Inner nuclear layer cystoid spaces are a poor prognostic factor in typical age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: To investigate predictive factors for changes in best-corrected visual acuity (BCVA) at 24 months after intravitreal ranibizumab (IVR) for neovascular age-related macular degeneration (nAMD). METHODS: This retrospective study included 55 eyes of 55 consecutive patients (32 men and 23 women) with nAMD who received three consecutive monthly IVR injections and were re-treated as needed over a 24-month period. We used the mean changes in logarithm of the minimal angle of resolution (logMAR) BCVA at 24 months as the dependent variable in regression analysis. RESULTS: The presence of intraretinal cystoid spaces in the inner nuclear layer (INLc, P = 0.004) and baseline subfoveal choroidal thickness (SFCT, P = 0.013) predicted BCVA changes from baseline to 24 months. The presence of INLc and thinning of SFCT were associated with decreased BCVA at 24 months. Thirty-five eyes without INLc showed improved logMAR BCVA, from 0.550 ± 0.273 to 0.368 ± 0.274 (P = 0.045); however, 20 eyes with INLc showed decreased logMAR BCVA, from 0.708 ± 0.347 to 0.971 ± 0.523 (P < 0.001) through the 24-month follow-up. The mean number of IVR injections during the follow-up period was 8.74 ± 4.76 in eyes without INLc and 10.63 ± 4.72 in eyes with INLc, without a statistically significant difference (P = 0.144). CONCLUSION: Eyes with INLc or thinned SFCT showed worse visual outcomes compared with eyes without the INLc or with thick SFCT. Furthermore, eyes without INLc showed improved BCVA; however, eyes with INLc showed decreased BCVA with an as-needed regimen.

CLINICAL OUTCOMES OF INTRAVITREAL BEVACIZUMAB VERSUS PHOTODYNAMIC THERAPY WITH OR WITHOUT BEVACIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION: A 7-Year Follow-up Study.

PURPOSE: To compare the long-term visual outcomes of intravitreal bevacizumab (IVB) with those of photodynamic therapy (PDT) for myopic choroidal neovascularization over a 7-year period. METHODS: Eyes treated with IVB (17 eyes) or PDT (20 eyes) that were followed up for at least 7 years were included in this retrospective study. Myopic maculopathy was classified according to the international photographic classification before treatment. The best-corrected visual acuity (BCVA) and the chorioretinal atrophy (CRA) size were measured before and after treatment over a 7-year period. RESULTS: The mean change in BCVA at 7 years was greater in the IVB group than in the PDT group (P = 0.044). While BCVA improved from baseline throughout the 7-year period in the IVB group (P = 0.029), there was no improvement in the PDT group (P = 0.266). In subgroup analysis for 18 eyes with preoperative tessellated fundi (Category 1), there was no difference in BCVA improvement (P = 0.166) and CRA size between the 2 groups at 7 years. However, for 17 eyes with preoperative diffuse CRA (Category 2), BCVA remained unchanged in the IVB group and decreased in the PDT group (P = 0.030) at 7 years. CONCLUSION: IVB resulted in superior long-term functional and anatomical outcomes compared with PDT. In particular, PDT resulted in a greater BCVA decrease and CRA increase compared with IVB in eyes with preoperative diffuse CRA. However, the clinical outcomes were not different in eyes with preoperative tessellated fundi.

Diabetic retinal pigment epitheliopathy: fundus autofluorescence and spectral-domain optical coherence tomography findings.

PURPOSE: To describe the characteristics of an unfamiliar disease entity, diabetic retinal pigment epitheliopathy (DRPE), using fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT). METHODS: This retrospective study included 17 eyes from 10 proliferative diabetic retinopathy (PDR) patients with granular hypo-autofluorescence and/or variable hyper-autofluorescence on FAF (DRPE group) and 17 eyes from 10 age- and sex-matched PDR patients without abnormal autofluorescence (PDR group). Eyes with diabetic macular edema were excluded. Visual acuity (VA), retinal thickness (RT), and choroidal thickness (CT) were compared between the groups. RESULTS: Eyes in the DRPE group had worse logMAR VA than eyes in the PDR group (0.369 ± 0.266 vs. 0.185 ± 0.119; P = 0.026). The thickness of the retinal pigment epithelium plus the inner segment/outer segment of the photoreceptors was reduced to a greater degree in the DRPE group than the PDR group (P < 0.001). Moreover, the thickness of the outer nuclear layer plus the outer plexiform layer was thinner in the DRPE group than in the PDR (P = 0.013). However, the thickness of the inner retina showed no differences between the two groups. CT was significantly thicker in the DRPE group than in the PDR group (329.00 ± 33.76 vs. 225.62 ± 37.47 µm; P < 0.001). CONCLUSIONS: Eyes with DRPE showed reduced VA, a thinner outer retina, and thicker choroid in comparison with eyes with PDR. Alterations of autofluorescence on FAF and changes in the outer retinal thickness and CT on SD-OCT can be helpful for differentiating DRPE in patients with PDR.

Central serous chorioretinopathy after renal transplantation.

PURPOSE: To describe the demographic and clinical characteristics of central serous chorioretinopathy (CSC) after renal transplantation (RT). METHODS: A retrospective medical chart review was performed on 451 among 2,980 patients, who underwent RT and visited vitreoretinal clinic at Yonsei Medical Center from 1979 to 2009. Correlation between daily corticosteroid dosage and remission time and factors relating to final visual acuity of <20/40 were studied. RESULTS: Twenty-eight patients (39 eyes) developed CSC at a median of 63 months after RT (range, 2 months to 20 years), and 18 (64%) patients were men. Accordingly, the prevalence of CSC after RT was estimated to be between 1% and 6%. All patients received a combination of corticosteroid and at least one other immunosuppressant agent at presentation. Reducing the daily corticosteroid dosage by 25% to 50% in CSC with classic pattern resulted in twice as faster remission (2 months) compared with the maintained dosage group (P = 0.025). Central serous chorioretinopathy recurrence (P = 0.002), intrinsic renal disease as cause of RT (P = 0.003), severe CSC variant (P = 0.009), and presenting visual acuity <20/40 (P = 0.009) predicted a final visual acuity <20/40. CONCLUSION: Central serous chorioretinopathy develops relatively often after RT and varies in presentation and severity. The cause of CSC after RT appears to be multifactorial and closely related to corticosteroid.

Risk of Retinal Vein Occlusion in Patients With End-Stage Renal Disease: A 12-Year, Retrospective, Nationwide Cohort Study in South Korea.

Purpose: The present study aimed to evaluate the risk of retinal vein occlusion (RVO) in Korean patients with end-stage renal disease (ESRD). Methods: In this retrospective, nationwide, propensity score-matched cohort study, subjects were randomly enrolled from the 12-year longitudinal Korean National Health Insurance Service-National Sample Cohort 2002-2013 database comprising 1 million subjects. The ESRD group comprised 988 patients newly diagnosed with ESRD from 2003 onward by washing out data from 2002. The comparison group comprised 4940 (5 for each patient with ESRD) randomly selected propensity score-matched individuals not diagnosed with ESRD. Each sampled patient was tracked until 2013 for RVO development. Multiple conditional Cox regression analysis was performed to compare the risk of RVO between the two groups. Results: The mean follow-up period was 7.37 years. The incidence of RVO was 3.95% in the ESRD group and 2.17% in the comparison group (P = 0.001). ESRD was associated with greater risk of RVO development after adjustment for possible confounders (adjusted hazard ratio [HR], 2.122; 95% confidence interval [CI], 1.396-3.226; P = 0.0004). The 50- to 60-year (adjusted HR, 2.635; 95% CI, 1.100-6.313; P = 0.0297) and 60- to 70-year (adjusted HR, 2.544; 95% CI, 1.059-6.110; P = 0.0368) age groups exhibited higher risk of RVO compared with the <40-year age group. Hyperlipidemia (adjusted HR, 1.670; 95% CI, 1.176-2.371; P = 0.0042) and hypertension (adjusted HR, 1.896; 95% CI, 1.165-3.086; P = 0.01) were also associated with RVO. Conclusions: An association between ESRD and subsequent RVO development was found after adjustment for possible confounding factors.

Dexamethasone Intravitreal Implant Rescue Treatment for Bevacizumab Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion.

PURPOSE: To evaluate the prognostic factors and outcomes of dexamethasone intravitreal implant (DEX implant) for intravitreal bevacizumab refractory macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: This was a retrospective, interventional case series. Medical records were reviewed, and a total of 38 eyes that were treated with DEX implant for macular edema secondary to BRVO that did not respond to at least two consecutive intravitreal bevacizumab injections (IBIs) were included. Best-corrected visual acuity (BCVA), central subfield macular thickness, and central subfoveal choroidal thickness were evaluated at baseline, 2 months, and 6 months after DEX implantation. RESULTS: Patients had undergone an average of 6.32 ± 4.66 prior IBI treatments. The average BCVA improved from 0.53 ± 0.26 to 0.41 ± 0.25 and 0.44 ± 0.23 logarithm of the minimal angle of resolution (logMAR) at 2 and 6 months, respectively (p < 0.001). The average central subfield macular thickness was 504.00 ± 121.54 µm at baseline and changed to 293.21 ± 74.17 µm and 427.28 ± 119.57 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.002). Average central subfoveal choroidal thickness was 237.46 ± 92.21 µm at baseline and changed to 204.75 ± 74.74 µm and 226.86 ± 90.77 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.455). Twenty-two eyes (58%) gained ≥0.1 logMAR at 2 months, while 16 eyes showed no improvement. Low BCVA at symptom presentation, low baseline BCVA, and shorter duration of macular edema were correlated with increased BCVA after treatment. CONCLUSIONS: The DEX implant improves functional and anatomical outcomes for up to 6 months in about half of the patients treated with IBI refractory macular edema secondary to BRVO, particularly in patients with low initial and baseline BCVA.

Changes in choroidal thickness after vitrectomy for epiretinal membrane combined with vitreomacular traction.

PURPOSE: To compare choroidal thickness after vitrectomy between epiretinal membrane (ERM) with and without vitreomacular traction (VMT). METHODS: In this retrospective study, 228 consecutive participants with ERM who underwent vitrectomy were categorized into two groups according to the presence of VMT on spectral domain-optical coherence tomography: VMT group (ERM with VMT, n = 21) and non-VMT group (ERM without VMT, n = 207). The primary outcome was the mean subfoveal choroidal thickness (SFCT) at baseline, and at 3 and 6 months postsurgery. RESULTS: At baseline, the prevalence of VMT in eyes with ERM was 9.6% (21/228), and mean SFCT was greater in the VMT than in the non-VMT group (270.3 ± 93.4 vs. 223.7 ± 82.1 µm; p = 0.015). After surgery, mean SFCT decreased in the VMT group (241.7 ± 92.3 µm at 3 months and 228.8 ± 86.4 µm at 6 months; p < 0.001), but remained unchanged in the non-VMT group (223.6 ± 78.9 µm at 3 months and 223.3 ± 82.6 µm at 6 months; p = 0.696). There were no differences in mean SFCT between the groups at 3 and 6 months after surgery (p = 0.339 and p = 0.772, respectively). CONCLUSION: Choroidal thickness was greater in ERM eyes with than without VMT possibly due to direct anteroposterior traction on the retina and choroid, increased vascular endothelial growth factor associated with stress on retinal pigment epithelial cells and inflammation. After vitrectomy, mean SFCT reduced in the eyes with VMT, but not in those without VMT.

Angiographically Documented Macular Ischemia after Single Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion.

This report describes a case of angiographically documented foveal avascular zone (FAZ) enlargement after a single intravitreal injection of bevacizumab for macular edema secondary to central retinal vein occlusion (CRVO). A 71-year-old female was treated with an intravitreal bevacizumab injection for macular edema following CRVO. Despite successfully decreased edema one month after injection, the postinjection best-corrected visual acuity immediately decreased from 20/40 to 20/1000 (Snellen equivalent). The FAZ area increased from 0.37 mm² to 3.11 mm² (8.4-fold increase). While intravitreal anti-vascular endothelial growth factor is effective and should be considered as a first-line treatment for macular edema secondary to CRVO, it may aggravate macular ischemia.

Peripapillary Choroidal Thickness Change of Polypoidal Choroidal Vasculopathy after Anti-vascular Endothelial Growth Factor.

PURPOSE: To investigate the peripapillary choroidal thickness (PCT) of polypoidal choroidal vasculopathy (PCV) and exudative age-related macular degeneration (AMD) and to evaluate their responses to anti-vascular endothelial growth factor (VEGF). METHODS: Thirty eyes with PCV and 25 eyes with exudative AMD who were treatment naïve were included in this study. PCT and subfoveal choroidal thickness were evaluated both before and after intravitreal anti-VEGF. RESULTS: The initial mean PCT of PCV (153.78 ± 56.23 µm) was thicker than that of exudative AMD (88.77 ± 23.11 µm, p < 0.001). Temporal, superior, nasal, and inferior PCTs of PCV were all thicker than those observedin exudative AMD (all p < 0.05). After anti-VEGF, the mean PCT of PCV was significantly reduced (134.17 ± 41.66 µm, p < 0.001), but the same was not true not in exudative AMD (86.87 ± 22.54 µm, p = 0.392). PCTshowed a similar tendency in all quadrants. CONCLUSIONS: PCV exhibits a thick choroid in the peripapillary region. PCT decreases after anti-VEGF in PCV but not in exudative AMD. In exudative AMD, subfoveal choroidal thickness decreased, but that in the peripapillary region did not.

Obstructive Sleep Apnea in Patients with Branch Retinal Vein Occlusion: A Preliminary Study.

PURPOSE: Our study aimed to determine whether obstructive sleep apnea (OSA) is common among branch retinal vein occlusion (BRVO) patients without systemic risk factors using a Watch PAT-100 portable monitoring device. METHODS: The study participants included consecutive patients with BRVO of less than 3 months duration without any risk factors known to be associated with OSA (diabetes, coronary artery disease, stroke, hematologic diseases, autoimmune disease, etc.) except for hypertension. All patients underwent full-night unattended polysomnography by means of a portable monitor Watch PAT-100 device. The apnea-hypopnea index (AHI) was calculated as the average number of apnea and hypopnea events per hour of sleep, and an AHI score of five or more events was diagnosed as OSA. RESULTS: Among 19 patients (6 males and 13 females), 42.1% (8 of 19) had an AHI reflective of OSA. In the 13 patients who had no concurrent illness, including hypertension, 30.8% (4 of 13) had positive test results for OSA; three of these patients were ranked as mild OSA, while one had moderate OSA. The OSA group had an average AHI of 12.3 ± 7.8, and the average AHI was 2.0 ± 0.9 in the non-OSA group. Although it was not statistically proven, we found that OSA patients experienced a more severe form of BRVO. CONCLUSIONS: We found a higher than expected rate of OSA in BRVO patients lacking concomitant diseases typically associated with OSA. Our findings suggest that OSA could be an additional risk factor in the pathogenesis of BRVO or at least a frequently associated condition that could function as a triggering factor.

Effects of Vitreomacular Adhesion on Age-Related Macular Degeneration.

Herein, we review the association between vitreomacular adhesion (VMA) and neovascular age-related macular degeneration (AMD). Meta-analyses have shown that eyes with neovascular AMD are twice as likely to have VMA as normal eyes. VMA in neovascular AMD may induce inflammation, macular traction, decrease in oxygenation, sequestering of vascular endothelial growth factor (VEGF), and other cytokines or may directly stimulate VEGF production. VMA may also interfere with the treatment effects of anti-VEGF therapy, which is the standard treatment for neovascular AMD, and releasing VMA can improve the treatment response to anti-VEGF treatment in neovascular AMD. We also reviewed currently available methods of relieving VMA.

Clinical outcomes of optimized prolate ablation and custom aspheric treatment in laser-assisted subepithelial keratectomy.

PURPOSE: To compare visual acuity, refractive, wavefront, and visual quality outcomes between optimized prolate ablation (OPA) and optical path difference custom aspheric treatment (OPDCAT) algorithms for myopia correction. SETTING: Private practice, Busan, South Korea. DESIGN: Prospective randomized masked clinical trial. METHODS: One eye of each patient was randomly selected to have laser-assisted subepithelial keratectomy with the OPA algorithm and the contralateral eye with the OPDCAT algorithm. Visual acuity, manifest refraction, ocular and corneal higher-order aberrations (HOAs), corneal asphericity (Q value), and modulation transfer function (MTF) in the 2 groups were compared 1, 3, and 6 months postoperatively. RESULTS: The study enrolled 39 patients. The mean manifest refraction spherical equivalent at 6 months was 0.19 diopter (D) ± 0.37 (SD) in the aspheric ablation group and 0.00 ± 0.33 D in the prolate ablation group. Predictability (± 0.50 D from intended refraction) at 6 months was 82% and 100%, respectively. Twenty-six eyes (93%) in the aspheric ablation group and 27 (96%) in the prolate ablation group had an uncorrected distance visual acuity of 20/20 or better. One eye in the aspheric ablation group and no eye in the prolate ablation group lost 1 line of corrected distance visual acuity. The prolate ablation group had fewer induced corneal and ocular spherical aberrations than the aspheric ablation group. Corneal asphericity was unchanged postoperatively in the prolate ablation group. The MTF under the correction of lower-order aberrations was higher in the prolate ablation group than in the aspheric ablation group. CONCLUSION: The prolate ablation algorithm gave more predictable visual outcomes, induced fewer corneal HOAs, and conserved more preoperative corneal asphericity than the aspheric algorithm. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.