VISUAL PROGNOSTIC VALUE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO AND PLATELET-TO-LYMPHOCYTE RATIO IN BEHÇET UVEITIS.

PURPOSE: To investigate the significance of systemic indicators, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as long-term visual prognostic factors in patients with Behçet uveitis. METHODS: This study comprised 114 eyes from 114 patients diagnosed with Behçet uveitis. Ophthalmologic evaluations and biochemical measurements including NLR and PLR values were consecutively obtained at each visit. Patients were divided into good and poor visual outcome groups, based on the visual acuity of 0.5 logarithm of the minimum angle of resolution in the worse-seeing eyes at the last visit. Factors associated with poor visual outcomes were analyzed, and optimal cutoff values of NLR and PLR were also evaluated. RESULTS: Sixty-six eyes (57.9%) were included in the good visual outcome group. Multivariate regression analysis showed that younger age of onset (odds ratio = 0.939; P = 0.010), longer disease duration (odds ratio = 1.164; P < 0.001), higher maximum NLR (odds ratio = 1.215; P = 0.033), and higher initial PLR (odds ratio = 1.014; P = 0.039) were significantly associated with poor visual outcomes. The optimal cutoff value for patients with poor visual outcome was 5.608 for NLR and 128.078 for PLR. CONCLUSION: A higher maximum NLR and higher initial PLR, as well as a younger age of onset and longer disease duration, were significantly associated with poor visual outcomes. Systemic inflammatory factors might be important indicators of visual prognosis in Behçet uveitis.

DETECTION AND LOCALIZATION OF RETINAL BREAKS IN ULTRAWIDEFIELD FUNDUS PHOTOGRAPHY USING a YOLO v3 ARCHITECTURE-BASED DEEP LEARNING MODEL.

PURPOSE: We aimed to develop a deep learning model for detecting and localizing retinal breaks in ultrawidefield fundus (UWF) images. METHODS: We retrospectively enrolled treatment-naive patients diagnosed with retinal break or rhegmatogenous retinal detachment and who had UWF images. The YOLO v3 architecture backbone was used to develop the model, using transfer learning. The performance of the model was evaluated using per-image classification and per-object detection. RESULTS: Overall, 4,505 UWF images from 940 patients were used in the current study. Among them, 306 UWF images from 84 patients were included in the test set. In per-object detection, the average precision for the object detection model considering every retinal break was 0.840. With the best threshold, the overall precision, recall, and F1 score were 0.6800, 0.9189, and 0.7816, respectively. In the per-image classification, the model showed an area under the receiver operating characteristic curve of 0.957 within the test set. The overall accuracy, sensitivity, and specificity in the test data set were 0.9085, 0.8966, and 0.9158, respectively. CONCLUSION: The UWF image-based deep learning model evaluated in the current study performed well in diagnosing and locating retinal breaks.

RETINITIS PIGMENTOSA SINE PIGMENTO: Clinical Spectrum and Pigment Development.

PURPOSE: To investigate the clinical findings, natural course, and pigment development of patients with retinitis pigmentosa (RP) sine pigmento using multimodal imaging. METHODS: We reviewed the medical records of 810 consecutive patients with RP and assessed serial ultra-widefield fundus photography, fundus autofluorescence, and optical coherence tomography images. Electrophysiological and visual field analysis findings were also reviewed. RESULTS: Of the 774 patients with RP who met the inclusion criteria, 88 were diagnosed with RP sine pigmento, with a prevalence of 11.4%. The mean age of the patients was 35.57 years compared with 49.83 years for patients with typical RP. Fifty-nine patients (67%) demonstrated minimal color change, whereas 29 (33%) presented with grayish flecks in the retinal pigment epithelium on fundus photography. All patients with RP sine pigmento had abnormalities on fundus autofluorescence, and the commonest fundus autofluorescence findings were punctate or reticular hypoautofluorescence. Of the 62 patients without pigmentation at the first visit and at the follow-up visits, 14 (22.6%) had developed pigmentation at their follow-up visit, with an average time of 3.92 years. Most patients retained a visual acuity of ≥20/50 within the age of 50 years. CONCLUSION: Diagnosing RP sine pigmento based solely on ophthalmoscopic findings is more difficult than in more typical cases. Multimodal imaging can provide insights into the clinical characteristics to facilitate the diagnosis, classification, and follow-up of patients.

Embryonic stem cell-derived photoreceptor precursor cells differentiated by coculture with RPE cells.

Purpose: To describe the derivation of photoreceptor precursor cells from human embryonic stem cells by coculture with RPE cells. Methods: Human embryonic stem cells were induced to differentiate into neural precursor cells and then cocultured with RPE cells to obtain cells showing retinal photoreceptor features. Immunofluorescent staining, reverse transcription-PCR (RT-PCR), and microarray analysis were performed to identify photoreceptor markers, and a cGMP assay was used for in vitro functional analysis. After subretinal injection in rat animal models, retinal function was determined with electroretinography and optokinetic response detection, and immunofluorescent staining was performed to assess the survival of the injected cells. Results: Cocultured cells were positive for rhodopsin, red and blue opsin, recoverin, and phosphodiesterase 6 beta on immunofluorescent staining and RT-PCR. Serial detection of stem cell-, neural precursor-, and photoreceptor-specific markers was noted in each stage of differentiation with microarray analysis. Increased cGMP hydrolysis in light-exposed conditions compared to that in dark conditions was observed. After the subretinal injection in the rats, preservation of optokinetic responses was noted up to 20 weeks, while electroretinographic response decreased. Survival of the injected cells was confirmed with positive immunofluorescence staining of human markers at 8 weeks. Conclusions: Cells showed photoreceptor-specific features when stem cell-derived neurogenic precursors were cocultured with RPE cells.

MICROSTRUCTURAL CHANGES IN CYSTOID MACULAR EDEMA IN RETINITIS PIGMENTOSA AFTER INTRAVITREAL DEXAMETHASONE IMPLANT INJECTION.

PURPOSE: To evaluate microstructural changes in cystoid macular edema in retinitis pigmentosa after intravitreal dexamethasone implant injection. METHODS: In an extended cohort of a randomized trial of intravitreal dexamethasone implant for the management of retinitis pigmentosa-associated cystoid macular edema, microstructural changes during six months after the treatment were evaluated using spectral-domain optical coherence tomography. RESULTS: Forty-two eyes were included, and all had cystoid space in the inner nuclear layer (INL) at baseline. No eyes showed subretinal fluid, and 28.6% showed hyperreflective foci. Among 38 eyes with cystoid space both in the INL and outer nuclear layer/Henle's layer, 13 (34.2%) showed complete resolution and 12 (31.6%) showed cystoid space only in the INL at 2 months after injection, whereas others showed persistent cystoid space in both layers. After complete resolution, cystoid space recurrence was earlier in the INL than in the outer nuclear layer/Henle's layer. Multivariable analysis showed that greater cystoid space area in the INL and outer nuclear layer/Henle's layer, presence of macular leakage, and longer intact external limiting membrane at baseline were associated with greater cystoid space area decrease after the treatment. CONCLUSION: Resolution and recurrence pattern of retinitis pigmentosa-associated cystoid macular edema after dexamethasone treatment showed that the INL is the primary layer of cystic change, and this suggests its pathogenesis is most likely caused by Müller cell dysfunction.

A RANDOMIZED PAIRED-EYE TRIAL OF INTRAVITREAL DEXAMETHASONE IMPLANT FOR CYSTOID MACULAR EDEMA IN RETINITIS PIGMENTOSA.

PURPOSE: To evaluate the efficacy and safety of intravitreal dexamethasone (DEX) implant in retinitis pigmentosa patients with cystoid macular edema (CME). METHODS: In this randomized, noncontrolled, paired-eye, single crossover clinical trial, one eye of retinitis pigmentosa patients with bilateral CME with central macular thickness of >250 µm was randomized to intravitreal DEX implant while the fellow eye was observed. Both eyes were started on topical dorzolamide. At Month 6, DEX implant was eligible for both eyes when CME was >250 µm. Patients were followed up until Month 12. Primary outcome measures were the central macular thickness and best-corrected visual acuity changes from baseline at Month 2. RESULTS: Fourteen patients with bilateral RP-CME were included. Study eyes showed significant central macular thickness decrease (median, -147.5 µm; P = 0.001) and best-corrected visual acuity improvement (median, +6 letters; P = 0.001) at Month 2, but not at Month 6. Intravitreal DEX implant at Month 6 produced comparable efficacy to baseline treatment in 11 fellow eyes and 12 study eyes. Topical dorzolamide did not show significant therapeutic efficacy. During 12 months, elevated intraocular pressure of >21 mmHg and cataract progression were observed in 14.3% and 40.0% of study eyes. CONCLUSION: Intravitreal DEX implant can both reduce macular thickness and improve vision in RP-CME, while repeated injection is required.

Anatomical configurations of vitreomacular traction syndrome: influence on clinical course and surgical outcomes.

PURPOSE: To develop a new classification system for vitreomacular traction (VMT) syndrome according to spectral-domain optical coherence tomography (SD-OCT) imaging and to investigate the clinical course of VMT patients. METHODS: This study included 68 eyes of 68 consecutive patients who were followed with observation or treated with vitrectomy for idiopathic VMT. Eyes were classified into one of three groups according to SD-OCT findings: group A (foveal pseudocyst, which was defined as the formation of cystoid cavity located in the inner part of the central fovea along with foveal thickening), group B (parafoveal retinoschisis, which was defined as intraretinal cysts or clefts along with no apparent foveal thickening), and group C (outer retinal dehiscence at the fovea, which is sometimes accompanied by foveal thinning). The minimum required follow-up period was 1 year. Clinical course and anatomical and functional outcomes were compared among the groups. RESULTS: Twenty-seven eyes (39.7%) were included in group A, 22 eyes (32.4%) were included in group B, and 19 eyes (27.9%) were included in group C. Among the 24 eyes that were managed by observation, a significantly larger percentage of patients in group A (6/10 [60%]) exhibited more spontaneous resolution of VMT compared with those in groups B (9.1%) or C (0%) (P = 0.010). In the 44 eyes that were managed with vitrectomy, a significantly larger percentage of patients in group C (4/16 [25%]) experienced subsequent full-thickness macular hole development following vitrectomy compared with those in groups B (0%) or C (0%) (P = 0.014). The percentage of patients with photoreceptor inner segment/outer segment disruption was significantly reduced in group A after vitrectomy, with group C exhibiting the lowest recovery rate. Postoperatively, group A experienced a significantly better visual outcome than group C (P = 0.021). CONCLUSIONS: A novel configuration system offering insight into the clinical course of VMT is proposed. According to this system, anatomical and functional outcomes were favorable in group A and worse in group C.

An analysis of ranibizumab treatment and visual outcomes in real-world settings: the UNCOVER study.

PURPOSE: To describe intravitreal ranibizumab treatment frequency, clinical monitoring, and visual outcomes (including mean central retinal thickness [CRT] and visual acuity [VA] changes from baseline) in neovascular age-related macular degeneration (nAMD) in real-world settings across three ranibizumab reimbursement scenarios in the Middle East, North Africa, and the Asia-Pacific region. METHODS: Non-interventional multicenter historical cohort study of intravitreal ranibizumab use for nAMD in routine clinical practice between April 2010 and April 2013. Eligible patients were diagnosed with nAMD, received at least one intravitreal ranibizumab injection during the study period, and had been observed for a minimum of 1 year (up to 3 years). Reimbursement scenarios were defined as self-paid, partially-reimbursed, and fully-reimbursed. RESULTS: More than three-fourths (n = 2521) of the analysis population was partially-reimbursed for ranibizumab, while 16.4% (n = 532) was fully-reimbursed, and 5.8% was self-paid (n = 188). The average annual ranibizumab injection frequency was 4.1 injections in the partially-reimbursed, 4.7 in the fully-reimbursed and 2.6 in the self-paid populations. The average clinical monitoring frequency was estimated to be 6.7 visits/year, with similar frequencies observed across reimbursement categories. On average, patients experienced VA reduction of -0.7 letters and a decrease in CRT of -44.4 µm. The greatest mean CRT change was observed in the self-paid group, with -92.6 µm. CONCLUSIONS: UNCOVER included a large, heterogeneous ranibizumab-treated nAMD population in real-world settings. Patients in all reimbursement scenarios attained vision stability on average, indicating control of disease activity.

Dexamethasone Intravitreal Implant for Early Treatment and Retreatment of Macular Edema Related to Branch Retinal Vein Occlusion: The Multicenter COBALT Study.

PURPOSE: To evaluate the effect of dexamethasone intravitreal implant for macular edema (ME) following branch retinal vein occlusion (BRVO) in Korean patients. METHODS: We performed a prospective, open-label, multicenter study of 71 patients with ME for < 3 months. Retreatment was allowed ≥4 months from the last injection. RESULTS: At 6 and 12 months, mean ± SD best-corrected visual acuity (BCVA) improvement was 18.6 ± 12.9 and 15.3 ± 15.0 letters, respectively. Approximately 70% of maximum treatment response was observed after 1 week. Over the 12-month period, 32 and 49% of patients received 1 and 3 injections, respectively, with a mean ± SD interval of 20.0 ± 5.0 weeks. Patients who required 3 injections had higher central retinal thickness (CRT) and larger macular nonperfusion at baseline compared to those requiring only 1 injection. Adverse events included increased intraocular pressure (35%) and newly diagnosed cataract (16%). CONCLUSIONS: Intravitreal dexamethasone treatment with an interval of ≥4 months provides rapid and significantly better improvement in BCVA and CRT in patients with BRVO-associated ME.

The effect on choroidal changes of the route of systemic corticosteroids in acute Vogt-Koyanagi-Harada disease.

PURPOSE: To determine whether route of corticosteroid administration during the acute stage of Vogt-Koyanagi-Harada (VKH) disease affects depigmentary change and subfoveal choroidal thickness (SCT) during the convalescent stage. METHODS: In this retrospective comparative study, VKH patients with the interval between diagnosis and final follow-up of ≥ 24 months were divided into two groups according to route of systemic corticosteroid; intravenous pulse therapy (IV pulse group) and oral administration (oral group). Sunset glow fundus (SGF) scores determined by ultra-wide field retinal imaging and SCT determined by enhanced depth imaging optical coherence tomography were compared. RESULTS: Forty eyes (20 patients) were included in the IV pulse group and 33 eyes (18 patients) in the oral group. At final follow-up, the IV pulse group showed significantly lower mean SGF score, indicating less advanced depigmentary change (3.7 ± 1.5 vs. 5.1 ± 1.2, P = 0.007) and greater mean SCT (239.7 ± 71.1 µm vs. 183.8 ± 72.6 µm, P = 0.012) than the oral group. However, visual acuities did not differ (P = 0.245). In a cross-sectional evaluation at multiple time points from disease onset, the IV pulse group showed significantly lower SGF scores from 1 to 6 years and greater SCTs from 2 to 5 years. Multivariable regression analysis showed that IV pulse therapy and less frequent and shorter duration of inflammation predicted a lower SGF score (R2 = 0.291, P < 0.001), and young age, IV pulse therapy, and shorter duration of inflammation predicted greater SCT (R2 = 0.27, P < 0.001). CONCLUSIONS: Compared to oral administration, high dose IV pulse corticosteroids during the acute stage of VKH disease resulted in less choroidal change during the convalescent stage.

Association of ARMS2 genotype with response to anti-vascular endothelial growth factor treatment in polypoidal choroidal vasculopathy.

BACKGROUND: To investigate whether genetic risk variants for age-related macular degeneration (AMD) are associated with response to intravitreal anti-vascular endothelial growth factor (VEGF) in polypoidal choroidal vasculopathy (PCV) patients. METHODS: This prospective cohort study included 95 treatment-naïve patients that underwent anti-VEGF treatment for PCV for 12 months. Patients were genotyped for 10 single nucleotide polymorphisms in eight AMD-relevant genes. Genotypic association with visual and anatomic outcome measures at 12 months after initial treatment, including mean change in best-corrected visual acuity (BCVA) and total foveal thickness, visual gain of ≥ 15 letters, dry status on optical coherence tomography (OCT), pigment epithelial detachment (PED) regression on OCT, polyp regression on indocyanine green angiography, and injection numbers, were investigated using regression models with adjustment for non-genetic covariates under additive genetic model. RESULTS: In 81 patients who completed 12-month anti-VEGF monotherapy without photodynamic therapy, significant pharmacogenetic association was found between ARMS2 rs10490924 and PED regression on OCT. Proportions of PED regression were 26.4% for TT, 45.7% for TG, and 63.6% for GG genotype, showing additive effect of G allele for higher chance of PED regression (OR, 2.96; 95% CI, 1.38-6.36; corrected P = 0.043). For entire 95 patients, no significant association was found between candidate polymorphisms and receiving photodynamic therapy within 12 months. CONCLUSIONS: In PCV patients, ARMS2 rs10490924 showed association with anatomic therapeutic response to anti-VEGF, suggesting pharmacogenetic relationship.

EPIRETINAL MEMBRANE IN NONEXUDATIVE AGE-RELATED MACULAR DEGENERATION: Anatomical Features, Visual Outcomes and Prognostic Factors.

PURPOSE: To evaluate clinical characteristics, assess surgical outcomes, and determine prognostic factors after vitrectomy for epiretinal membrane (ERM) associated with nonexudative age-related macular degeneration (AMD). METHODS: This study comprised 171 consecutive patients with idiopathic ERM (n = 132) or nonexudative AMD-associated ERM (AMD-ERM, n = 39) undergoing vitrectomy. Preoperative morphologic characteristics on spectral-domain optical coherence tomography images and postoperative outcomes of the two groups were compared. Factors influencing postoperative best-corrected visual acuity in the AMD-ERM group were also analyzed. RESULTS: The AMD-ERM group was more likely to have an ERM with a smooth appearance (P = 0.009), a less severe vessel traction score (P = 0.002), a thinner central foveal thickness (P = 0.016), and more photoreceptor disruption than idiopathic ERM group. Mean central foveal thickness improved from 404.92 ± 82.08 and 369.87 ± 68.17 µm at baseline to 339.77 ± 39.27 and 331.72 ± 45.76 µm 1 year after surgery in eyes with idiopathic ERM and AMD-ERM, respectively (all P < 0.001). Mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.30 (20/40) ± 0.21 and 0.32 (20/42) ± 0.18 at baseline to 0.02 (20/21) ± 0.09 and 0.13 (20/27) ± 0.17 1 year after surgery in the idiopathic ERM and AMD-ERM groups, respectively (all P < 0.001). Baseline integrity of the ellipsoid zone line (P = 0.009) and preoperative best-corrected visual acuity (P = 0.024) were significantly correlated with visual outcome in the AMD-ERM group. CONCLUSION: Morphologic differences between AMD-ERM and idiopathic ERM were identified. Vitrectomy resulted in significant anatomical and visual improvements in eyes with AMD-ERM, but final visual outcome was worse in these eyes than in those with idiopathic ERM.

RECOVERY OF FOVEAL PHOTORECEPTOR INTEGRITY AFTER VITRECTOMY IN EYES WITH AN IMPENDING MACULAR HOLE WITH VITREOMACULAR TRACTION SYNDROME.

PURPOSE: To identify factors associated with the recovery of foveal photoreceptor disruption in eyes with an impending macular hole (MH) with vitreomacular traction syndrome after surgery. METHODS: This study comprised 33 consecutive patients who underwent vitrectomy for Stage 1 impending macular hole with disrupted photoreceptor inner segment/outer segment (IS/OS) layer and were followed up for a minimum of 1 year after surgery. Preoperative optical coherence tomography (OCT) parameters were compared between eyes that achieved complete restoration of the IS/OS layer (Group A) and those that did not (Group B). Postoperative serial changes in best-corrected visual acuity (BCVA) and IS/OS disrupted length were also investigated. RESULTS: Smooth and symmetric foveolar contour was restored in 29 eyes (87.9%). Complete recovery of IS/OS disruption was observed in 11 of 33 cases (33.3%, Group A). Group A exhibited a larger percentage of foveal pseudocysts (54.5% vs. 13.6%, P = 0.033) and a smaller mean aperture size (102.1 ± 182.1 µm vs. 241.5 ± 163.8 µm, P = 0.031) than Group B. Postoperatively, Group A revealed a significantly better visual outcome than Group Be, which was the same as Group B, but with the four eyes that developed a full-thickness macular hole excluded. CONCLUSION: Restoration of the foveal photoreceptor layer was more likely to occur in eyes with a foveal pseudocyst and smaller aperture size.

Ranibizumab in Myopic Choroidal Neovascularization: A Subgroup Analysis by Ethnicity, Age, and Ocular Characteristics in RADIANCE.

PURPOSE: To assess the impact of ethnicity, age, and ocular characteristics on ranibizumab efficacy in myopic choroidal neovascularization (CNV). METHODS: In this post hoc subgroup analysis from the phase III RADIANCE study, best-corrected visual acuity (BCVA) outcomes and treatment exposure were analyzed in 105 patients treated with ranibizumab 0.5 mg. Baseline categories included ethnicity, age, baseline BCVA, lesion area, CNV lesion area, refraction sphere, axial length, subretinal fluid, and location of CNV. RESULTS: At month 12, the mean change in BCVA was numerically higher in East-Asians than in Caucasians (17.0 vs. 14.1 letters). The median number of injections varied with ethnicity (East-Asians vs. Caucasians: 2 vs. 3), baseline BCVA (highest vs. lowest: 1 vs. 4), CNV lesion area and lesion area (largest vs. smallest: 5 vs. 1 and 5 vs. 2). CONCLUSIONS: East-Asians showed numerically higher BCVA gains than Caucasians. The number of injections varied across subgroups, emphasizing the need for individualized treatment.

Complications of Pathologic Myopia.

Pathologic myopia (PM) is one of the leading causes of visual impairment worldwide. The pathophysiology of PM is not fully understood, but the axial elongation of the eye followed by chorioretinal thinning is suggested as a key mechanism. Pathologic myopia may lead to many complications such as chorioretinal atrophy, foveoschisis, choroidal neovascularization, rhegmatogenous retinal detachment, cataract, and glaucoma. Some complications affect visual acuity significantly, showing poor visual prognosis. This article aims to review the types, pathophysiology, treatment, and visual outcome of the complications of PM.

The diagnostic application of targeted re-sequencing in Korean patients with retinitis pigmentosa.

BACKGROUND: Identification of the causative genes of retinitis pigmentosa (RP) is important for the clinical care of patients with RP. However, a comprehensive genetic study has not been performed in Korean RP patients. Moreover, the genetic heterogeneity found in sensorineural genetic disorders makes identification of pathogenic mutations challenging. Therefore, high throughput genetic testing using massively parallel sequencing is needed. RESULTS: Sixty-two Korean patients with nonsyndromic RP (46 patients from 18 families and 16 simplex cases) who consented to molecular genetic testing were recruited in this study and targeted exome sequencing was applied on 53 RP-related genes. Causal variants were characterised by selecting exonic and splicing variants, selecting variants with low allele frequency (below 1 %), and discarding the remaining variants with quality below 20. The variants were additionally confirmed by an inheritance pattern and cosegregation test of the families, and the rest of the variants were prioritised using in-silico prediction tools. Finally, causal variants were detected from 10 of 18 familial cases (55.5 %) and 7 of 16 simplex cases (43.7 %) in total. Novel variants were detected in 13 of 20 (65 %) candidate variants. Compound heterozygous variants were found in four of 7 simplex cases. CONCLUSION: Panel-based targeted re-sequencing can be used as an effective molecular diagnostic tool for RP.

A clinical grading system based on ultra-wide field retinal imaging for sunset glow fundus in Vogt-Koyanagi-Harada disease.

BACKGROUND: To develop a grading system for sunset glow fundus (SGF) based on the results of ultra-wide field retinal imaging and to investigate the factors related to the severity of SGF in patients with Vogt-Koyanagi-Harada (VKH) disease. METHODS: Records of 55 eyes with VKH disease were retrospectively reviewed. All patients had undergone serial fundus photography, ultra-wide field retinal imaging and spectral-domain optical coherence tomography. The morphologic characteristics of SGF and associated features related to the severity of the condition were evaluated. RESULTS: Sunset glow fundi were classified into 3 groups based on the extent and severity of depigmentary changes: early (n = 7), intermediate (n = 10) and advanced (n = 20). Grade 0 indicates the absence of sunset glow appearance. Eyes with a higher SGF grade were more likely to exhibit chronic recurrence (P < 0.001) and an anterior chamber reaction ≥ 2+ (P < 0.001), and were less likely to exhibit exudative retinal detachment (P < 0.001) at the initial presentation. Higher grades were more likely to exhibit cataracts (P < 0.001), glaucoma (P = 0.010), patchy chorioretinal atrophic lesions (P = 0.012), depigmented atrophic lesions (P < 0.001), an increased peripapillary atrophy/disc area ratio (P < 0.001), a decreased subfoveal choroidal thickness (P < 0.001), more frequent uveitis recurrences (P = 0.012) and a longer disease duration (P < 0.001). SGF progression was faster in eyes with a longer active inflammatory period. CONCLUSIONS: We present a simple and logical grading system for SGF as determined by using ultra-wide field retinal imaging. This grading system offers a means of assessing the degree of inflammation and facilitates speculation about the duration of VKH disease.

CHOROIDAL THICKNESS AFTER FULL-FLUENCE AND HALF-FLUENCE PHOTODYNAMIC THERAPY IN CHRONIC CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To compare clinical outcomes after full-fluence and half-fluence photodynamic therapy (PDT) in chronic central serous chorioretinopathy, focusing on changes in subfoveal choroidal thickness (SFCT) using enhanced depth imaging optical coherence tomography. METHODS: Retrospective, comparative interventional case series. RESULTS: In the full-fluence (n = 25) and half-fluence groups (n = 43), SFCT decreased from 351 ± 70 µm and 362 ± 63 µm at baseline to 276 ± 65 µm and 322 ± 70 µm at 3 months and remained at 267 ± 66 µm and 318 ± 76 µm at 12 months, respectively (all P < 0.001, for each comparison with baseline). The change in SFCT was greater in the full-fluence group than in the half-fluence group (P = 0.001). In the half-fluence group, SFCT was thicker in the treated eye than in the fellow eye (P = 0.045), whereas in the full-fluence group, the difference in SFCT was not significant (P = 0.209). Best-corrected visual acuity and central retinal thickness improved after PDT in both groups (all P < 0.001). However, the differences between the groups were not significant (P = 0.873 and P = 0.124, respectively). CONCLUSION: The results at 1 year show that full-fluence PDT reduces SFCT more than half-fluence PDT, and that SFCT after half-fluence PDT was still thicker than that in the fellow eye. The clinical implications of this finding for long-term outcomes including recurrence rate remain to be elucidated.

Pharmacogenetic associations with long-term response to anti-vascular endothelial growth factor treatment in neovascular AMD patients.

PURPOSE: To investigate the pharmacogenetic associations between the genetic risk variants of age-related macular degeneration (AMD) and long-term outcome after intravitreal anti-vascular endothelial growth factor (VEGF) treatment in Korean neovascular AMD patients. METHODS: This prospective study included 394 treatment-naïve patients (394 eyes) that underwent intravitreal anti-VEGF treatment for neovascular AMD for at least 12 months. Patients were genotyped for 17 single nucleotide polymorphisms within 13 AMD-relevant genes. Initially, patients underwent three monthly injections of intravitreal ranibizumab and were retreated as needed with ranibizumab or bevacizumab. For each candidate polymorphism, genotypic associations with treatment outcome measures at months 12 and 24, including mean change in best-corrected visual acuity (BCVA) from baseline, visual gain of ≥15 letters, mean change in central subfield macular thickness (CSMT) from baseline on spectral domain optical coherence tomography (OCT), presence of fluid on OCT, and mean number of injections, were investigated using logistic or linear regression models with adjustment for non-genetic covariates. RESULTS: At month 24, BCVA improved by 4.5 ± 22.5 letters and CSMT decreased by 69.4 ± 112.6 µm from baseline. Regression analysis with Bonferroni correction showed that the TT genotype for VEGFA rs3025039 was associated with a significantly higher chance of a visual gain of ≥15 letters at month 24 than other genotypes (odds ratio, 4.57; 95% confidence interval, 1.89 - 11.1; corrected p = 0.0434). As for tomographic outcome, the minor allele homozygotes for ARMS2 rs10490924 and HTRA1 rs1100638 (GG genotype for both) were associated with a larger CSMT reduction at month 12 than other genotypes, with borderline significance after Bonferroni correction (118.6 ± 132.7 µm versus 62.7 ± 89.7 µm, corrected p = 0.0656 for rs10490924; 115.7 ± 131.7 µm versus 63.6 ± 89.8 µm, corrected p = 0.0528 for rs11200638). No polymorphism showed a significant association with the number of injections. CONCLUSIONS: In this Korean neovascular AMD cohort, treatment outcome after anti-VEGF was found to differ by the genotypes of VEGFA rs3025039, ARMS2 rs10490924, and HTRA1 rs11200638. Given more evidence of pharmacogenetic associations with the anti-VEGF agent, individualized therapeutic approaches based on genetic background could lead to optimal treatment in neovascular AMD.

Ganglion cell-inner plexiform layer thickness after epiretinal membrane surgery: a spectral-domain optical coherence tomography study.

PURPOSE: To investigate postoperative macular ganglion cell-inner plexiform layer (GCIPL) thickness, determine the factors related to GCIPL thickness, and evaluate the association of GCIPL thickness with postoperative visual outcomes in patients with idiopathic epiretinal membrane (ERM). DESIGN: Retrospective, cohort study. PARTICIPANTS: Sixty-two patients with unilateral idiopathic ERM who were followed for ≥ 6 months after surgery. METHODS: Ophthalmologic evaluations included best-corrected visual acuity (BCVA) assessment, spectral-domain optical coherence tomography, and macular visual field (VF) mean sensitivity (MS) as measured by Humphrey VF test. Macular GCIPL thickness in eyes with ERM was compared with that of the normal contralateral eyes 6 months after surgery. The correlation between the interocular difference in GCIPL thickness and postoperative visual outcome was evaluated. MAIN OUTCOME MEASURES: Postoperative macular GCIPL thickness, factors related to the interocular differences in GCIPL thickness, and correlations of GCIPL thickness with BCVA and macular VF MS 6 months after surgery. RESULTS: Macular GCIPL thickness was significantly lower in eyes with ERM 6 months after surgery (71.77 ± 10.21 µm) than in the unaffected contralateral eyes (81.69 ± 5.33 µm; P<0.001). Thirty-three subjects were followed for 1 year after surgery, and the macular GCIPL thickness in eyes with ERM did not significantly change between 6 and 12 months after surgery (71.77 ± 10.21 vs 70.64 ± 9.57 µm; P = 0.179). Preoperative central foveal thickness was the only factor significantly correlated with interocular differences in macular GCIPL thickness (r = 0.3677; P = 0.0033). Among patients with intact photoreceptor layers, a greater decrease in GCIPL thickness was correlated with a worse postoperative BCVA (r = 0.5209; P<0.0001) and a greater decrease in macular VF MS (r = -0.2845; P = 0.0390). CONCLUSIONS: Macular GCIPL thickness decreased after vitrectomy to remove an idiopathic ERM. The decrease in GCIPL thickness was significantly correlated with postoperative visual outcomes in patients with intact photoreceptor layers.