Association of Subretinal Fluid Duration and Baseline Chorioretinal Structure With Optical Coherence Tomography in Central Serous Chorioretinopathy.

Purpose: This study investigated the association between subretinal fluid (SRF) duration and baseline chorioretinal structure in patients with naïve (first-episode and untreated) central serous chorioretinopathy (CSC). Methods: We divided 59 patients into non-prolonged (<3 months) and prolonged (>3 months) groups based on SRF fluid persistence from the initial visit. The follow-up period varied as the shorter duration was chosen between SRF disappearance time and 3 months from the initial visit. We measured the central retinal thickness (CRT), central choroidal thickness (CCT), SRF height (SRFH), and outer nuclear layer thickness (ONL) using spectral-domain optical coherence tomography (SD-OCT) at the initial visit and recorded SRF duration. We compared these parameters between the groups, conducted multivariate analysis for SRF duration of more than 3 months, and investigated the correlation among CCT and CRT, SRFH, or ONL, and among SRF duration and CRT, CCT, SRFH, or ONL. Results: CCT was significantly thicker in the prolonged than in the non-prolonged group at the initial visit (P = 0.044) and significantly correlated with CRT and SRFH (P = 0.007, r = 0.35 and P = 0.002, r = 0.39). SRF duration significantly correlated with CRT and SRFH (P = 0.009, r = 0.40 and P = 0.003, r = 0.41). The optimal model for SRF duration more than 3 months included age (P = 0.054) and CCT (P = 0.008). Conclusions: Thicker baseline CCT can lead to a longer SRF duration in naïve CSC. Translational Relevance: This association aids in early detection of cases at a higher risk of prolonged SRF.

Refractive outcomes after immediate primary phacoemulsification for acute primary angle closure.

This study investigated the refractive outcomes of 64 eyes overall including 32 immediate primary phacoemulsification in acute primary angle closure (APAC) eyes and 32 of their fellow eyes. We investigated best-corrected visual acuity, intraocular pressure (IOP), average keratometric diopter (K), spherical equivalent, axial length (AL), central corneal thickness, and anterior chamber depth (ACD) at preoperative examination (Pre) and more than 1-month post-phacoemulsification (1 m), and changes in values. Using SRK/T, Barrett Universal II (Barrett), Hill-Radial Basis Function Version 3.0 (RBF 3.0), and Kane formulas, we calculated and compared refractive prediction error (PE), absolute value of PE (AE), and changes in K, AL, and ACD from Pre to 1 m between APAC and fellow eyes. From Pre to 1 m, K remained similar in APAC and fellow eyes (p = 0.069 and p = 0.082); AL significantly decreased in APAC and in fellow eyes (both p < 0.001); and ACD significantly increased in APAC and in fellow eyes (both p < 0.001). The change in AL differed significantly between the two groups (p = 0.007). Compared to the fellow eyes, PE with SRK/T and Barret formulas (p = 0.0496 and p = 0.039) and AE with Barrett and RBF 3.0 formula (p = 0.001 and p = 0.024) were significantly larger in the APAC eyes. Thus, attention should be paid to refractive prediction error in immediate primary phacoemulsification for APAC eyes caused by preoperative AL elongation due to high IOP.

A useful technique of starting internal limiting membrane peeling from the edge of the internal limiting membrane defect in epiretinal membrane surgery.

Clinicians should be aware that internal limiting membrane (ILM) defects may occur concurrently with epiretinal membrane, and starting ILM peeling at the ILM defect margin may be useful in such cases. Abstract: We describe a useful surgical technique for the treatment of idiopathic epiretinal membrane with concurrent internal limiting membrane (ILM) defect, in which ILM peeling was started from the ILM defect margin. A dissociated optic nerve fiber layer-like appearance on fundus examination and optical coherence tomography may suggest an ILM defect.

Visual Prognostic Factors in Eyes with Subretinal Fluid Associated with Branch Retinal Vein Occlusion.

We investigated whether foveal ellipsoid zone (EZ) status affects visual prognosis in eyes with subretinal fluid (SRF) associated with branch retinal vein occlusion (BRVO). We included 38 eyes retrospectively and classified those with or without a continuous EZ on the SRF of the central foveola on the vertical optical coherence tomography (OCT) image at the initial visit as intact (n = 26) and disruptive EZ (n = 12) groups, respectively. In addition, we classified the intact EZ eyes into clear (n = 15) and blurred (n = 11) EZ groups according to whether EZ on the SRF was observed distinctly or not. Multiple regression analyses showed that baseline EZ status significantly correlated (p = 0.0028) with the 12-months logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), indicating that baseline intact EZ significantly improves visual prognosis. The 12-months logMAR BCVA of the intact EZ group was significantly better (p < 0.001) than that of the disruptive EZ group, and did not differ significantly between the clear and blurred EZ groups. Thus, baseline foveal EZ status on vertical OCT images can be a novel biomarker for visual prognosis in eyes with SRF associated with BRVO.

Three-Year Outcomes of Immediate Primary Phacoemulsification on Acute Primary Angle Closure Eyes and the Fellow Eyes.

Purpose: This study investigated the long-term outcomes (> 3 years) of immediate primary phacoemulsification in eyes with acute primary angle closure (APAC) and in the fellow eyes with shallow anterior chamber to prevent APAC development. Patients and Methods: This is a retrospective study of phacoemulsification for APAC using bilateral eyes. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of IOP-lowering medications at the preoperative examination (Pre), postoperative month 1 (1m), year 3 (3y), and last visit were compared between 14 eyes with APAC and their 14 fellow eyes. The number of corneal endothelial cells (CECs) at Pre and at more than 2 weeks after phacoemulsification was compared. The visual field mean deviation (MD) within 1 year after phacoemulsification and at the last visit was also compared. Results: For APAC eyes, BCVA was significantly improved at 1m, 3y, and at the last visit as compared with Pre (p < 0.05). IOP significantly decreased at 1m, 3y, and at the last visit compared with Pre (p < 0.05). IOP-lowering medication use decreased significantly from Pre to 1m (p < 0.05). The number of CECs was not significantly different between Pre and more than 2 weeks after phacoemulsification. BCVA was significantly worse in APAC eyes than in fellow eyes at Pre (p < 0.05). IOP and the number of IOP-lowering medications were significantly higher in APAC eyes than in fellow eyes at Pre (p < 0.05). Conclusion: Primary phacoemulsification improved visual acuity for APAC eyes and maintained good IOP control without the need for reoperation. Moreover, it preserved the number of CECs for the APAC and fellow eyes in the long term.

Safety and Efficacy of Rapid Primary Phacoemulsification on Acute Primary Angle Closure with and without Preoperative IOP-Lowering Medication.

This study aimed to investigate the safety and efficacy of rapid primary phacoemulsification in patients with acute primary angle closure (APAC) (n = 41), with or without preoperative IOP-lowering medication. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of corneal endothelial cells (CECs), and number of IOP-lowering medications at the preoperative examination (Pre), postoperative day 1 (1d), week 1 (1w), and month 1 (1m) were used as indicators and compared. BCVA significantly improved at 1d, 1w, and 1m compared with Pre (p < 0.05) and significantly improved at 1m compared to 1d (p < 0.05) for all eyes. IOP significantly decreased at 1d, 1w, and 1m compared with Pre (p < 0.05). CECs were not significantly different between Pre and 1m; the number of IOP-lowering medications decreased significantly from Pre to 1m (p < 0.05). BCVA and IOP were not significantly different between the two groups for all periods. CECs were not significantly different between the two groups at Pre and 1m. Rapid primary phacoemulsification improved visual acuity due to improvement of corneal edema without central visual field defects and good IOP control without reoperation or IOP-lowering medication and maintained the number of corneal endothelial cells with or without preoperative IOP-lowering medication in patients with APAC.

Epiretinal Membrane Surgery for a Patient with Dyskinesia Related to Parkinson's Disease Using Intravenous Dexmedetomidine Administration.

General anesthesia is usually selected when patients cannot remain still during surgery with local anesthesia. However, damage to the lungs from positive pressure ventilation under general anesthesia is a major concern in patients with Parkinson's disease. We report a case in which dyskinesia related to Parkinson's disease was attenuated by intravenous dexmedetomidine (DEX) administration, following which epiretinal membrane (ERM) and inner limited membrane peeling could be smoothly performed. A 68-year-old woman with systemic dyskinesia related to Parkinson's disease underwent cataract surgery for her right eye with local anesthesia (topical anesthesia with 4% lidocaine and sub-Tenon's anesthesia with 2% lidocaine and 30% nitrous oxide inhalation). During the surgery, continuous involuntary facial movement related to Parkinson's disease remained uncontrollable. One week later, she underwent cataract surgery and pars plana vitrectomy for the ERM of her left eye. In addition to local anesthesia (topical anesthesia with 4% lidocaine and retrobulbar anesthesia with 2% lidocaine and 30% nitrous oxide inhalation), the patient received intravenous DEX, which halted movement from the beginning of surgery until the end. Therefore, ERM surgery was performed without the influence of dyskinesia. This case highlights that intravenous DEX administration can inhibit dyskinesia related to Parkinson's disease during ERM surgery, which is among the most delicate microscopic procedures performed in ophthalmological settings. Additional studies are required to examine the actual effectiveness of DEX administration in patients with Parkinson's disease-related dyskinesia undergoing ophthalmological procedures.

Rapid Progression of Polypoidal Choroidal Vasculopathy following Third BNT162b2 mRNA Vaccination.

The study aimed to describe a case of rapid progression of polypoidal choroidal vasculopathy (PCV) following the third administration of the Pfizer-BioNTech (BNT162b2) mRNA vaccine. A 79-year-old Japanese man visited our hospital with a 1-week history of blurred vision in the left eye 16 h following the administration of the third BNT162b2 mRNA vaccine. The clinical examinations and imaging tests revealed massive submacular hemorrhage (SMH) and excessive subretinal fluid (SRF), owing to PCV in the left eye. No ocular abnormality was observed in the right eye. His medical history included diabetes and ocular history included cataracts, nonproliferative diabetic retinopathy, glaucoma in both eyes, and irregular retinal pigment epithelium elevation in the left eye. Since he received a single intravitreal injection of aflibercept approximately 2 years ago for the treatment of diabetic macular edema in the left eye, the left eye was stable. We performed an intravitreal injection of bevacizumab and combined phacoemulsification with pars plana vitrectomy with gas, including subretinal injection of tissue plasminogen activator to displace the SMH. Thirteen days after the surgery, the SMH and SRF decreased. Although rare, mRNA COVID-19 vaccine administrations could be associated with PCV deterioration.

Effects of Low-Concentration Nitrous Oxide Anesthesia on Patient Anxiety During Cataract Surgery: A Retrospective Cohort Study.

Purpose: We investigated the effects of 30% low-concentration nitrous oxide (N2O) anesthesia on anxiety, pain, and vital signs and the patient population that would benefit from low-concentration N2O anesthesia during cataract surgery. Patients and Methods: Sixty-three patients who underwent cataract surgery due to visual impairment from cataracts were included in this single-center retrospective cohort study conducted at the Ophthalmology Department of Shinseikai Toyama Hospital, Japan. Fifty eyes of 39 patients received a combination of local and N2O anesthesia (N2O group), and 30 eyes of 24 patients received local anesthesia without N2O anesthesia (Air group). The primary outcome measures were visual analogue scale (VAS) scores for patient anxiety, pain, and vital signs. The secondary outcome measures were the patient population. Results: The change in the VAS scores for anxiety and pain decreased significantly (p = 0.002 and p = 0.014, respectively) in the N2O group (-15.6 ± 22.9 and 12.4 ± 14.9, respectively) compared with that in the Air group (1.2 ± 20.6 and 24.2 ± 22.4, respectively). The systolic and diastolic blood pressure changes did not significantly differ between both groups (p = 0.093 and p = 0.23, respectively). The change in heart rate decreased significantly (p = 0.001) in the N2O group (-4.8 ± 4.8 bpm) compared with that in the Air group (-0.6 ± 5.8 bpm). Multivariate analyses demonstrated that the change in anxiety level in the N2O group correlated significantly with patient age (p = 0.045) and preoperative VAS score for anxiety (p = 0.0001), whereas the change in anxiety level in the Air group did not correlate with any factor. Conclusion: Low-concentration N2O anesthesia showed beneficial effects on intraoperative anxiety and pain during cataract surgery; this may aid the stabilization of intraoperative vital signs. Moreover, low-concentration N2O anesthesia during cataract surgery could benefit young patients and patients with high levels of preoperative anxiety.

A case of bilateral uveitis associated with seminoma/germinoma in thymus and pineal glands, two primary lesions.

Purpose: To report a case of bilateral ocular paraneoplastic syndrome by seminoma/germinoma in thymus and pineal glands, two primary lesions. Observations: A 18-year-old male presented at a local clinic complaining of just floaters in left eye without any other clinical signs and symptoms. The treating ophthalmologist found bilateral uveitis, and referred to our hospital. Bilateral retinal periphlebitis and optic disc swelling were shown. Vitreous opacity was found in left eye. We started ocular and systemic examinations to identify the cause of the uveitis, and also initiated oral steroid therapy. The survey using aqueous humor and blood samples showed no specific results for his uveitis. Computer tomography (CT) and magnetic resonance imaging (MRI) detected tumors in thymus and pineal glands. Five months after his first visit, the tumor in his thymus was resected, and was diagnosed as a seminoma/germinoma by pathological examination. Three months later, the tumor in the pineal gland was diagnosed as a germinoma by biopsy followed by chemotherapy and focal radiotherapy. Finally no abnormal ocular finding but slight optic disc atrophy was ascertained. Conclusions and importance: This is a case of ocular paraneoplastic syndrome induced by seminoma/germinoma in thymus and pineal glands, two primary lesions. Systemic screening by CT and MRI enables prompt diagnosis, treatment and favorable clinical course for such pathogenesis.

Foveal Intraretinal Fluid Localization Affects the Visual Prognosis of Branch Retinal Vein Occlusion.

We investigated whether baseline foveal intraretinal fluid (IRF) localization affects the visual prognosis of branch retinal vein occlusion (BRVO). Fifty eyes from 50 patients were included in this retrospective study. We classified the eyes with IRF involving and not involving the central foveola on the vertical optical coherence tomography (OCT) image at the initial visit into both-sides (n = 17) and one-side IRF (n = 33) groups, respectively. Multiple regression analyses demonstrated that not only the baseline logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) but also the IRF localization significantly correlated with the 12-month logMAR BCVA (p = 0.04 and p = 0.001, respectively), indicating that eyes with better baseline logMAR BCVA and one-side IRF have a significantly better visual prognosis in BRVO. The foveal ellipsoid zone band was significantly more disrupted (p < 0.001) in the both-sides IRF (47.1%) group than in the one-side IRF (3.0%) group. No eyes with decimal BCVA less than 0.5 were detected in the one-side IRF group at 12 months. Thus, baseline foveal IRF localization on vertical OCT images can be considered a novel biomarker for the visual prognosis of BRVO.

Direct Photocoagulation for Treating Microaneurysms with Hyperreflective Ring in Eyes with Refractory Macular Edema Associated with Branch Retinal Vein Occlusion.

Microaneurysms (MAs) with hyperreflective rings are sometimes detected in eyes with refractory macular edema (ME) associated with branch retinal vein occlusion (BRVO) for more than 12 months after onset when examined using optical coherence tomography (OCT). We proposed that these MAs could result in refractory ME secondary to BRVO and hypothesized that OCT-guided direct photocoagulation of MAs could result in a reduction in refractory ME. Eleven eyes (from eleven different patients) with refractory ME associated with BRVO for more than 12 months following initial treatment were included. The mean number of MAs in each eye at baseline was 3.5 ± 2.0 (range, 1-8). The mean central subfield thickness, central macular volume, and parafoveal macular volume significantly decreased 6 months following initial direct photocoagulation when compared with those at baseline (baseline = 378.7 ± 61.8 µm, post-treatment = 304.2 ± 66.7 µm, p = 0.0005; baseline = 0.3 ± 0.049 mm3, post-treatment = 0.24 ± 0.053 mm3, p = 0.001; and baseline = 2.5 ± 0.14 mm3, post-treatment = 2.28 ± 0.15 mm3, p = 0.001, respectively). Moreover, the mean best-corrected visual acuity significantly improved 6 months following initial direct photocoagulation when compared with that at baseline (baseline = 0.096 ± 0.2 logarithm of the minimum angle of resolution (logMAR), post-treatment = 0.0077 ± 0.14 logMAR, p = 0.031). Direct photocoagulation could be suggested as a treatment option for refractory ME associated with BRVO in MAs with a hyperreflective ring on OCT.

Acute Onset of Dense Vitreous Hemorrhage Associated with Retinal Arterial Macroaneurysm on the Optic Disc.

We present a rare case of acute onset of dense vitreous hemorrhage (VH) associated with ruptured retinal arterial macroaneurysm (RAM) on the optic disc. A 63-year-old Japanese man had undergone phacoemulsification combined with pars plana vitrectomy (PPV) including internal limiting membrane peeling in the right eye for a macular hole approximately 1 year before presentation. His decimal best-corrected visual acuity (BCVA) in the right eye was stable at 0.8 with no recurrence of macular hole. He visited our hospital emergently prior to his regular postoperative visit for a sudden decrease in visual acuity in the right eye. Clinical examinations and imaging tests revealed dense VH in the right eye, and we could not observe the fundus. B-mode ultrasonography of the right eye showed dense VH without retinal detachment and a bulge on the optic disc. His BCVA decreased to hand movement in the right eye. He had no medical history of hypertension, diabetes, dyslipidemia, antithrombotics, or ocular inflammation in both eyes. Accordingly, we performed PPV on the right eye. During vitrectomy, we found a RAM on the optic disc with retinal hemorrhage on the nasal side. We carefully reviewed the preoperative color fundus photographs and noticed that RAM was not present on the optic disc at the time of his visit 4 months earlier. After surgery, his BCVA improved to 1.2, the color of the RAM on the optic disc changed to grayish yellow, and optical coherence tomography images showed a shrunken RAM. RAM on the optic disc could cause VH early after its onset.

Acute Retinal Pigment Epitheliitis following Vaccination.

We present a rare case of acute retinal pigment epitheliitis (ARPE) following vaccination. An 18-year-old Japanese man visited our hospital with a 5-day history of a central scotoma in the right eye. He had received the second dose of coronavirus disease 2019 vaccination (BNT162b2 mRNA, Pfizer-BioNTech) 1 month prior, following which he developed a low-grade fever of 37.3-37.5°C for 2 days accompanied by joint pain. Although he had received influenza vaccination 5 days prior to this presentation, no systemic symptoms other than injection site pain were observed. Blood test results were unremarkable. Ophthalmological examination revealed a decimal best-corrected visual acuity (BCVA) of 0.8 and 1.2 in the right and left eyes, respectively. Intraocular pressure was 15 mm Hg in both eyes. Intraocular inflammation was not observed. Fundus examination revealed a localized lesion of pigment stippling associated with yellowish hypopigmentation in the fovea. Fluorescein angiography revealed slight transmission hyperfluorescence without leakage. Optical coherence tomography (OCT) revealed disruption of the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). We diagnosed the patient with ARPE in the right eye. The patient was followed up without treatment. Five weeks after onset, the central scotoma in the right eye disappeared, and patient's BCVA in the right eye improved to 1.5. OCT showed improvement in ELM and EZ continuity in the right eye, but IZ remained disruptive. Although the exact pathophysiology of the association between ARPE and these vaccinations is unclear, ARPE may develop after the vaccination.

Smooth borders between inner nuclear layer and outer plexiform layer predict fewer macular edema recurrences in branch retinal vein occlusion.

We hypothesized the smoothness of the border between the inner nuclear layer (INL) and outer plexiform layer (OPL) associates with the frequency of macular edema (ME) recurrences secondary to branch retinal vein occlusion (BRVO). Thirty-seven consecutive eyes with BRVO treated with anti-vascular endothelial growth factor (VEGF) injections at 1-year follow-up were included. We manually traced the border between the INL and OPL within the 1.5-mm vertical line from the fovea on optical coherence tomography (OCT) images at the initial visit. The jagged ratio (JR), the border length divided by the spline curve length, was calculated. We performed univariate and multivariate regression analyses, including JR, patient characteristics, number of cystoid spaces in the INL, INL area, and outer retina area. Multivariate regression analysis showed JR significantly correlates with the total number of anti-VEGF injections (P < 0.0001). Moreover, the mean JR was significantly lower in the nine eyes receiving two or fewer injections than in the 28 eyes receiving three or more injections (1.02 ± 0.01 vs. 1.13 ± 0.06, P < 0.0001). A smooth border between the INL and the OPL on OCT images at the initial visit may be a biomarker for fewer ME recurrences in eyes with BRVO.

Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics.

Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI.

Visual Acuity Recovery After Macular Hole Closure Associated With Foveal Avascular Zone Change.

Purpose: To evaluate changes in the foveal avascular zone (FAZ) area during the postoperative period of macular hole (MH) surgery using the optical coherence tomography angiography (OCTA) and to investigate its relationship to visual acuity (VA). Methods: Consecutive unilateral MH patients who underwent successful MH closure with at least a six-month observation period were studied retrospectively. To evaluate the FAZ area, OCTA images were obtained at the preoperative visit, the first postoperative visit, and the six-month visit. Main outcome measures were postoperative FAZ change and its relationship to VA change after MH closure. Results: Fifty-one cases were studied. The FAZ area was 0.42 ± 0.11 mm2 at the preoperative visit, 0.25 ± 0.091 mm2 at the first postoperative visit and 0.31 ± 0.11 mm2 at the six-month visit. FAZ area at the first postoperative visit was significantly smaller (P < 0.0001) than at the preoperative visit. FAZ area at the six-month visit was significantly greater (P < 0.0001) than at the first postoperative visit, but still significantly smaller (P = 0.0002) compared to the normal fellow eye. The postoperative FAZ area enlargement from the first postoperative visit to the six-month visit was significantly correlated with the postoperative VA recovery (P = 0.0322) and the postoperative photoreceptor reconstruction (P = 0.0213). Conclusions: The FAZ area once decreases along with MH closure; it thereafter increases toward the normal value over time. The postoperative FAZ change was correlated with the VA recovery. Translational Relevance: This study suggests that the postoperative FAZ area enlargement might be a potential biomarker indicating foveal reconstruction after MH closure.

Collateral Vessels in Branch Retinal Vein Occlusion: Anatomic and Functional Analyses by OCT Angiography.

PURPOSE: To analyze collateral vessels (CVs) associated with branch retinal vein occlusion (BRVO) anatomically and functionally using OCT angiography (OCTA). DESIGN: Retrospective review. PARTICIPANTS: Twenty-nine consecutive patients with BRVO. METHODS: The distribution of the CVs 12 months after the onset of BRVO was studied using spectral-domain OCTA. En face 3 × 3-mm OCTA images were acquired from 9 locations centered on the fovea and used to create a montage image of an 8.1 × 8.1-mm square. The CVs were identified in 3 separate areas: the radial peripapillary capillary (RPC), superficial capillary plexus (SCP), and deep capillary plexus (DCP) layers. The numbers of CVs were evaluated in 4 regions: zone 1, the area within a 3-mm diameter circle centered on the fovea; zone 2, the area between the 3-mm diameter circle and its outer 6-mm diameter circle; zone 3, the area beyond the 6-mm diameter circle; and the temporal raphe. MAIN OUTCOME MEASURES: The relationship between the number of CVs and vessel density (VD) in each layer, persistent macular edema (ME) at 12 months, and the number of injections of anti-vascular endothelial growth factor (VEGF) agents. RESULTS: The number of CVs in zone 1 was correlated negatively (P = 0.0079) with the VD in the SCP, and the numbers of CVs in zone 3 and the temporal raphe were correlated negatively (P = 0.0017 and P = 0.036, respectively) with the VD in the DCP. The number of CVs in the RPC and total number of CVs were also correlated negatively (P = 0.0034 and P = 0.0113, respectively) with the VD in the DCP. In patients with persistent ME, the number of CVs in zone 1 was significantly (P = 0.0156) greater than in patients with nonpersistent ME and correlated positively (P = 0.025) with the number of anti-VEGF injections. CONCLUSIONS: The CVs in BRVO form as result of capillary dropout and are considered to represent remodeling of the retinal capillaries. The CVs around the fovea may be good indicators of persistent ME.

Efficacy and safety of intravitreal drug injections using a short 34-gauge needle.

PURPOSE: To evaluate the efficacy and safety of intravitreal drug injections using a short 34-gauge needle. STUDY DESIGN: Retrospective study. METHODS: This study included patients with age-related macular degeneration, diabetic macular edema, or macular edema associated with retinal vein occlusion. We reviewed the medical records of consecutive patients with one of those three diseases treated with antivascular endothelial growth factor (VEGF) agents using an 8-mm-long 34-gauge needle. Sustained intraocular pressure (IOP) elevations were defined as IOP exceeding 21 mmHg or 6-mmHg or higher increases from baseline on 2 consecutive visits at least 1 month apart. The main outcome measures were improved best-corrected visual acuity (BCVA), central retinal thickness (CRT), IOP changes, and incidence of complications related to the 34-gauge needle. RESULTS: Six hundred ninety-eight injections were administered to 243 consecutive patients (mean age, 74.0 years) and reviewed. The mean follow-up time was 30.2 ± 15.9 weeks. The mean number of intravitreal injections/eye was 2.7 ± 1.8 (range, 1-9). The mean BCVA improved significantly (P < .0001), from 0.43 ± 0.4 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.36 ± 0.41 logMAR units at the last visit. The mean CRT decreased significantly (P < .0001), from 426.9 ± 168.5 microns at baseline to 297.6 ± 121.1 microns at the last visit. The mean IOP decreased significantly (P < .0001), from 13.6 ± 3.0 mmHg at baseline to 12.9 ± 3.1 mmHg at the visit after the first injection. A retinal tear occurred in 0.14%/injection (1/698). A sustained IOP elevation occurred in 1.29%/injection (9/698). CONCLUSION: Despite a few complications, the short 34-gauge needle was efficacious and safe for anti-VEGF intravitreal injections.