THE EFFECT OF PHOTOPIGMENT BLEACHING ON FUNDUS AUTOFLUORESCENCE IN ACUTE CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: To evaluate the effect of photobleaching on fundus autofluorescence (FAF) images in acute central serous chorioretinopathy. METHODS: We obtained prephotobleaching and postphotobleaching images using an Optomap 200Tx, and photobleaching was induced with a Heidelberg Retina Angiograph 2. Degrees of photobleaching were assessed as grayscale values in Optomap images. Concordances among the three kinds of images were analyzed. Hyper-AF lesions in prephotobleaching images were classified as Type 1 (changed to normal-AF after photobleaching) and Type 2 (unchanged after photobleaching). The FAF composite patterns of central serous chorioretinopathy lesions were classified as diffuse or mottled. Initial and final best-corrected visual acuity, central retinal thickness, and disease duration were compared according to fovea FAF type. RESULTS: Forty-one eyes of 41 patients were analyzed. The lesion brightness of postphotobleaching Optomap FAF showed greater concordance with Heidelberg Retina Angiograph 2 FAF (94.74%) than the prephotobleaching Optomap FAF (80.49%). Eyes with Type 1 fovea had greater initial and final best-corrected visual acuity (20/23 vs. 20/41, 20/21 vs. 20/32, P < 0.0001, P = 0.001, respectively) and shorter disease duration (19.68 ± 12.98 vs. 51.55 ± 44.98 days, P = 0.043) than those with Type 2 fovea. However, eyes with diffuse Type 2 fovea had only lower initial and final best-corrected visual acuity (20/23 vs. 20/45, 20/21 vs. 20/36, P < 0.0001, P < 0.0001, respectively) than those with Type 1 fovea. CONCLUSION: Understanding the photobleaching effect is necessary for the accurate interpretation of FAF images. Furthermore, comparing prephotobleaching and postphotobleaching FAF images may be helpful for estimation of lesion status in central serous chorioretinopathy.

Comparison of intravitreal aflibercept and ranibizumab injections on subfoveal and peripapillary choroidal thickness in eyes with neovascular age-related macular degeneration.

PURPOSE: We aimed to compare changes in subfoveal and peripapillary choroidal thickness (CT) after intravitreal aflibercept or ranibizumab injections for neovascular age-related macular degeneration (AMD). METHODS: Medical records of 54 treatment-naïve, consecutive patients (54 eyes) who were diagnosed with neovascular AMD and received three monthly injections of aflibercept (21 eyes) or ranibizumab (33 eyes) were reviewed. Subfoveal and peripapillary CT were measured with images obtained using spectral domain optical coherence tomography at baseline and at three months. RESULTS: Subfoveal CT decreased from 232.2 ± 94.4 µm at baseline to 207.1 ± 89.3 µm at three months in the aflibercept group (p < 0.001) and from 231.5 ± 102.9 µm to 220.0 ± 98.0 µm in the ranibizumab group (p = 0.006). The reduction was greater in the aflibercept group than in the ranibizumab group (p = 0.024). Peripapillary CT decreased from 157.2 ± 62.2 µm at baseline to 147.4 ± 62.2 µm at three months in the aflibercept group (p < 0.001). However, the change in peripapillary CT from 154.9 ± 46.5 µm at baseline to 152.3 ± 50.0 µm at three months was not significant in the ranibizumab group (p = 0.123). CONCLUSIONS: Intravitreally injected aflibercept significantly decreased subfoveal CT more than ranibizumab. Choroidal thinning after aflibercept injection was not limited to the subfoveal area, but extended beyond the macula as well.

Peripapillary choroidal thickness in patients with early age-related macular degeneration and reticular pseudodrusen.

PURPOSE: The purpose of this study was to investigate peripapillary and macular choroidal thickness (CT) in patients with early age-related macular degeneration (AMD) with or without reticular pseudodrusen (RPD). METHODS: We investigated the medical records of 89 patients (89 eyes) with early AMD. The eyes were grouped into three categories according to the extent of RPD: no RPD, localized RPD, and diffuse RPD. Peripapillary and macular CT were measured with images obtained by spectral domain optical coherence tomography. CT in the peripapillary and macular areas was compared among groups. RESULTS: Both RPD groups exhibited an older subject age and a greater female predominance compared to the non-RPD group (P = 0.007 and P = 0.030, respectively). Macular and peripapillary CT were different among the three groups (all, P < 0.001), and both RPD groups showed a thinner choroid in all areas compared to the non-RPD group after adjusting for age and sex (all, P ≤ 0.016). Temporal peripapillary and nasal macular CT at 500 µm and 1500 µm, respectively, from the fovea in eyes with diffuse RPD were significantly thinner than that in eyes with localized RPD (P = 0.008, P = 0.016 and P < 0.001, respectively). CONCLUSIONS: In addition to the macular area, the peripapillary CT, including the area outside the macula, was thinner in eyes with RPD than in those without RPD. Significant differences in the papillomacular choroid were observed based on RPD distribution type, which suggests that variation in CT is based on the extent of RPD.

Peripapillary choroidal thickness after intravitreal ranibizumab injections in eyes with neovascular age-related macular degeneration.

BACKGROUND: The purpose of this study was to investigate peripapillary choroidal thickness (CT) in eyes with neovascular age-related macular degeneration (AMD) and to assess whether peripapillary CT is affected by intravitreal injection of ranibizumab (IVR) in eyes with neovascular AMD. METHODS: Peripapillary and subfoveal CT were measured in spectral domain optical coherence tomography images from 39 eyes of neovascular AMD patients and 39 eyes of age-matched controls retrospectively. The patients were treated with 0.5 mg IVR monthly for 3 months and retreated as needed. Peripapillary CT at baseline, 3 months and 6 months was measured at four locations (superior, nasal, inferior and temporal areas). RESULTS: The mean peripapillary and subfoveal baseline CTs of the eyes with neovascular AMD (153.3 ± 45.3 µm and 228.6 ± 78.6 µm) were not different from those of the controls (149.0 ± 42.3 µm and 221.4 ± 54.1 µm; P = 0.665 and P = 0.639, respectively). Subfoveal CT decreased at 3 months (213.8 ± 75.8 µm, P < 0.001) and 6 months (215.1 ± 72.8 µm, P = 0.002) following IVR treatment. Mean peripapillary CT did not show significant changes at 3 months (149.6 ± 43.8 µm, P = 0.156) or 6 months (150.0 ± 43.4 µm, P = 0.187). Subanalysis revealed that only temporal peripapillary CT decreased from baseline (167.1 ± 54.5 µm) to 3 months (159.4 ± 50.8 µm, P = 0.010) and was sustained at 6 months (160.6 ± 49.6, P = 0.026). However, superior, nasal and inferior peripapillary CT did not show significant changes after IVR. CONCLUSIONS: Changes in peripapillary CT after IVR were limited to the macular area. This result may suggest that IVR does not affect CT outside of the macula in the eyes of patients with neovascular AMD.

The Effects of Alcohol on Visual Evoked Potential and Multifocal Electroretinography.

The aim of this study was to investigate the acute effects of ethanol administration on pattern-reversal visual evoked potential (VEP) and multifocal electroretinography (mfERG). Fifteen healthy subjects with no ocular or general disease were recruited. VEP (0.25° pattern sizes) and mfERG with 19 elements in two recording segments were performed before ethanol administration to obtain baseline for each participant. A few days later, the participants visited again for VEP and mfERG measurements after ethanol administration. Ethanol (0.75 g/kg) was administered orally over the course of 30 minutes. VEP and blood alcohol concentration were evaluated one hour after ethanol administration, and mfERG was conducted after pupil dilation. The Wilcoxon signed-rank test was used to compare parameter changes after randomized eye selection. The mean blood alcohol concentration was 0.034% ± 0.05% by volume. VEP revealed a P100 latency delay (109.4 ± 5.3; 113.1 ± 8.2; P = 0.008) after alcohol administration. The P1 implicit time of ring 1 on mfERG showed a trend of shortening after alcohol administration (37.9 ± 1.0; 37.2 ± 1.5; P = 0.048). However, the changes did not show statistical significance after Bonferroni correction. In conclusion, orally administrated ethanol (0.75 g/kg) appears to suppress the central nervous system, but it is not clear whether alcohol intake affects the retina.

Subconjunctival hemorrhage after intravitreal injection of anti-vascular endothelial growth factor.

PURPOSE: To investigate the risk factors for subconjunctival hemorrhage (SCH) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) and evaluate the relationship between hemodynamic status at the time of injection and SCH. METHODS: We retrospectively reviewed the medical records of 598 cases of 173 patients who underwent intravitreal injection of ranibizumab whose hemodynamic status was monitored at the time of the injection. Cases with SCH after the injection were included in the SCH group. We compared systemic factors, including the hemodynamic status between the SCH group and the control group. RESULTS: The SCH group included 67 cases and the control group included 531 cases without SCH. Baseline hemodynamic status was not significantly related to development of SCH. However, systolic blood pressure (BP) at injection was a significant risk factors for SCH (P = 0.034). Elevated systolic BP, mean arterial pressure (MAP), and pulse rate from baseline to time of injection were significantly related to the development of SCH (P = 0.011, P = 0.014, P = 0.036, respectively). In multivariate analysis, hypertension, a large change in MAP, and a fewer previous injections were significant risk factors for SCH after intravitreal injection (P = 0.030, P = 0.032, P = 0.028, respectively). CONCLUSIONS: Hemodynamic risk factors exist for SCH after intravitreal injection of anti-VEGF. To reduce the risk of SCH, strategies should seek to decrease patient anxiety, especially in those with hypertension.

The change of macular thickness following single-session pattern scan laser panretinal photocoagulation for diabetic retinopathy.

PURPOSE: To identify the incidence and risk factors of macular edema development following single-session pattern scan laser panretinal photocoagulation (PRP) for eyes with diabetic retinopathy. METHODS: Medical records were reviewed in consecutive patients who underwent single-session PRP for diabetic retinopathy. The eyes with baseline central subfield retinal thickness (CRT) less than 300 µm were included. RESULTS: Macular edema developed in 11 (8.5%) of 129 eyes 1 months after PRP. In the multivariate analysis, baseline CRT (µm) (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.00-1.08, p = 0.048) and presence of intraretinal cystoid spaces or subretinal fluid on spectral-domain optical coherence tomography (SD-OCT) images (OR = 38.33; 95% CI = 1.36-1,083.14, p = 0.032) were significantly associated with macular edema development at 1-month visit. Macular edema developed in two (2.1%) of 97 eyes without cystoid spaces or subretinal fluid. The macular edema was spontaneously resolved in five (45.5%) of 11 cases at 3-month visit. CONCLUSIONS: SD-OCT may be helpful in predicting the development of macular edema, although the macular edema rarely developed after single-session pattern scan laser PRP and was spontaneously resolved in many cases.

Central serous chorioretinopathy fundus autofluorescence comparison with two different confocal scanning laser ophthalmoscopes.

PURPOSE: To compare the lesion characteristics of two different types of confocal scanning laser ophthalmoscopy (cSLO) autofluorescence (AF) images in central serous chorioretinopathy (CSC). METHODS: The study included 63 eyes of 61 patients; 63 pairs of fundus autofluorescence (FAF) images were compared before CSC resolution in 63 eyes, FAF images of 31 eyes were also compared after CSC resolution. The lesion characteristics (brightness and composite pattern) were compared between Heidelberg Retina Angiograph 2 (HRA2; Heidelberg Engineering, Germany) and Optomap Tx (Optomap; Optos, Scotland) FAF images. The lesion composite pattern was categorized as diffuse or granular. Diffuse AF was defined as homogenously increased or decreased AF, and granular AF was defined as dot-like, coarse changes in AF. The mean disease duration and subretinal fluid (SRF) height in the spectral domain optical coherence tomography were compared according to the FAF image characteristics. RESULTS: Lesion brightness before CSC resolution was hypo-AF in 48 eyes (76.2 %), hyper-AF in three (4.8 %), and mixed-AF in 12 (19.0 %) in HRA2 FAF images. In comparison, nine (14.3 %) images were hypo-AF, 44 (69.8 %) were hyper-AF, and 10 (15.9 %) were mixed-AF in Optomap FAF images (P < 0.0001). There was no significant difference in lesion composite pattern between the two FAF image wavelengths. Patients with lesions that were hyper-AF in Optomap FAF and hypo-AF in HRA2 FAF had a shorter disease duration and greater SRF height (1 month, 281 um) than those who were hyper-AF in both Optomap and HRA2 images (26 months, 153 um; P = 0.004, 0.001). CONCLUSIONS: The two types of FAF images of CSC showed different lesion brightness before and after CSC resolution but demonstrated similar lesion composite patterns.

PERIPAPILLARY CHOROIDAL THICKNESS IN CENTRAL SEROUS CHORIORETINOPATHY: Is Choroid Outside the Macula Also Thick?

PURPOSE: To investigate peripapillary choroidal thickness (CT) outside the macula in central serous chorioretinopathy (CSC). METHODS: We reviewed the medical records of 34 patients with unilaterally symptomatic idiopathic CSC and 34 age-matched controls. Subfoveal and peripapillary CT were measured from images obtained by spectral domain optical coherence tomography. The nasal peripapillary CT of the choroid outside the macula was determined. RESULTS: The subfoveal CT of CSC (369.74 ± 54.17 µm) and fellow eyes (316.18 ± 54.68 µm) of the patient group were thicker than those of the normal controls (281.90 ± 40.97 µm, all P < 0.05). The subfoveal CT in CSC was significantly thicker than those in the fellow eyes. Nasal CT was also thicker in CSC (217.59 ± 62.03 µm) and fellow eyes (206.66 ± 59.35 µm) of the patient group compared with the normal controls (179.52 ± 39.64 µm, all P < 0.05). However, there was no difference in nasal CT between CSC and fellow eyes (P = 0.150). CONCLUSION: This result may suggest that manifest CSC occurs in patients with thick choroids both within and outside the macula, especially when subfoveal CT is increased.

Characteristics of cystoid spaces in type 2 idiopathic macular telangiectasia on spectral domain optical coherence tomography images.

PURPOSE: To investigate the morphologic and topographic characteristics of intraretinal cystoid spaces in eyes with Type 2 idiopathic macular telangiectasia (MacTel 2). METHODS: Using B-scan and en face images of eyes with MacTel 2 taken from a spectral domain optical coherence tomography database, the circularities and mean gray values of the cystoid spaces were measured to determine their boundaries and reflectivity. The characteristics of cystoid spaces in MacTel 2 eyes were compared with those in eyes with Type 1 idiopathic macular telangiectasia (MacTel 1), retinal vein occlusion, and diabetic macular edema, which are caused by vascular leakage. The cystoid spaces of en face optical coherence tomography images were matched with fluorescein angiographic images. RESULTS: The circularity of the cystoid spaces in B-scan and en face optical coherence tomography images of 16 eyes with MacTel 2 was lower than that of eyes with MacTel 1 (P = 0.004 and P = 0.003, respectively), retinal vein occlusion (P < 0.001 and P < 0.001, respectively), and diabetic macular edema (P < 0.001 and P < 0.001, respectively). The mean gray value ratio of the cystoid spaces of eyes with MacTel 2 was lower than that of eyes with MacTel 1 (P = 0.002) and diabetic macular edema (P < 0.001). In eyes with MacTel 2, the cystoid spaces were located in the foveal center or parafoveal area. CONCLUSION: Characteristics of cystoid spaces of eyes with MacTel 2 were different from those in eyes with MacTel 1, retinal vein occlusion, and diabetic macular edema. The irregular boundaries and low reflectivity of the cystoid spaces in MacTel 2 may represent the degenerative origin of the disease.

Comparison of cornea endothelial cell counts after combined phacovitrectomy versus pars plana vitrectomy with fragmentation.

BACKGROUND: To compare postoperative cornea endothelial cell loss between combined phacovitrectomy and pars plana vitrectomy (PPV) with fragmentation. METHODS: Eighty-eight consecutive patients (92 eyes) who underwent combined phacovitrectomy (53 eyes from 50 patients) or PPV with fragmentation (39 eyes from 38 patients) were enrolled in this retrospective study. Endothelial cell density (ECD) was calculated with specular microscopy at 1 and 3 months after surgery. RESULTS: At 3 months after surgery, the mean ECD decreased significantly from 2,646 ± 296 cells/mm(2) to 2,422 ± 347 cells/mm(2) in the combined phacovitrectomy group (P < 0.001). However, the PPV with fragmentation group did not show any significant changes in ECD during the same period (from 2,123 ± 628 cells/mm(2) to 2,073 ± 574 cells/mm(2)). The mean endothelial cell loss in the combined phacovitrectomy group (7.9 and 9.5 %) was significantly higher than that in the PPV with fragmentation group (0.7 and 2.4 %) both at 1 and 3 months postoperatively (P = 0.001 and P = 0.001 respectively). CONCLUSION: In this study, corneal endothelial cell loss during the early postoperative period was significantly higher after combined phacovitrectomy than after PPV with fragmentation.

Glial proliferation after vitrectomy for a macular hole: a spectral domain optical coherence tomography study.

PURPOSE: To characterize eyes with glial proliferation after macular hole (MH) surgery. METHODS: We retrospectively reviewed patients who underwent vitrectomy for an idiopathic MH using spectral domain optical coherence tomography (SD-OCT). The pattern of the closed MH after surgery was categorized according to the presence (group 1) or absence (group 2) of apparent glial proliferation, which was determined by glial tissue reflectivity involving the external limiting membrane (ELM) and photoreceptor layers. Photoreceptor layer defect areas were categorized as mild or severe. Best-corrected visual acuity (BCVA) and pre- and postoperative OCT parameters were compared between the two groups. RESULTS: Among 30 eyes followed-up for a median of 11 months, seven (23 %) were assigned to group 1 and 23 (77 %) to group 2. The median age was higher in group 1 (70 years) than in group 2 (63 years). The postoperative BCVA was poorer in group 1 than in group 2 at 3 months and at the final examination (P = 0.022 and P < 0.001 respectively). The median preoperative basal hole diameter in group 1 (1,219 µm) was larger than that of group 2 (590 µm) (P = 0.002). The MH index (hole height/basal hole diameter) was smaller in group 1 than in group 2 (P = 0.012). At the final examination, group 1 had larger mild and severe photoreceptor layer defect areas (medians 1,300 µm and 207 µm respectively) than group 2 (medians 110 µm and 70 µm respectively) (P < 0.001 and P < 0.001 respectively). CONCLUSIONS: Eyes with glial proliferation after surgery for MH had different preoperative characteristics than eyes with no evidence of glial proliferation. In addition to a large hole diameter, other factors such as a small MH index and advanced age could be involved in the development of glial proliferation.

Hyperreflective external limiting membranes after successful macular hole surgery.

PURPOSE: To evaluate changes in external limiting membranes (ELMs) in the foveae of patients with surgically closed macular holes. METHODS: In this retrospective observational case series, spectral-domain optical coherence tomography scan images were obtained from eyes of patients with macular holes closed after vitrectomy. The integrity of the ELMs was evaluated at the fovea. In eyes with a restored ELM, the reflectivity of the ELM was estimated. RESULTS: At a mean of 19 months (range, 3.0-59.7 months) after surgery, the integrity of the ELM was restored in 21 (77.8%) of 27 eyes with closed macular holes. The ELM was not restored in six eyes with glial sealing, in which glial tissues were present in the entire retinal layer. All 21 eyes with restored ELMs had an area of hyperreflectivity within the ELM observed at the thinnest part of the fovea; this was associated with an underlying photoreceptor defect. CONCLUSION: Abnormally hyperreflective ELMs were frequently observed at the thinnest point of the fovea after macular hole surgery. These hyperreflective ELMs may be newly formed after surgery.

Morphologic characteristics of chronic macular hole on optical coherence tomography.

PURPOSE: To investigate the morphologic characteristics of chronic macular holes (MHs) using optical coherence tomography. METHODS: We retrospectively reviewed optical coherence tomographic images of consecutive patients who had been diagnosed with MH. Chronic MH was defined as MH that was observed without being surgically treated for at least 1 year. Optical coherence tomographic parameters were compared between chronic and acute MH. RESULTS: Thirteen eyes of 13 patients were classified as chronic MH, and 67 eyes of 67 patients were classified as controls. While the basal hole diameter of chronic MH was not different from that of controls (P = 0.146), the minimum hole diameter (781.8 µm) of chronic MH was larger than that of controls (448.4 µm; P < 0.001). The hole height and MH index were smaller in the chronic MH group (380.6 µm; 0.31) than in control group (469.9 µm, 0.53; P = 0.033, P = 0.003). Intraretinal fluid was less frequently observed in chronic MH than in controls (P < 0.001). Retinal pigment epithelial atrophy was only observed in chronic MH. CONCLUSION: Chronic MH has features distinct from those of acute symptomatic MH on optical coherence tomography. These findings provide useful insight for the differentiation of chronic MH from acute MH.

Fixation and photoreceptor integrity in optical coherence tomography.

PURPOSE: To investigate eccentric fixation (EF) in full-thickness macular hole (FTMH) and epiretinal membrane (ERM) and its relationship to photoreceptor integrity. METHODS: The amount of EF during spectral domain optical coherence tomography scanning was determined as the distance between the scan center and the foveal center. We investigated the difference in reflectivity of the photoreceptor inner segment/outer segment (IS/OS) junction at the scan center and the foveal center. RESULTS: The amount of EF was significantly greater in preoperative FTMH (median, 209 µm; interquartile range [IQR], 146 µm, 367 µm), postoperative FTMH (median, 138 µm; IQR, 95 µm, 461 µm), preoperative ERM (median, 210 µm; IQR, 151 µm, 308 µm), and after removal of ERM (median, 129 µm; IQR, 72 µm, 175 µm) than normal eyes (median, 67 µm; IQR, 47 µm, 101 µm). Abnormal EF was more frequently observed in eyes with greater inner segment/outer segment reflectivity at the scan center than at the foveal center. CONCLUSIONS: Fixation during the spectral domain optical coherence tomography scanning was frequently eccentric in FTMH and ERM and might be dependent on photoreceptor integrity.

The change of macular thickness measured by optical coherence tomography in relation to glycemic control in diabetic patients.

BACKGROUND: To demonstrate the change in macular thickness using optical coherence tomography in diabetic patients and to assess its relationship with glycosylated hemoglobin (HbA1c) levels. METHODS: Diabetic patients who underwent at least two macular thickness measurements with OCT within a 12-month period were included. HbA1c values within 1 month of each OCT study, and clinical data such as age, insulin treatment, systemic hypertension, and the severity of diabetic retinopathy were collected. The change in three macula parameters including center point thickness (CPT), central subfoveal macular thickness (CSMT), and total macular volume (TMV) between two measurements was calculated. Patients were divided into two groups based on the half-width of the 95% confidence interval for percent change, the increase group (group 1) and the decrease group (group 2). The associations of CPT change, CSMT change, and TMV change with baseline HbA1c levels, HbA1c change, and other clinical factors were investigated using correlation analysis and group comparison. RESULTS: A total of 23 eyes of 23 patients were studied. In correlation analysis; the increase in CPT, CSMT, and TMV was correlated with baseline HbA1c (CPT, Spearman's rho = 0.462, p = 0.027; CSMT, Spearman's rho = 0.479, p = 0.021; TMV, Spearman's rho = 0.589, p = 0.003), and the change of HbA1c (CPT, Spearman's rho = -0.585, p = 0.003; CSMT, Spearman's rho = -0.583, p = 0.004; TMV, Spearman's rho = -0.725, p < 0.001). In group comparison for CPT, group 1 have a higher baseline HbA1c (11.2% vs 8.7% of THb, p = 0.044) and a greater HbA1c reduction (-3.3% vs -1.2% of THb, p = 0.044) than group 2. For CSMT, group 1 tended to have a greater HbA1c reduction (-2.9% vs -1.2% of THb, p = 0.074) than group 2. For TMV, group 1 had a higher baseline HbA1c (11.6% vs 8.4% of THb, p = 0.001) and a greater HbA1c reduction (-3.5% vs -0.5% of THb, p < 0.001) than group 2. CONCLUSIONS: The change in macular thickness and volume developed in relation to HbA1c levels during a less than 12-month period. A high baseline HbA1c and a large reduction of HbA1c were risk factors for the increase in macular thickness. Prospective study with a large number of patients is needed to clarify the change of macular thickness in relation to glycemic control.

Comparison of choroidal thickness among patients with healthy eyes, early age-related maculopathy, neovascular age-related macular degeneration, central serous chorioretinopathy, and polypoidal choroidal vasculopathy.

PURPOSE: To compare choroidal thicknesses among eyes with early age-related maculopathy (ARM), neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and central serous chorioretinopathy. METHODS: Patients with age-related maculopathy (37 eyes), neovascular age-related macular degeneration (24 eyes), polypoidal choroidal vasculopathy (12 eyes), and central serous chorioretinopathy (31 eyes) underwent spectral-domain optical coherence tomography evaluations using a choroid scanning protocol. A horizontal linear section comprising 50 averaged scans was obtained of each macula. The choroidal thickness was measured from the outer border of the retinal pigment epithelium to the inner scleral border. Twenty-nine subjects with healthy eyes served as a control group. Analysis of covariance tests were performed to evaluate the effects of various diagnoses on choroidal thickness after removal of variance (covariates = gender, age, and refractive error). RESULTS: Among the different covariates, age was associated with choroidal thickness (fovea: F = 12.067, P = 0.001). After controlling for age differences, the choroid was thicker in polypoidal choroidal vasculopathy (319.92 ± 68.66 µm) and central serous chorioretinopathy (367.81 ± 105.56 µm) patients than in controls (241.97 ± 66.37 µm) and age-related maculopathy patients (186.62 ± 64.02 µm). However, there were no significant differences in mean choroidal thickness between neovascular age-related macular degeneration (226.46 ± 102.87 µm) and any of the other diagnoses. CONCLUSION: The choroid was thicker in eyes with polypoidal choroidal vasculopathy or central serous chorioretinopathy than in control or age-related maculopathy groups.

Risk factors for the development of transient hypotony after silicone oil removal.

PURPOSE: The purpose of the study was to determine the incidence, duration, and risk factors for postoperative transient hypotony after pars plana silicone oil removal. METHODS: This was a retrospective, noncomparative, interventional case series. The records of 89 eyes of 89 patients who underwent pars plana silicone oil removal with at least 6 months of follow-up were reviewed. Postoperative transient hypotony was defined as an intraocular pressure of <6 mmHg occurring within 1 week of surgery, which recovered within 4 months after surgery. RESULTS: Transient hypotony occurred in 35 of 89 eyes (39.3%). Thirty-three eyes recovered within 1 week after surgery. The logistic regression model, including age, number of previous pars plana vitrectomies, number of intraoperative endolaser applications, extent of remaining posterior proliferative vitreoretinopathy and the degree of proliferative vitreoretinopathy removal, number of preoperative antiglaucoma ophthalmic solutions, duration of postoperative anterior chamber inflammation, axial length, preoperative intraocular pressure, and duration of oil tamponade, showed that only axial length was significantly associated with the development of postoperative transient hypotony (odds ratio = 1.385, P = 0.023). CONCLUSION: Transient hypotony frequently developed after silicone oil removal, and most cases recovered within 1 week postoperatively. Patients with a long axial length had increased odds of developing transient hypotony after silicone oil removal.

Risk factors for pseudophakic retinal detachment after intraocular lens scleral fixation with or without pars plana vitrectomy.

PURPOSE: To identify the risk factors of pseudophakic retinal detachment after intraocular lens scleral fixation. METHODS: We retrospectively reviewed the medical records of all patients who underwent intraocular lens implantation with scleral fixation and had at least 6 months of follow-up between January 2002 and December 2007. The risk factors for pseudophakic retinal detachment were investigated using various surgical variables. To find the significant predictors among the variables, we carried out binary logistic regression analysis with a backward selection method based on likelihood ratios. RESULTS: Data from 395 eyes were analyzed. The pseudophakic retinal detachment rates were 8.46% (11 of the 130 eyes) in patients treated with pars plana vitrectomy (PPV) and 3.02% (8 of the 265 eyes) in patients treated without the PPV. Performing PPV (P = 0.023) was the only significant risk factor for pseudophakic retinal detachment after intraocular lens scleral fixation by logistic regression analysis. The odds ratio for PPV was 2.970 (95% confidence interval: 1.164-7.574). CONCLUSION: Performing PPV could be a risk factor of the pseudophakic retinal detachment after intraocular lens scleral fixation. If there is a choice, it should be decided carefully whether a PPV is performed at the time of intraocular lens scleral fixation.