Characteristics of the Foveal Microvasculature in Asian Patients with Dry Age-Related Macular Degeneration: An Optical Coherence Tomography Angiography Study.

PURPOSE: To evaluate changes in the foveal microvasculature in patients with dry age-related macular degeneration (dry AMD) using optical coherence tomography angiography (OCTA). METHODS: Eighty-three eyes with dry AMD and 83 age- and sex-matched normal eyes were enrolled. A 3 × 3 mm2 OCTA (Zeiss HD-OCT 5000 with AngioPlex; Carl Zeiss Meditec, Dublin, CA, USA) scan was used to acquire images. Vessel density (VD), perfusion density (PD), and the foveal avascular zone (FAZ) of the superficial capillary plexus were analyzed. RESULTS: The VD of the full area, central area, and inner ring of the dry AMD patients (18.61, 8.41, and 20.45, respectively) were significantly lower than those of the controls (20.06, 11.09, and 22.51, respectively). The PD of the full area, central area, and inner ring of the dry AMD patients (0.34, 0.15, and 0.37, respectively) were also significantly lower than those of the controls (0.36, 0.19, and 0.40, respectively). The FAZ area and perimeter in the dry AMD patients (0.29 mm2 and 2.47 mm, respectively) were larger than those in the controls (0.23 mm2 and 2.09 mm, respectively). The FAZ circularity index in the dry AMD patients was smaller than that in the controls (0.61 vs. 0.66). Using univariate linear regression, age, best-corrected visual acuity (BCVA), central macular thickness (CMT), and ganglion cell-inner plexiform layer (GC-IPL) thickness were associated with both VD and PD of the full area. Using multivariate analysis, only GC-IPL thickness was significantly associated with the VD and PD of the full area (p = 0.001 and p = 0.004, respectively). CONCLUSIONS: OCTA revealed changes in the foveal microcirculation of patients with dry AMD. Age, BCVA, CMT, and GC-IPL thickness should be considered when analyzing the OCTA data of patients with dry AMD. GC-IPL thickness is particularly important during clinical evaluation of VD and PD in patients with dry AMD.

Longitudinal Changes in Peripapillary Retinal Nerve Fiber Layer Thickness in High Myopia: A Prospective, Observational Study.

PURPOSE: To determine longitudinal change of peripapillary retinal nerve fiber layer (pRNFL) thickness in patients with high myopia without ophthalmic disease. DESIGN: Prospective observational study. PARTICIPANTS: Participants were divided into 2 groups: a high myopia group (80 eyes) that included eyes with an axial length ≥26.0 mm and a control group (80 eyes) that included eyes with a spherical equivalent (SE) between +3.0 and -6.0 diopters (D). Both groups were further divided into age subgroups by decade: 20s, 30s, 40s, and 50s. Each subgroup included 20 eyes. METHODS: After the initial visit, pRNFL thickness measurements were performed 2 times more with at least 1-year intervals between examinations using spectral-domain OCT. The mean pRNFL thickness was fitted with linear mixed models. MAIN OUTCOME MEASURES: The pRNFL thickness and rate of pRNFL thickness reduction. RESULTS: The mean patient age and thickness of the pRNFL at the first visit were 39.5±12.5 years and 90.16±9.06 µm, and 41.5±12.2 years and 96.80±9.50 µm in the high myopia and control groups, respectively. The high myopia group showed a significant reduction in mean pRNFL thickness between the first and second visits, and between the second and third visits (P < 0.001 and P = 0.002, respectively). For individuals aged 50 to 59 years, the reduction rate was -1.69 and -0.63 µm/year in the high myopia and control groups, respectively; the interaction between group and duration was significant (P = 0.014). The reduction rate in individuals aged 40 to 49 years was -1.70 and -0.48 µm/year in the 2 groups, respectively; the interaction was also significant (P = 0.031). Among those aged 30 to 39 years and 20 to 29 years, no such significant interactions were observed (-0.95 vs. -0.57 µm/year, P = 0.086 and -0.31 vs. -0.19 µm/year, P = 0.858, respectively). CONCLUSIONS: Highly myopic eyes had a significantly greater decrease in pRNFL over 2 years than normal eyes. In addition, the reduction rate of pRNFL thickness was greater in older patients with high myopia, whereas similar values were shown in normal controls except individuals aged 20 to 29 years.

THICKNESSES OF CENTRAL MACULAR, RETINAL NERVE FIBER, AND GANGLION CELL INNER PLEXIFORM LAYERS IN PATIENTS WITH HYPERTENSION.

PURPOSE: To compare retinal thickness between patients with chronic hypertension without retinopathy, hypertensive retinopathy, Keith-Wagener-Barker Grade IV status, and normal controls using spectral domain optical coherence tomography. METHODS: In this retrospective study, we analyzed patients who visited our retinal clinic from January 2013 to February 2016. Of those included, 58 eyes of 58 patients were in the healthy control group (Group A), 37 eyes of 37 patients were in the chronic hypertension without retinopathy group (disease duration of at least 10 years; Group B), and 31 eyes of 31 patients with relieved hypertensive retinopathy (Grade IV hypertensive retinopathy a year or more ago but no longer had hypertensive retinopathy at the time of the study; Group C). The thicknesses of the central macula, retinal nerve fiber layer (RNFL), and ganglion cell inner plexiform layer (GCIPL) were measured by spectral domain optical coherence tomography in each group. RESULTS: The average thicknesses of the central macula, RNFL, and GCIPL layers were lower in Group B than in Group A (P < 0.001, 0.001, and <0.001, respectively). The thicknesses of the three layers were lower in Group C than in Group B (P < 0.001, <0.001, and <0.001, respectively). Of the three groups, the average thicknesses of the central macula, RNFL, and GCIPL were lowest in the Group C (P < 0.001, <0.001, and <0.001, respectively). CONCLUSION: The central macula, RNFL, and GCIPL in Group B were significantly thinner than those of healthy eyes, and these retinal changes were more prominent in Group C. Thus, the effects of retinal changes associated with hypertension should be considered when analyzing the thicknesses of the central macular, RNFL, and GCIPL layers in patients with ocular disorders, including retinal, glaucoma, and neuro-ophthalmological diseases.

PRIMARY CORE VITRECTOMY TECHNIQUE BEFORE CATARACT SURGERY IN COMBINED PHACOVITRECTOMY FOR EYES WITH DENSE VITREOUS HEMORRHAGES.

PURPOSE: To investigate the efficacy and safety of a primary core vitrectomy technique for combined phacovitrectomy in eyes showing a poor red reflex because of dense vitreous hemorrhage before cataract surgery. METHODS: A total of 156 eyes from 156 patients, who underwent combined phacovitrectomy because of cataract and dense vitreous hemorrhage, and who were followed up for at least 6 months were included. The patients were divided into a primary phacoemulsification group (Group A, 80 eyes) who underwent phacoemulsification first followed by total vitrectomy and a primary vitrectomy group (Group B, 76 eyes) who underwent core vitrectomy first followed by cataract surgery and followed by total vitrectomy. A conventional 23-gauge combined phacovitrectomy was performed in all patients. The operation time, including the total continuous curvilinear capsulorhexis time and total cataract surgery time, and the incidence of surgery-related complications were evaluated in the two groups. RESULTS: Diabetic retinopathy was the most common cause for vitreous hemorrhage in both groups (Group A: 51 eyes; Group B: 39 eyes). The total continuous curvilinear capsulorhexis time (P = 0.001) and total cataract surgery time (P = 0.036) were significantly shorter in Group B than in Group A. Among the complications, radial tears occurred more frequently in Group A than Group B, but these differences were not statistically significant (P = 0.211). Pupil size reduction during cataract surgery was greater in Group B than in Group A (P = 0.034). There were no significant differences in posterior capsular ruptures or posterior capsular opacities between the two groups. Other postoperative complications were not observed in either group until 6 months after surgery. CONCLUSION: Primary core vitrectomy combined with phacovitrectomy of patients who had dense vitreous hemorrhage helped to obtain a good red reflex and enabled surgeons to perform successful cataract surgery. In addition, primary core vitrectomy was an easy and safe technique, which reduced the surgery time and surgery-related complications. This surgical technique would, therefore, be helpful to vitreoretinal surgeons.

Healthcare Utilization and Treatment Patterns in Diabetic Macular Edema in Korea: a Retrospective Chart Review.

BACKGROUND: Limited data exist on real-world treatment patterns for diabetic macular edema (DME) in Korea. In this study, we investigated DME treatment patterns from 2009 to 2014 and the impact of baseline treatment on healthcare resource utilization and visual acuity (VA) outcomes. METHODS: A retrospective cohort chart review of DME patients treated at 11 hospital ophthalmology clinics between January 1, 2012 and December 31, 2013 was conducted. We collected data on demographics, healthcare resource utilization (clinic visits, treatment visits, and visits for ocular investigations), distribution of DME treatments, and VA. RESULTS: Overall, 522 DME patients (men, 55.2%; mean age, 59 years; mean HbA1c [n = 209], 8.4%) with 842 DME eyes were evaluated. For all treatments, healthcare resource utilization was significantly higher during the first 6 months versus months 7-12, year 2, or year 3 (P ≤ 0.001), but was highest for patients whose first treatment was an anti-vascular endothelial growth factor (VEGF) treatment (visits/quarter; anti-VEGF, 1.9; corticosteroids, 1.7; laser, 1.4). Use of macular laser therapy decreased (44% to 8%), whereas use of anti-VEGF injections increased (44% to 69%) during the study period. However, VA improvement was not commensurate with healthcare resource utilization of anti-VEGF treatment (mean VA gain, 2.7 letters). CONCLUSION: A trend toward increasing use of intravitreal anti-VEGF injections for DME treatment was observed in Korea. However, the frequency of dosing and monitoring was lower in clinical practice versus major clinical trials, which may have led to the less-than-favorable improvements in visual outcomes.

THICKNESS OF THE MACULA, RETINAL NERVE FIBER LAYER, AND GANGLION CELL-INNER PLEXIFORM LAYER IN THE AGE-RELATED MACULAR DEGENERATION: The Repeatability Study of Spectral Domain Optical Coherence Tomography.

PURPOSE: To determine the repeatability of measuring the thickness of the central macula, retinal nerve fiber layer, and ganglion cell-inner plexiform layer (GC-IPL) using spectral domain optical coherence tomography (Cirrus HD-OCT) in eyes with age-related macular degeneration. METHODS: One hundred and thirty-four eyes were included. The measurement repeatability was assessed by an experienced examiner who performed two consecutive measurements using a 512 × 128 macular cube scan and a 200 × 200 optic disk cube scan. To assess changes in macular morphology in patients with age-related macular degeneration, the patients were divided into the following three groups according to the central macular thickness (CMT): A group, CMT < 200 µm; B group, 200 µm ≤ CMT < 300 µm; and C group, CMT > 300 µm. RESULTS: Measurement repeatability was assessed using test-retest variability, a coefficient of variation, and an intraclass correlation coefficient. The mean measurement repeatability for the central macular, retinal nerve fiber layer, and GC-IPL thickness was high in the B group. The mean measurement repeatability for both the central macula and retinal nerve fiber layer thickness was high in the A and C groups, but was lower for the GC-IPL thickness. The measurement repeatability for GC-IPL thickness was high in the B group, but low in the A group and in the C group. CONCLUSION: The automated measurement repeatability for GC-IPL thickness was significantly lower in patients with age-related macular degeneration with out of normal CMT range. The effect of changes in macular morphology should be considered when analyzing GC-IPL thicknesses in a variety of ocular diseases.

LONGITUDINAL CHANGES IN THICKNESSES OF THE MACULA, GANGLION CELL-INNER PLEXIFORM LAYER, AND RETINAL NERVE FIBER LAYER AFTER VITRECTOMY: A 12-Month Observational Study.

PURPOSE: To analyze longitudinal changes in the thicknesses of the macula, ganglion cell-inner plexiform layer (GC-IPL), and peripapillary retinal nerve fiber layer (RNFL) after vitrectomy. METHODS: Thirty-eight patients diagnosed with intraocular lens (IOL) dislocation without evidence of other vitreoretinal diseases were included. They underwent conventional vitrectomy and IOL transscleral fixation, with a follow-up of 12 months. Using spectral domain optical coherence tomography, the thicknesses of the macula, GC-IPL, and peripapillary RNFL in the vitrectomized and fellow control eyes were measured. Various optic nerve head parameters were also determined. RESULTS: Optical coherence tomography showed that there were no significant differences in postoperative central macular thickness compared with baseline values. The average GC-IPL thickness increased 1 month after surgery from baseline (P = 0.038). The average RNFL thickness increased from baseline at 1 month (P = 0.001) and 3 months (P = 0.011) after vitrectomy. The mean foveal, GC-IPL, and RNFL thicknesses of the study eyes compared with the fellow control eyes increased at 1 month (P = 0.034), 1 month (P = 0.048), and 1 month (P = 0.013) to 3 months (P = 0.038), respectively, after surgery. However, no significant differences were found in intraocular pressure or optic nerve head parameters between the study and fellow control eyes at 12 months after surgery. CONCLUSION: Transient increases in the thickness of the macula and GC-IPL were observed at 1 month after vitrectomy, and the postoperative RNFL thickness increased until 3 months after surgery, after which it returned to preoperative levels. There was no significant change in intraocular pressure or optic nerve head parameters before and after surgery.

Interocular Asymmetry of the Ganglion Cell-inner Plexiform Layer in Diabetic Retinopathy.

SIGNIFICANCE: The interocular difference in the ganglion cell-inner plexiform layer thickness showed a significant correlation with the diabetic retinopathy (DR) severity. PURPOSE: The purpose of this study was to analyze the interocular differences in the foveal, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GC-IPL) thickness of DR patients using spectral-domain optical coherence tomography. METHODS: A total of 508 eyes from 254 patients with different severities of DR and 184 eyes from 92 control subjects were included. The GC-IPL, foveal, and RNFL thicknesses were measured, and the interocular differences in these thicknesses were correlated in control subjects and DR patients. RESULTS: The interocular difference in the average GC-IPL thickness significantly increased with the severity of DR. The interocular differences in the average GC-IPL thicknesses of the severe nonproliferative DR (NPDR) and the proliferative DR patients were significantly higher than those of the control group. However, there was no significant difference in thickness between the control group and the group with mild to moderate NPDR. In the group with proliferative DR, the interocular difference in the average GC-IPL was greater than those in the central foveal and RNFL thicknesses. Multivariate regression analyses showed that the DR severity and the interocular difference in central foveal thickness were significantly correlated with the interocular difference in the average GC-IPL thickness. CONCLUSIONS: The interocular differences in the central foveal, RNFL, and GC-IPL thicknesses significantly increased with increased DR severity. However, there was no significant difference between the control group and the group with mild to moderate NPDR. The GC-IPL differences showed a significant correlation with DR severity. These findings may be an indicator of DR progression.

Retinal Nerve Fiber Layer Thickness in Various Retinal Diseases.

SIGNIFICANCE: Peripapillary retinal nerve fiber layer (RNFL) thickness measurements may be influenced by the range and severity of lesions that are observed distinctively in each retinal disease. PURPOSE: We investigated the effects of various macular (central serous chorioretinopathy, macular hole, epiretinal membrane, wet age-related macular degeneration) and retinal vascular (branch retinal vein occlusion, central retinal vein occlusion, diabetic macular edema) diseases on peripapillary RNFL thickness measurements using spectral-domain optical coherence tomography. METHODS: Six hundred thirty-one eyes from 464 patients with various retinal diseases and 167 controls of similar age were included in this retrospective study. Using spectral-domain optical coherence tomography, we measured the thickness of the macula and the RNFL in both various retinal disease eyes and normal control eyes. Four sectorial and average RNFL thicknesses were compared between each disease and age-matched control eyes. The macular thicknesses were also compared. RESULTS: In the macular disease group, superior (P = .033) and temporal (P = .024) quadrant RNFL thicknesses of central serous chorioretinopathy and temporal (P < .001) quadrant RNFL thicknesses of epiretinal membrane were greater than the age-matched control eyes. No RNFL measurements in macular hole or wet age-related macular degeneration differed significantly from the controls. In the retinal vascular disease group, all sectorial and average RNFL thicknesses of diabetic macular edema and central retinal vein occlusion were greater than those of the controls (all P < .05). In branch retinal vein occlusion, superior (P = .012) and temporal (P < .001) quadrant RNFL thicknesses were greater than those of the controls. CONCLUSIONS: Peripapillary RNFL thickness measurements may be influenced by the range and severity of lesions that are observed distinctively in each retinal disease. It also appeared that macular disease had a local effect on RNFL thickness, whereas retinal vascular disease had a diffuse effect on RNFL thickness.

Effects of Measurement Center Shift on Ganglion Cell-inner Plexiform Layer Thickness Measurements.

SIGNIFICANCE: Our authors studied the effects of measurement center shift on ganglion cell-inner plexiform layer (GCIPL) thickness measurements in Cirrus spectral-domain optical coherence tomography (SD-OCT). The measurement center shift affects the GCIPL thickness measurement depending on the distance of shift. PURPOSE: The purpose of this study was to explore changes in macular GCIPL thicknesses measurements after manual shifting of the measurement center using SD-OCT. METHODS: A prospective study was conducted. A total of 30 normal eyes of 30 subjects were included in the study. An experienced examiner obtained two consecutive measurements of GCIPL thickness using SD-OCT. Coefficients of repeatability were calculated for the average, minimum, and sectoral (superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal) thicknesses. Next, the measurement center was manually shifted from the foveal center. Three measurement centers were horizontally placed at 59-µm intervals from the foveal center, and two further centers were placed 176 µm apart. Also, three measurement centers were vertically placed at 47-µm intervals from the foveal center, and two further centers were placed 142 µm apart. The thickness of GCIPL was measured again at each shift point, and the changes of thickness before and after movement were analyzed. RESULTS: When the measurement centers were shifted to positions 59 µm horizontally or 47 µm vertically from the fovea, no significant changes in GCIPL thicknesses were evident. However, upon more pronounced shifting, the average GCIPL thickness of the direction of the shift region was significantly lower than baseline, whereas the GCIPL of the diametrically opposite sector was thicker than baseline. CONCLUSIONS: The impact of changes associated with shifting of the measurement center should be taken into consideration when measuring GCIPL thickness in patients with retinal diseases, glaucoma, or neuro-ophthalmological conditions.

The effect of center point shift on the measurement of macular thickness: a spectral domain-optical coherence tomography study.

PURPOSE: To evaluate the effect of spectral domain-optical coherence tomography (SD-OCT) measurement center shift on the measurement of macular thickness. METHODS: This was a prospective observational case series. A total of 60 normal eyes of 60 subjects included in the study. SD-OCT macular scanning (macular cube 512 × 128 scan) was performed twice by an experienced examiner. The average retinal thicknesses of the nine macular sectors as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) were recorded. Each coefficient of repeatability was calculated for the macular thickness measurements of the ETDRS subfields. Thereafter, the measurement center was manually decentered to a seven scan point, each from the central fovea in steps of 58.7 µm horizontally and 47.2 µm vertically. At each shift point, the change in the macular thickness was compared. RESULTS: When the displacement distance between the measurement center point and the foveal center was within 117.4 µm horizontally and 141.6 µm vertically, the macular thickness measurements did not show any significant differences. However, if the offset of the EDTRS grid center from the anatomic fovea exceeded, we noted that the thickness at the fovea increased and the opposite-direction region at the inner circle was significantly thinner than the displaced point. CONCLUSIONS: The effect of measurement center shift needs to be considered when analyzing the macular thickness measurements in various ophthalmologic diseases.

Tauroursodeoxycholic acid improves viability of artificial RBCs.

Tauroursodeoxycholic acid (TUDCA) is known to prevent apoptosis through the Bax pathway and to promote neovascularization by enhancing the mobilization of stem cells, their differentiation. This study was performed to investigate the effect of TUDCA on erythropoiesis in hematopoietic stem cells (HSCs). Since erythropoiesis of CD34(+) HSCs is divided into four phases, the total cell number, viable cell number, cell viability, cell morphology, and expressed erythroid markers in each phase were examined. The number of viable control cells and their viability did not differ from those of the TUDCA-treated cells in phase I and II. However, TUDCA increased cell viability compared to the control in phases III and IV. Cell distribution differed that the immature erythroid cell number was higher for the TUDCA-treated cells than for the control cells until phase III, but all developed into RBCs in the last. The final RBC number and viability was significantly higher in TUDCA-treated cells compared to the control cells. Taken together, we suggest that TUDCA addition to cell cultures for artificial RBC production could be used as a new protocol for improving the viability of RBCs.

Short-Term Visual Acuity and Intraocular Pressure Changes and Their Correlation after Anti-Vascular Endothelial Growth Factor Injection.

PURPOSE: To assess the effect of intravitreal anti-vascular endothelial growth factor injection on short-term changes in intraocular pressure (IOP) and visual acuity (VA) and the correlation between the two values. METHODS: This study included 25 eyes of 25 patients undergoing intravitreal injection of bevacizumab (IVB) with preinjection uncorrected VA (UCVA) >20/40. IOP and UCVA were measured before injection and 1, 5, 10, 15, 20, 25, and 30 min after injection, using a Tono-Pen (Reichert, Chicago, Ill., USA). The IOP and VA values before and after injection were compared. The correlation between IOP and VA at each time point was analyzed. RESULTS: The preinjection IOP value (17.7 mm Hg) increased sharply to 43.1 mm Hg 1 min after injection, followed by a decrease to 30.4, 24.6, 20.7, 18.7, 18.2, and 17.7 mm Hg at 5, 10, 15, 20, 25, and 30 min, respectively. The preinjection UCVA value (0.21; logMAR) increased to 0.96 one minute after injection, followed by a decrease to 0.61, 0.44, 0.33, 0.27, 0.23, and 0.22 at 5, 10, 15, 20, 25, and 30 min, respectively. Significant differences were evident between the preinjection IOP and VA values and those observed over the 5- to 25-min period after injection (p < 0.05). The correlation between IOP and VA was significant 1, 5, and 10 min after injection [p < 0.001 (1 min), p = 0.033 (5 min), and p = 0.002 (10 min)]. CONCLUSIONS: Differences in all IOP and VA values were significant up to 25 min after IVB, compared with preinjection values; however, no significant difference was found 30 min after injection. Such fluctuations in VA and IOP were positively correlated. The patients' own knowledge of VA fluctuations after injection may provide ophthalmologists with sufficient evidence to make an indirect clinical judgment regarding short-term complications of intravitreal injection.

Effects of Retinal Angiography on Optical Coherence Tomography Measurements.

PURPOSE: To evaluate the effects of retinal angiography, using fluorescein and indocyanine green dyes, on optical coherence tomography (OCT) measurements. METHODS: In total, 76 eyes from 76 consecutive patients were included. Macular cube 512 × 128 combination scanning and optic disc 200 × 200 scanning using spectral-domain (SD)-OCT were performed twice, before and after retinal angiography, with fluorescein or indocyanine green. Signal strength, regional retinal thickness of the 9 Early Treatment Diabetic Retinopathy Study subfields, total macular volume, and retinal nerve fiber layer thickness obtained before and after angiography were compared. Repeatability was also investigated. RESULTS: Comparing the results of OCT measured before and after retinal angiography, there was no statistically significant difference in any parameter assessed. The interclass correlation values for each measurement were all >0.808 (range 0.808-0.999). CONCLUSION: Retinal angiography using fluorescein and indocyanine green dyes has no significant effect on OCT measurements.

Effects of Refractive Power on Macular Thickness Measurement Using Spectral-Domain Optical Coherence Tomography.

PURPOSE: To investigate the effects of refractive power on macular thickness measurements by spectral-domain optical coherence tomography (SD-OCT). SUBJECTS AND METHODS: For this prospective cohort study, a total of 50 eyes from 50 normal subjects with no systemic or ocular disease and no history of ocular surgery were studied from February 2014 to May 2014. We used soft contact lenses with a wide range of diopters to change the refractive power. The macular thickness of uncorrected eyes without contact lenses was measured by SD-OCT, and we compared the findings with the results of subsequent investigations in which macular thickness was measured in the presence of soft contact lenses of different diopters (-8, -4, 0, +4, and +8). We divided the patients into three groups according to the axial length (AL) and analyzed the effect of induced refraction change. The main outcome measure was macular thickness measured by OCT. RESULTS: The average age of the subjects was 28.0 ± 3.4 years (mean ± SD), and included 17 eyes with normal AL, 18 eyes with mid-range AL, and 15 eyes with long AL. The central macular thickness was 254.5 ± 17.5 µm for eyes without contact lenses, which was not significantly different from the measurements in the presence of plano contact lenses (254.2 ± 18.1 µm). Even with soft contact lenses of four different diopters (-8, -4, +4, and +8), central macular thickness (254.4 ± 16.2, 253.7 ± 17.3, 257.3 ± 17.9, and 256.9 ± 17.9 µm, respectively) was not significantly different from that of naked eyes in each group. CONCLUSION: These results suggest that central macular thickness measured by SD-OCT is unaffected by refractive power.

Baseline predictors of visual acuity and retinal thickness in patients with retinal vein occlusion.

This study investigated the baseline predictors of best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6 months in patients with treatment-naïve branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). This multicenter, interventional case series included 208 BRVO and 123 CRVO patients with follow-up period of 6 months or more. Outcome measures of BCVA (logMAR) included absolute change from baseline and a gain or loss of ≥ 0.3 from baseline. Outcome measures of CRT included absolute change from baseline and a measurement of ≤ 250 µm or ≥ 400 µm at 6 months. Univariate and multiple regression analyses were done to find baseline predictors. For BRVO, younger age, worse baseline BCVA, and shorter duration of symptom were associated with more gain in BCVA. For CRVO, worse baseline BCVA was associated with more gain in BCVA. For CRT outcomes, higher baseline CRT predicted greater decrease at 6 months in both BRVO and CRVO. Younger age and better baseline BCVA were associated with an increased likelihood of measurement of a ≤ 250 µm outcome for BRVO and CRVO, respectively. For CRVO, smoking was associated with greater decrease from baseline and decreased likelihood of measurement of a CRT ≥ 400 µm at 6 months. In conclusion, several baseline factors including age, symptom duration, and baseline BCVA and CRT are associated with BCVA and CRT outcomes at 6 months, which may help to predict disease course for RVO patients.

Sectoral retinal nerve fiber layer thinning in branch retinal vein occlusion.

PURPOSE: To analyze longitudinal changes in the retinal nerve fiber layer (RNFL) thickness in branch retinal vein occlusion (BRVO) using optical coherence tomography. METHODS: The authors prospectively analyzed 20 eyes in 20 patients diagnosed with branch retinal vein occlusion (BRVO) and followed for more than 1 year. The RNFL thickness of the normal and occluded eyes was measured at the time of diagnosis and at 1, 3, 6, and 12 months. The authors compared the changes in the occluded eye over the follow-up and the differences between two eyes at each time. They also analyzed the area opposite the occluded area. RESULTS: The thickness of the RNFL in BRVO was significantly reduced at 1, 3, 6, and 12 months (P = 0.005 at 1 month and P = 0.001 at 3, 6, and 12 months) compared with initial thickness. The RNFL thickness at 3 months did not differ significantly between 2 eyes, whereas at 6 months and 12 months, significant (P = 0.032, P = 0.002, respectively.) thinning was observed in the occluded eye. Analysis of the area opposite that of BRVO revealed no significant (P > 0.05) change during the follow-up and no difference between the 2 eyes. CONCLUSION: There was a significant decrease in RNFL thickness over time in BRVO and significant thinning at 6 months compared with the normal eye. Retinal nerve fiber layer thinning needs to be differentiated from glaucoma or systemic disease, but it should be considered the natural course after BRVO.

Clear corneal vitrectomy combined with phacoemulsification and foldable intraocular lens implantation.

BACKGROUND: We have developed a technique for the treatment of cataract and epiretinal membrane using a 25-gauge vitrectomy system through corneal ports. DESIGN: Randomized, prospective study, Toyama Prefectural Central Hospital, Toyama, Japan. PARTICIPANTS: Twenty eyes of equal patients scheduled for cataract surgery combined with vitrectomy. METHODS: Twenty eyes with cataract and epiretinal membrane were received treatment with our newly developed system (clear corneal vitrectomy) or the standard 25-gauge pars plana vitrectomy with corneal incision cataract surgery. The newly developed system uses 0.5-mm wide corneal side ports located at the superonasal, superotemporal and inferotemporal positions. After phacoemulsification using corneal incision, an infusion cannula was inserted from the inferotemporal port. Then core 25-gauge vitrectomy was performed using the corneal three port. After the epiretinal membrane was removed using forceps, an intraocular lens was implanted into the capsular bag. Finally, all corneal incision wounds were hydrated. MAIN OUTCOME MEASUREMENT: Visual acuity, intraocular pressure, corneal thickness, corneal endothelial cell and ocular inflammation were examined. RESULTS: All procedures were uncomplicated in both groups. There was no leakage of aqueous humour from the corneal wounds in the developed system. There were no significant differences in visual acuity, corneal thickness and endothelial cell density loss. CONCLUSIONS: Clear corneal vitrectomy would be a good option for selected cases with cataract and vitreoretinal diseases.