion points, and minimum linear diameter size. RESULTS: Sixty patients were included: 37 had isolated VMT and 23 VMT with a MH. Four weeks after ocriplasmin injection, the overall VMT release rate was 66.7% (40/60); 64.9% (24/37) in eyes with isolated VMT and 69.6% (16/23) in eyes with MH. VMT release was associated with younger age (P = 0.02). Macular hole closure was achieved in 26.1% (6/23) and was associated with a smaller ratio of the temporal to the nasal PVC angle (P < 0.01). Of the 17 persistent MHs, 76.5% (13/17) increased in minimum linear diameter size from baseline 186 (±78) to 358 (±133) µm (P < 0.001). Progression in minimum linear diameter size showed a negative linear association with the size of the nasal PVC angle (R2 = 0.39, P = 0.002) and a positive linear association with the ratio of the temporal to nasal PVC angle (R2 = 0.39, P = 0.002). CONCLUSION: In patients with VMT-associated MHs, the risk of MH enlargement following ocriplasmin is negatively correlated with the nasal PVC angle size and is increased if the ratio of the temporal to nasal angle is >1.

FIVE-YEAR CHANGES IN METAMORPHOPSIA AND THE ASSOCIATION OF OUTER RETINAL LAYERS AFTER VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT INVOLVING THE MACULA.

PURPOSE: To evaluate the 5-year changes in metamorphopsia and outer retinal morphology after vitrectomy for macula-off rhegmatogenous retinal detachment. METHODS: The authors included 21 eyes from 21 patients with macula-off rhegmatogenous retinal detachment who underwent pars plana vitrectomy. Metamorphopsia was quantified using M-CHARTS. Using spectral-domain optical coherence tomography, the authors assessed the risk factors for metamorphopsia severity 5 years after surgery. RESULTS: Metamorphopsia scores substantially improved from 1 month to 5 years postoperatively; however, they remained unchanged from 1 year to 5 years postoperatively. Overall, 11 patients (52.4%) had metamorphopsia 5 years postoperatively. The metamorphopsia scores in eyes with a continuous interdigitation zone and ellipsoid zone at 5 years were considerably lower than those in eyes with a disrupted interdigitation zone. Multiple regression analysis revealed that the metamorphopsia score at 5 years was markedly associated with the score at 1 month and continuous interdigitation zone. CONCLUSION: No statistically significant change was observed in metamorphopsia scores after 1 year postoperatively, and >50% of the patients had metamorphopsia at 5 years postoperatively. The improvement was associated with lower metamorphopsia scores at 1 month and continuous interdigitation zone at 5 years. Moreover, the study revealed that early metamorphopsia was a poor prognostic marker for long-term functional deficits.

SURGICAL OUTCOMES AND INTRAOPERATIVE PARAMETERS OF THREE-DIMENSIONAL VISUALIZATION SYSTEM VERSUS CONVENTIONAL MICROSCOPES FOR MACULAR SURGERY IN HIGHLY MYOPIC EYES: A Prospective Randomized Clinical Trial.

PURPOSE: To investigate the surgical outcomes and intraoperative parameters of 3D visualization system for macular diseases in highly myopic eyes. METHODS: In this single-center, prospective, randomized, comparative interventional study, 40 highly myopic eyes (axial length > 26 mm) were randomly assigned to either a 3D visualization system or a conventional microscope group. Surgical outcomes and intraoperative parameters, including the number of indocyanine green injections, surgical time, and epiretinal membrane/internal limiting membrane peeling time, were compared. RESULTS: The 3D group required significantly fewer indocyanine green injections (1.3 ± 0.5 vs. 2.3 ± 0.7, P < 0.001), had shorter epiretinal membrane/internal limiting membrane peeling times (522.8 ± 258.0 vs. 751.8 ± 320.2 seconds, P < 0.05), and experienced fewer intraoperative retinal hemorrhages (0 vs. 7 cases, P < 0.05) compared with the conventional microscope group. Anatomical and functional outcomes were comparable between the two groups. CONCLUSION: The 3D system exhibited a lower number of indocyanine green injections, shorter epiretinal membrane/internal limiting membrane peeling times, and a reduced incidence of intraoperative retinal hemorrhages, suggesting the 3D visualization system may offer advantages for macular surgery in highly myopic eyes.

Semi-Automated Analysis of Dome-Shaped Macula in Preterm and Full-Term Infants Using Handheld Swept-Source Optical Coherence Tomography.

Purpose: Dome-shaped macula (DSM) is known to occur in highly myopic adults and, recently, preterm infants. This study uses investigational handheld swept-source optical coherence tomography (SS-OCT) to further characterize infantile DSM. Methods: In this prospective, observational study, preterm infants undergoing retinopathy of prematurity screening and full-term infants within 72 hours of birth were imaged. Two trained graders assessed macular features, including DSM, subretinal fluid, and macular edema. A semi-automated program measured foveal immaturity, dome height, and diameter. Results: Two hundred seventeen imaging sessions from 50 full-term and 30 preterm infants were included (46% female, preterm birth weight 1038 ± 335 g, and gestational age 28.7 ± 3.1 weeks). DSM occurred in 40% preterm versus 14% full-term infants (P = 0.01). Mean postmenstrual age at first DSM diagnosis was 38.4 ± 0.0 weeks among preterm and 40.4 ± 1.1 weeks among full-term infants (P < 0.001). Dome height and diameter measured 55.67 ± 44.22 µm and 3583.15 ± 1090.35 µm for preterm versus 88.37 ± 44.73 µm and 3581.97 ± 355.07 µm for full-term infants (P = 0.24 and P = 0.96, respectively). All 27 images (11 preterm and 7 full-term infants) with 3-dimensional analysis had round dome configuration. No other associations were seen, including macular fluid (P = 0.17). Conclusions: Infants frequently exhibit DSM without an association with macular fluid. Preterm infants were more likely than full-term infants to have DSM. Unlike DSM in children and adults, infantile DSM configuration is mostly round rather than ridge-shaped.

Influence of vortex vein engorgement for photodynamic therapy in central serous chorioretinopathy.

This study evaluates the efficacy of photodynamic therapy (PDT) in treating central serous chorioretinopathy (CSC) based on the number of engorged vortex vein draining macula visualized on ultra-widefield (UWF) indocyanine green angiography (ICGA). Thirty-six eyes of 36 patients with treatment-naïve CSC were included. Macula-draining vortex veins were assessed in each quadrant using UWF ICGA. The resolution of subretinal fluid (SRF), pigment epithelial detachment (PED), ellipsoid zone (EZ) disintegrity, and retinal pigment epithelium (RPE) irregularity were evaluated at 3 months after PDT. Visual and anatomical improvements were monitored for 12 months. Logistic regression analysis was performed to identify factors associated with poor visual outcomes. A higher number of macula-draining vortex vein was associated to persistent SRF (p = 0.004), PED (p = 0.001), EZ disintegrity (p = 0.011), and RPE irregularity (p = 0.001). Macula-draining vortex veins were also correlated with poor EZ restoration and limited best corrected visual acuity (BCVA) improvements. In multivariate analysis, the number of macula-draining vortex vein (B = 0.197, p = 0.047) was a risk factor for worse BCVA at 12 months. Increased macula-draining vortex vein was related with unfavorable anatomical and poor visual outcomes after PDT in CSC patients.

Alterations in optical coherence tomography angiography parameters after cataract surgery in patients with diabetes.

This prospective study aimed to investigate microvascular changes in diabetic patients undergoing cataract surgery. Foveal avascular zone (FAZ) area, as well as vessel density (VD) in the macula and radial peripapillary capillary plexus (RPC), were compared before and after surgery. Sixty eyes (72.3%) had no diabetic retinopathy (no DR group) and 23 eyes (27.7%) had non-proliferative diabetic retinopathy (DR group). In the no DR group, the FAZ area in the superficial capillary plexus (SCP) decreased from 0.41 ± 0.13 to 0.38 ± 0.11 mm2 (P = 0.036), while no significant change was observed in the DR group (0.33 ± 0.12 to 0.30 ± 0.12 mm2, P = 0.091) at 6 months postoperatively. VD in the RPC increased from 34.4 ± 2.3% to 35.6 ± 2.3% in the no DR group (P = 0.009), but there was no significant change in the DR group (33.0 ± 3.5% vs. 34.0 ± 2.3%, P = 0.051) after 6 months. VD in the macula did not change in either group. Phacoemulsification reduced the FAZ area in the SCP and increased the VD in the RPC in diabetic patients without diabetic retinopathy at six months postoperatively.

A Novel Artificial Intelligence-Based Classification of Highly Myopic Eyes Based on Visual Function and Fundus Features.

Purpose: To develop a novel classification of highly myopic eyes using artificial intelligence (AI) and investigate its relationship with contrast sensitivity function (CSF) and fundus features. Methods: We enrolled 616 highly myopic eyes of 616 patients. CSF was measured using the quantitative CSF method. Myopic macular degeneration (MMD) was graded according to the International META-PM Classification. Thickness of the macula and peripapillary retinal nerve fiber layer (p-RNFL) were assessed by fundus photography and optical coherence tomography, respectively. Classification was performed by combining CSF and fundus features with principal component analysis and k-means clustering. Results: With 83.35% total variance explained, highly myopic eyes were classified into four AI categories. The percentages of AI categories 1 to 4 were 14.9%, 37.5%, 36.2%, and 11.4%, respectively. Contrast acuity of the eyes in AI category 1 was the highest, which decreased by half in AI category 2. For AI categories 2 to 4, every increase in category led to a decrease of 0.23 logarithm of the minimum angle of resolution in contrast acuity. Compared with those in AI category 1, eyes in AI category 2 presented a higher percentage of MMD2 and thinner temporal p-RNFL. Eyes in AI categories 3 and 4 presented significantly higher percentage of MMD ≥ 3, thinner nasal macular thickness and p-RNFL (P < 0.05). Multivariate regression showed AI category 4 had higher MMD grades and thinner macular compared with AI category 3. Conclusions: We proposed an AI-based classification of highly myopic eyes with clear relevance to visual function and fundus features. Translational Relevance: This classification helps to discover the early hidden visual deficits of highly myopic patients, becoming a useful tool to evaluate the disease comprehensively.

Evaluation of lamina cribrosa parameters, nerve fiber thickness, and macular thickness in primary open-angle glaucoma and pseudoexfoliation glaucoma using optical coherence tomography.

PURPOSE: To evaluate the lamina cribrosa, retinal nerve fiber layer (RNFL), and macula in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) and healthy individuals using enhanced depth imaging (EDI) of spectral-domain optical coherence tomography (SD-OCT). METHODS: A total of 158 eyes were included in the study, comprising 58 eyes of 29 patients with POAG, 50 eyes of 25 patients with PEXG, and 50 eyes of 25 healthy individuals. The lamina cribrosa thickness (LCT) (at three locations), lamina cribrosa depth (LCD), RNFL thickness, and the macular thickness were measured using the EDI mode of the SD-OCT. The results were compared among the three groups. RESULTS: In both POAG and PEXG groups, the LCT was significantly thinner in the center, mid-superior, and mid-inferior areas in both eyes than in the control group (p < 0.001). However, no statistically significant difference was observed between the POAG and PEXG groups in terms of LCT at all three measurement locations in both eyes (p > 0.05). The LCD was significantly lower in the control group compared to the POAG and PEXG groups (p < 0.05), but there was no significant difference between the POAG and PEXG groups (p > 0.05). The RNFL thickness was significantly lower in both the POAG and PEXG groups compared to the control group in both eyes (p < 0.05). CONCLUSION: The LCT and LCD of patients with POAG and PEXG were thinner than those of healthy individuals, but there was no significant difference between the patients with POAG and PEXG.

Prediction of Axial Length From Macular Optical Coherence Tomography Using Deep Learning Model.

Purpose: The purpose of this study was to develop a deep learning model for predicting the axial length (AL) of eyes using optical coherence tomography (OCT) images. Methods: We retrospectively included patients with AL measurements and OCT images taken within 3 months. We utilized a 5-fold cross-validation with the ResNet-152 architecture, incorporating horizontal OCT images, vertical OCT images, and dual-input images. The mean absolute error (MAE), R-squared (R2), and the percentages of eyes within error ranges of ±1.0, ±2.0, and ±3.0 mm were calculated. Results: A total of 9064 eyes of 5349 patients (total image number of 18,128) were included. The average AL of the eyes was 24.35 ± 2.03 (range = 20.53-37.07). Utilizing horizontal and vertical OCT images as dual inputs, deep learning models predicted AL with MAE and R2 of 0.592 mm and 0.847 mm, respectively, in the internal test set (1824 eyes of 1070 patients). In the external test set (171 eyes of 123 patients), the deep learning models predicted AL with MAE and R2 of 0.556 mm and 0.663 mm, respectively. Regarding error margins of ±1.0, ±2.0, and ±3.0 mm, the dual-input models showed accuracies of 83.50%, 98.14%, and 99.45%, respectively, in the internal test set, and 85.38%, 99.42%, and 100.00%, respectively, in the external test set. Conclusions: A deep learning-based model accurately predicts AL from OCT images. The dual-input model showed the best performance, demonstrating the potential of macular OCT images in AL prediction. Translational Relevance: The study provides new insights into the relationship between retinal and choroidal structures and AL elongation using artificial intelligence models.

Assessment of the impact of low-density lipoprotein cholesterol on retinal vessels using optical coherence tomography angiography.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) is acknowledged as an independent risk factor (IRF) for atherosclerotic cardiovascular disease. Nevertheless, studies on the impact of LDL-C on microvasculature are still scarce. The retina, abundant in microvasculature, can now be examined for microvascular alterations through the novel, non-invasive, and quantitative optical coherence tomography angiography (OCTA) technique. METHODS: In this cross-sectional study, 243 patients from the geriatric department were recruited (between December 2022 and December 2023). Individuals were classified into four groups based on their LDL-C levels: Group 1 (≤ 1.8 mmol/L), Group 2 (> 1.8 mmol/L to ≤ 2.6 mmol/L), Group 3 (> 2.6 mmol/L to ≤ 3.4 mmol/L), and Group 4 (> 3.4 mmol/L). The OCTA results including retinal vessel density (VD), foveal avascular zone (FAZ) area, macula thickness, and retinal nerve fiber layer (RNFL) thickness were contrasted across these groups. T-tests, analysis of variance, Welch's tests, or rank-sum tests were employed for statistical comparisons. In cases where significant differences between groups were found, post-hoc multiple comparisons or rank-sum tests were performed for pairwise group comparisons. Spearman's correlation coefficient was employed to perform bivariate correlation analysis to evaluate the relationship between LDL-C levels and various OCTA measurements. Multivariable regression analysis was used to evaluate the association between LDL-C levels and various OCTA measurements. Linear regression analysis or mixed-effects linear models were applied. RESULTS: It was discovered that individuals with LDL-C levels exceeding 2.6 mmol/L (Groups 3 and 4) exhibited reduced VD in the retina, encompassing both the optic disc and macular regions, compared to those with LDL-C levels at or below 2.6 mmol/L (Groups 1 and 2). A negative correlation among LDL-C levels and retinal VD was identified, with r values spanning from - 0.228 to -0.385. Further regression analysis presented ß values between - 0.954 and - 2.378. Additionally, no notable disparities were detected among the groups regarding FAZ area, macular thickness, and RNFL thickness. CONCLUSIONS: The outcomes of this study suggest that elevated LDL-C levels constitute an IRF for decreased VD across the entire retina. TRIAL REGISTRATION: NCT05644548, December 1, 2022.

Evaluation of the effect of vitreomacular interface disorders on anti-VEGF treatment in patients with diabetic macular edema in real life: MARMASIA study group report No. 10.

PURPOSE: The aim of this study is to investigate the effect of vitreomacular interface disorders (VMID) on treatment response in patients treated with anti-vascular endothelial growth factor (anti-VEGF) due to diabetic macular edema (DME). METHODS: Three hundred seventy-seven eyes of 239 patients in the MARMASIA Study Group who received intravitreal anti-VEGF treatment (IVT) due to DME were included in the study. The group 1 consisted of 44 eyes of the patients who had not received any treatment before, were followed up regularly for 24 months after at least a 3-month loading dose, and suffered from VMID such as epiretinal membrane, vitreomacular adhesion or traction, and lamellar hole. The group 2 consisted of 333 eyes of the patients without VMID. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients at baseline, 3rd month, 6th month, 1st year and 2nd year follow-ups were measured. RESULTS: The mean age of the Groups 1 and 2 was 67.1 ± 11.3 and 61.9 ± 10.2 years, respectively. 61.3% of the group 1 and 58.8% of the group 2 were female (p > 0.05). The duration of diabetes was 19.2 ± 3.7 and 15.8 ± 3.2 years, respectively, and the number of follow-ups was 16.09 ± 4.68 and 12.06 ± 4.58, respectively in the groups (p < 0.001, 0.001, respectively). The number of IVT was 7.13 ± 2.71 and 7.20 ± 2.22, respectively in the groups 1 and 2 and no statistically significant difference was observed between them (p = 0.860). According to logMAR, BCVA values at baseline were 0.63 ± 0.24 and 0.59 ± 0.26 (p = 0.29), respectively, in the groups and the amount of change in BCVA at the end of the 2nd year was - 0.02 ± 0.48 in the group 1 and - 0.12 ± 0.48 in the group 2. It was observed as 0.48 (p = 0.13). Although the increase in BCVA was greater at all follow-ups in the group 2 compared to their initial examination, no significant difference was observed between the groups in terms of BCVA change. The CMT values of the groups at baseline were 442.5 ± 131.3 µm and 590.9 ± 170.6 µm, respectively (p = 0.03) The decrease in CMT after IVT was significantly greater in the group 2 at all follow-ups when compared to the first group (p < 0.05). CONCLUSION: While the presence of VMID in DME patients receiving IVT did not affect visual results, it negatively affected the anatomical response and macular edema morphology. The presence of VMID at baseline affected the success of IVT. It should be taken into consideration that VMID may resolve spontaneously or with IVT, and new cases of VMID may occur in patients during the treatment process.

Macular exudate in idiopathic intracranial hypertension affects outer retina and visual acuity.

BACKGROUND: Optical coherence tomography (OCT) is suggested as a potential tool for retinal biomarkers in idiopathic intracranial hypertension (IIH). We explored how macular exudate (ME) affects retinal structure in IIH and investigated its relationship with their clinical features. METHODS: Patients diagnosed with IIH and matched controls were enrolled. ME detection was done on fundus photography; swept-source OCT was used to image and measure the retinal sublayer thicknesses, including the retinal nerve fibre layer, ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer (INL) and outer retinal layer (ORL). IIH patients underwent lumbar puncture where intracranial pressure (ICP) was assessed. RESULTS: 195 eyes from 98 IIH patients (42 eyes had ME) and 224 eyes from 112 controls were included. IIH patients had thicker INL and ORL compared with controls (both p<0.001) while IIH eyes with ME had thicker INL and ORL thicknesses compared with eyes without ME (both p<0.05). In IIH patients, the retinal sublayer thicknesses correlated with their ICP levels, and GCIPL thickness correlated with visual acuity (VA). Furthermore, ME was associated with higher ICP, worse papilledema and lower VA (all p<0.001). CONCLUSION: ME affects retinal thickness in IIH patients and is associated with more severe clinical features in IIH. OCT may provide biomarkers informative of clinical changes in IIH. Further longitudinal studies are needed to explore the evolution of ME and its relationship to VA and retinal structure.

Efficacy and Durability of Faricimab in Naïve Eyes with Neovascular Age-Related Macular Degeneration.

INTRODUCTION: The aim of the study was to evaluate functional and anatomical changes in patients with neovascular age-related macular degeneration (nAMD) treated with a loading dose of faricimab intravitreal injections (IVIs). METHODS: Eighteen eyes of 18 patients with active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University G. D'Annunzio, Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI as per label. Enrolled patients underwent complete ophthalmic evaluation, including optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All measurements were evaluated at baseline (T0) and then monthly up to week 20 (T4). Main outcome measures were changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachments (PEDs) presence and maximum height (PED-MH), intraretinal fluid (IRF) presence, subfoveal subretinal fluid (SSRF) presence and thickness. RESULTS: BCVA improved and CMT reduced significantly during follow-up (p < 0.001). In addition, SFCT decreased significantly (p = 0.031). Between T0 and T4, SSRF presence reduced from 55.6 to 16.7% (p = 0.045); IRF presence changed from 50 to 22.2%, respectively (p = 0.074). PED-MH was reduced in 58.8% of patients at T4. At week 20, 72.3% of patients were in the q12/q16 interval. CONCLUSION: Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of anatomical and functional parameters and a treatment interval after the loading phase equal or greater than 12 weeks in the majority of patients.

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OBJECTIVES: Retinal vein occlusion (RVO) is the second most common retinal vascular disease worldwide, and the retinal perfusion status is closely related to the prognosis of the disease. Macular perfusion status is particularly correlated with visual acuity. This study aims to investigate the changes in macular perfusion indicators in RVO using optical coherence tomography angiography (OCTA) and analyze the correlation between macular perfusion status and visual acuity. METHODS: This cross-sectional study included 41 RVO patients, who were divided into 2 groups based on the occlusion site: 18 cases in the central retinal vein occlusion (CRVO) group and 23 cases in the branch retinal vein occlusion (BRVO) group. Additionally, they were categorized into ischemic RVO (23 cases) and non-ischemic RVO (16 cases) groups based on the presence of ischemia (2 eyes were excluded due to hemorrhage obscuring the peripheral retina, making it impossible to confirm the area of non-perfusion). A control group of 29 healthy individuals matched by sex and age was also recruited. Macular perfusion indicators were measured using OCTA, and the correlation between macular perfusion status and visual acuity was analyzed. RESULTS: Compared with healthy eyes, RVO eyes showed an increased foveal avascular zone (FAZ) area and significantly reduced superficial and deep vessel density (P<0.001). However, there were no significant differences in central foveal thickness (CFT) or macular perfusion indicators between the CRVO and BRVO groups (P>0.05). The best corrected visual acuity (BCVA) at the logarithm of the minimum angle of resolution (logMAR BCVA) was significantly negatively correlated with both superficial and deep retinal vessel density in RVO eyes (unstandardized coefficient B=-0.039, B=-0.042; P=0.017, P=0.040). The average BCVA in the ischemic RVO group was significantly worse than that in the non-ischemic RVO group (0.82±0.44 vs 0.45±0.29, P=0.007). The ischemic RVO group also had a larger FAZ area (P=0.003) and lower superficial and deep retinal vessel density (P<0.001, P=0.008, respectively) compared with the non-ischemic RVO group. The severity of macular ischemia did not correspond directly with the peripheral ischemia severity in RVO. CONCLUSIONS: Macular perfusion status is significantly reduced in RVO eyes compared to healthy eyes, which negatively impacts and limits visual acuity in RVO patients. Eyes with ischemic RVO have poorer visual acuity and macular perfusion status than those with non-ischemic RVO. OCTA is advantageous for observing vascular morphology and quantifying macular perfusion status, making it an effective tool for assessing disease progression.

Optical coherence tomography angiography analysis of the fellow eye in unilateral pseudoexfoliation syndrome.

PURPOSE: To compare the macular and optic disc vascular parameters in the unaffected fellow eyes of subjects with unilateral pseudoexfoliation syndrome (PXS) and controls using optical coherence tomography angiography (OCTA). METHODS: The medical records of 61 eyes of 61 patients were analyzed in a retrospective study. Of these, 30 eyes were unaffected fellow eyes and 31 eyes were control eyes. The vessel density (VD), perfusion density (PD) and foveal avascular zone (FAZ)-related parameters of the superficial capillary plexus (SCP) in the circumpapillary and macular area and the VD and PD of the deep capillary plexus (DCP) in the macular area were measured using OCTA after dilatation and were compared between two groups after adjustment for age, sex and axial length. RESULTS: There were no statistically significant differences in sex ratio or mean age, central corneal thickness measurements, refractive errors, intraocular pressures and axial length between both groups (all P > 0.05). In the circumpapillary area, inferior VD and PD in the inner zone, as well as average, temporal, inferior, and nasal VD and PD in the outer zone were significantly reduced in the unaffected fellow eyes with unilateral PXS, while the circumpapillary retinal nerve fiber layer (RNFL) thicknesses were similar between groups. In the macular SCP, VDs were significantly lower in all sectors in the inner area and in the outer zones (p < 0.05 for all), PDs were significantly lower in all sectors (p < 0.05 for all) except the nasal sector of the outer zone (p = 0.003 for average, p = 0.029 for superior sector, p = 0.004 for temporal sector, p < 0.001 for inferior sector), and the FAZ circularity (p = 0.037) were significantly lower in the unaffected fellow eyes with unilateral PXS, whereas macular ganglion cell inner plexiform layer (GCIPL) thickness was similar between the two groups. CONCLUSIONS: Although circumpapillary RNFL and GCIPL thicknesses were similar between the two groups, VDs and PDs in the circumpapillary and macular SCP and FAZ circularity were significantly lower in the fellow eye of subjects with unilateral PXS.