Retinal haemorrhages on ultra-widefield red channel images and perfusion status in central retinal vein occlusion.

PURPOSE: To evaluate the relationship between retinal haemorrhages detected on Ultra-widefield (UWF) red channel images and perfusion status in eyes with acute central retinal vein occlusion (CRVO). METHODS: UWF fundus images were split into green and red channels using ImageJ software. The retinal haemorrhages were calculated quantitatively with both the green and red channel images, resulting in green channel haemorrhages (GCH) and red channel haemorrhages (RCH). The nonperfusion area (NPA) was also calculated from fluorescein angiography in each eye. The relationships between both the GCH and RCH with the NPA were investigated. RESULTS: Thirty-two eyes of 32 patients with acute CRVO (18 men, 14 women) were included. The mean GCH and RCH values were 10.4% ± 8.2% and 1.7% ± 1.7%, respectively. The mean NPA was 39.2% ± 28.8%. Significant correlations were seen between the GCH and NPA (r = 0.38; P = 0.022) and RCH and NPA (r = 0.44; P = 0.010, linear regression analysis). Multivariate analysis suggested that only the RCHs were correlated significantly with the NPA. CONCLUSIONS: Retinal haemorrhages detected by UWF red channel imaging were less compared to green channel imaging and associated closely with retinal NPAs in eyes with acute CRVO. UWF red channel imaging allowed us to identify ischaemia-related haemorrhage.

Foveal microstructure and visual function in patients with lamellar macular hole, epiretinal membrane foveoschisis or macular pseudohole.

PURPOSE: To compare the foveal microstructures, such as the prevalence of epiretinal proliferation (EP) and residual ellipsoid zone (EZ), in eyes with lamellar macular hole (LMH), epiretinal retinal membrane (ERM) foveoschisis and macular pseudohole (MPH), and to investigate the association of the foveal microstructure with visual functions. METHOD: In addition to the prevalence of EP, we calculated the residual EZ index within 1mm and 3 mm (rEZ1 and rEZ3) in all examined eyes. Comparisons were conducted to baseline characteristics (logMAR visual acuity [logMAR VA], metamorphopsia score [Mave], central retinal thickness [CRT], the prevalence of EP, rEZ1 and rEZ3) between MPH, ERM foveoschisis and LMH subgroups. The relationships (1) between logMAR VA and each of age, type (MPH, ERM foveoschisis and LMH), the prevalence of EP, rEZ1, rEZ3, spherical equivalent (SE) and CRT and (2) between Mave and each of variables were investigated. RESULTS: Fifty-one eyes of 48 patients were enroled. The mean age was 65.2 ± 11.1 years. Ten eyes were diagnosed as LMH, 22 eyes as ERM foveoschisis and 19 eyes as MPH, respectively. There was a significant difference in CRT only between LMH and ERM foveoschisis (p = 0.023). There was a tendency toward significance in rEZ1 between LMH and ERM foveoschisis (p = 0.057), but not in rEZ3. The optimal model for logMAR VA included age, rEZ1, SE and CRT. On the other hand, the optimal model for Mave included the prevalence of EP, rEZ1 and SE. CONCLUSION: Microstructural observations are useful to predict visual functions in LMH, ERM foveoshisis and MPH.

Endophthalmitis outbreak caused by Fusarium oxysporum after cataract surgery.

PURPOSE: To evaluate an outbreak of endophthalmitis caused by Fusarium oxysporum after cataract surgery. METHODS: In the present study, we conducted a retrospective review of the medical records of cases of endophthalmitis that developed after cataract surgery. All eyes underwent phacoemulsification and intraocular lens implantation (PEA + IOL) at a single eye clinic on the same date. Symptoms of endophthalmitis occurred 21.5 ± 3.4 days after the cataract surgery. RESULTS: Nine eyes of 9 patients with fungal endophthalmitis (5 males and 4 females) were enrolled in the current study. The mean age of the patients was 63.4 ± 8.5 years. Soon after the diagnosis of endophthalmitis, pars plana vitrectomy (PPV) had been performed in all the eyes. However, because there was no response to the first PPV plus antibacterial drug therapy, we performed repeat PPV for all the eyes, combined with IOL removal and antifungal therapy (natamycin eye drops plus oral voriconazole or fosfluconazole). After the antifungal drug therapy, no recurrence of endophthalmitis was observed in any of the operated eyes, and good visual outcomes were obtained. Fusarium oxysporum was identified by culture and sequencing analysis. CONCLUSION: Early diagnosis and appropriate, adequate treatment are needed for successful management of fungal endophthalmitis.

Association Between Retinal Artery Angle and Visual Function in Eyes With Idiopathic Epiretinal Membrane.

Purpose: This study investigated the relationship between retinal artery angle and visual function in eyes with idiopathic epiretinal membrane (ERM). Methods: Ultra-wide field fundus imaging was conducted to analyze ERM and normal contralateral eyes. In addition to the logMAR visual acuity (VA) measurement, the average of the vertical and horizontal metamorphopsia scores (Mave) was measured using m-Charts for each eye. We calculated the retinal artery angle (Yugami correlated angle [YCA]) in all the examined eyes using ImageJ software. The YCAs were then compared between the ERM and normal contralateral eyes. Additionally, the relationship between YCA and visual function was investigated in the ERM eyes. Results: Data from 40 patients with ERM were analyzed. The mean age of the participants was 67.1 ± 8.1 years. The YCA was significantly smaller in the ERM eyes, compared with the contralateral eyes (P < 0.001, respectively; Wilcoxon signed rank test). Among age, axial length, YCAs, central retinal thickness (CRT), and central choroidal thickness (CCT), the optimal model for logMAR VA included age, YCA, and CRT. On the other hand, the optimal model for Mave included YCA and CCT. Conclusions: The retinal artery angle may be useful for predicting visual function in eyes with ERM. Translational Relevance: Our established quantitative measurements in fundus photography have potential clinical use in predicting visual function in ERM.

Correlation between choroidal structure and smoking in eyes with central serous chorioretinopathy.

PURPOSE: A smoking habit can cause various health problems encompassing retinal diseases including central serous chorioretinopathy (CSC). The aim of the current study was to investigate the effect of smoking on the choroidal structure in patients with CSC. METHODS: The choroidal vascular index (CVI) was calculated using the binarized OCT images. Baseline parameters (age, refractive error [SE], subfoveal choroidal thickness [SFCT] and CVI) were compared between smokers and non-smokers using Wilcoxon rank sum test. Moreover, the associations between SFCT and the baseline parameters were analyzed using a multivariate linear regression followed by the AICc model selection. RESULTS: Among 75 CSC patients, 45 patients were smokers and 30 patients were non-smokers. No significant differences in age and SE were seen between the smoking group and the non-smoking group. A significant difference in the SFCT was seen between two groups (382.0 ± 68.2 µm in the smoking group vs. 339.3 ± 52.3 µm in the non-smoking group, p = 0.0038), while no significant difference was observed in the CVI (p = 0.32). The optimal model for SFCT included the variables of age, SE and past history of smoking among the baseline parameters. Additionally, increased pack years was associated with increased SFCT. CONCLUSION: Cigarette smoking was associated with an increased SFCT in patients with CSC. Thicker choroid in smoking CSC patients may be an important modulator of the disease.

Using ultra-widefield red channel images to improve the detection of ischemic central retinal vein occlusion.

PURPOSE: To examine the usefulness of red channel fundus imaging to detect the ischemic status in eyes with central retinal vein occlusion (CRVO). METHODS: Ultra-widefield (UWF) fundus images were obtained from 42 eyes with CRVO. Twenty-one eyes were ischemic, and 21 eyes were non-ischemic. Rubeosis was found in 11 ischemic eyes. UWF images were split into red and green channels using ImageJ software. Both the color and red channel images were used to predict the presence or absence of ischemia when examined by masked graders. The sensitivity and specificity of UWF imagings for the detection of ischemia were calculated in Group A (total 42 eyes), Group B (32 eyes excluding non-rubeotic ischemic CRVO) and Group C (31 eyes excluding rubeotic ischemic CRVO), respectively. Moreover, a linear mixed model was conducted to investigate the relationship between the type of images and the accuracy of prediction in each group. RESULTS: No significant difference in the sensitivity of color fundus imaging was seen between Group A and Group B. By contrast, a significant difference in the sensitivity of red channel imaging was seen between Group A and Group B (p = 0.031). The accuracies of the predictions were not associated with the type of image in Group A and Group B, but were significantly associated in Group C (p = 0.026). CONCLUSIONS: UWF red channel imaging enabled more accurate detection of the ischemic status, compared with color fundus images, especially in non-rubeotic CRVO eyes.

Relationship Between Optical Coherence Tomography Parameter and Visual Function in Eyes With Epiretinal Membrane.

Purpose: To investigate the associations between visual function and the optical coherence tomography (OCT) parameters in eyes with idiopathic epiretinal membrane (ERM). Methods: Thirty-nine consecutive eyes with ERM were enrolled. In addition to OCT parameters, such as central retinal thickness (CRT), the area of gap between the ERM and the retinal surface (SUKIMA) was newly defined and calculated from the vertical and horizontal OCT images (SUKIMAv and SUKIMAh). The average of SUKIMAv and SUKIMAh (SUKIMAave) was used for the statistical analysis. The vertical and horizontal metamorphopsia scores (MV, MH) and the average of MV and MH (Mave) were also used for the analysis. Results: The Mave was not significantly associated with logMAR visual acuity (VA) (P = 0.57, linear regression analysis). Analysis using second-order bias-corrected Akaike information criterion model selection identified the age, CRT, and SUKIMAave as being associated with logMAR VA. On the other hand, among the OCT parameters, SUKIMAave and CRT were associated with the Mave. In addition, there was a significant relationship between SUKIMAh and MV (P = 0.011) and between SUKIMAv and MH (P = 0.0014). Conclusions: We identified SUKIMA as a novel OCT parameter that is useful to predict both VA and metamorphopsia in patients with ERM.