Superficial capillary plexus vessel density/deep capillary plexus vessel density ratio in healthy eyes.

BACKGROUND: To identify factors differently affecting the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in healthy eyes using their vessel density (VD) ratio. METHODS: Healthy eyes were enrolled. The ratio between the VD of SCP and DCP (SVD/DVD ratio) was calculated. Pearson correlation analyses were performed to identify the relationships between this ratio and other factors. RESULTS: The mean SVD and DVD were 36.2 ± 5.7 and 37.7 ± 4.9%, respectively, and the mean SVD/DVD ratio was 0.96 ± 0.15. The SVD was significantly correlated with the best-corrected visual acuity (BCVA) (r = - 0.368, P <  0.001), age (r = - 0.408, P <  0.001), and OCTA quality (r = 0.520, P <  0.001). The DVD was significantly correlated with the BCVA (r = - 0.150, P = 0.008), age (r = - 0.229, P <  0.001), and OCTA quality (r = 0.555, P <  0.001). Among various factors, age (r = - 0.296, P <  0.001), the BCVA (r = - 0.237, P <  0.001), axial length (r = 0.234, P <  0.001), and OCTA quality (r = 0.270, P < 0.001) were significantly correlated with the SVD/DVD ratio. CONCLUSIONS: Age, BCVA, axial length, and OCTA image quality were significantly correlated with the SVD/DVD ratio. Age, the BCVA, and OCTA quality were more strongly correlated with the SCP, and the axial length was more strongly correlated with the DCP.

Prospective trial of treat-and-extend regimen with aflibercept for branch retinal vein occlusion: 1-year results of the PLATON trial.

PURPOSE: To evaluate the functional and anatomical outcomes of a treat-and-extend (TAE) regimen with aflibercept for treatment-naive macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: This was a prospective, multicenter, noncomparative, open-label clinical trial. Forty-eight eyes of 48 patients received three monthly intravitreal aflibercept injections prior to the TAE regimen. However, if the best-corrected visual acuity (BCVA) was ≥ 20/20 and the central macular thickness (CMT) was < 250 µm during the loading phase, the patient immediately proceeded to the TAE regimen. The treatment interval was adjusted by 4 weeks based on changes in CMT. The primary outcome was the mean change in BCVA from baseline to 52 weeks. RESULTS: The mean change in BCVA was 23.6 ± 14.2 letters. The proportion of patients with BCVA gain ≥ 15 letters was 77.1% at 24 weeks and 72.9% at 52 weeks. The mean reduction in CMT was 326.2 ± 235.6 µm at 24 weeks and 324.2 ± 238.0 µm at 52 weeks. The mean number of injections was 6.7 ± 1.2 (range: 6-11, all patients received three monthly intravitreal aflibercept injections) over 52 weeks, and 34 patients (70.8%) reached the maximal extension interval of 16 weeks at 52 weeks. CONCLUSIONS: The TAE regimen using aflibercept for ME secondary to BRVO, which has a treatment interval of up to 16 weeks, showed comparable efficacy to the fixed-dosing regimen along with reduced treatment burden.

REPEATABILITY OF MACULAR MICROVASCULATURE MEASUREMENTS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY ACCORDING TO TEAR BREAKUP TIME IN DRY EYE DISEASE.

PURPOSE: It is hypothesized that an unstable tear film would affect the quality and repeatability of optical coherence tomography angiography (OCTA). Therefore, OCTA repeatability according to tear break-up time (TBUT) was compared. METHODS: The 3 × 3 OCTA was performed twice and, the eyes were divided into 3 groups according to the TBUT (Group 1: TBUT ≤ 5 seconds, 43 eyes; Group 2: 5 seconds < TBUT ≤ 10 seconds, 35 eyes; Group 3: TBUT > 10 seconds, 34 eyes). The intraclass correlation coefficient, coefficient of variation, and test-retest SD were calculated and compared. RESULTS: The signal strengths of OCTA were 9.1 ± 1.2, 9.5 ± 0.8, and 9.5 ± 0.8 in each group from Groups 1, 2, and 3, respectively, which showed significant difference (P = 0.049). The intraclass correlation coefficient of vessel density were 0.733, 0.840, and 0.974 in Groups 1 to 3, respectively, and the values increased in the order of Groups 1, 2, and 3. The coefficient of variation were 6.41 ± 6.09, 3.29 ± 2.22, and 1.30 ± 1.17, and the test-retest SD were 0.83 ± 0.70, 0.47 ± 0.31, and 0.19 ± 0.17 in Groups 1, 2, and 3, respectively. The coefficient of variation and test-retest SD values decreased in the order of Groups 1, 2, and 3, and showed a significant difference (all, P < 0.05). CONCLUSION: The repeatability of OCTA tended to decrease with a shorter TBUT. When the TBUT is <5 seconds, care must be taken to interpret the OCTA results correctly.

Efficacy of Triamcinolone-Soaked Nasal Packing on Endoscopic Dacryocystorhinostomy.

PURPOSE: To evaluate the efficacy of triamcinolone-soaked nasal packing in endoscopic dacryocystorhinostomy (EDCR). METHODS: Patients who underwent EDCR between September 2012 and August 2017 were included. They were assigned to triamcinolone (201 eyes) or control (206 eyes) group based on the order of surgery. Granulation occurrence and outcome were assessed at 3 and 6 months postoperatively, respectively. RESULTS: The success rates were 94.3% (overall anatomical success), 90.4% (complete anatomical success), 92.1% (overall functional success), and 76.7% (complete functional success). The overall functional success rate was significantly higher in the triamcinolone group (95.0% vs. 89.3%, p = 0.033). The overall anatomical success rate (96.0% vs. 92.7%, p = 0.149) and complete functional success rate (79.6% vs. 73.8%, p = 0.166) were also higher in the triamcinolone group, but this difference was not statistically significant. Granulation occurred in 62 eyes (15.2%); the incidence was significantly lower in the triamcinolone group (10.0% vs. 20.4%, p = 0.003). CONCLUSION: The authors suggest that use of triamcinolone-soaked nasal packing in EDCR is effective in significantly reducing the incidence of postoperative granulation and epiphora.

Clinical characteristics and prognosis of Total Rhegmatogenous retinal detachment: a matched case-control study.

BACKGROUND: Although many studies have reported clinical features, surgical outcomes of rhegmatogenous retinal detachment (RRD), studies focusing on total RRD are rare. In this study, we investigate the clinical characteristics, risk factors, and prognosis of total RRD. METHODS: A retrospective chart review was performed on cases of 44 total RRD and an age- and sex-matched 88 partial RRD. Two groups were compared for clinical characteristics, risk factors, and prognosis. RESULTS: The prevalence of total RRD in all cases of retinal detachment was 4.4%. Pseudophakic eye, ocular trauma, and proliferative vitreoretinopathy (PVR) were significantly associated with a risk of total RRD (P = .002, P = .003, and P < .001, respectively). In the total RRD group, retinal breaks were located in both superior and inferior parts of the retina, and macular holes and giant retinal tears were frequently found. The best-corrected visual acuity (log MAR) before surgery and final best-corrected visual acuity after surgery were 2.23 ± 0.45 and 1.88 ± 0.96, which was significantly poorer than in the partial RRD group (P < .001). The success rate after primary surgery was 75.0% in the total RRD group, which was significantly lower than partial RRD group (P < .001). Old age, pseudophakic eye, and macular hole as the type of retinal break were highly associated with low success rate. (P = .010, P = .0500, and P = .002). CONCLUSIONS: Patients with total RRD had higher recurrence rate and poorer visual outcome after surgery than patients with focal RRD. Old age, pseudophakic eye, and presence of macular hole were important risk factors for recurrence after total RRD repair. Additional surgical procedures should be considered to combine with vitrectomy to achieve better surgical outcomes in these patients.

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.

Serous Retinal Detachment Causes a Transient Reduction on Spectral Domain OCT Estimates of Ganglion Cell Layer Thickness.

SIGNIFICANCE: During the acute stage of central serous chorioretinopathy (CSC) with retinal elevation, the spectral domain optical coherence tomography (SD-OCT) estimate of ganglion cell layer complex thickness is reduced. Thickness returns to normal after resolution of the event. Measurement error is at least partially responsible for this effect. The reduction in ganglion cell layer complex thickness does not represent atrophy and is not predictive of a poor outcome. PURPOSE: We investigated the effects of serous retinal detachment on the ganglion cell layer complex analysis (GCA) by SD-OCT in CSC patients during the acute episodes and after resolution of fluid. METHODS: We retrospectively reviewed medical records of 30 patients who visited the hospital with a first episode of CSC. We analyzed GCA maps using SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) at the initial visit with serous retinal elevation and after the absorption of subretinal fluid. For repeatability analysis, we used the intraclass correlation and repeatability coefficient from two consecutive measurements 5 minutes apart in 12 patients. RESULTS: At the initial visit, an average thickness of ganglion cell layer complex was thinner than that measured in the fellow eye (67.4 ± 27.4 µm), but after the absorption of subretinal fluid, it normalized to 87.0 ± 6.7 µm; the difference was statistically significant. The intraclass correlation and repeatability coefficient were low during the period of serous elevation but normalized after fluid resorption. Abnormalities of GCA resulted from the segmentation error of ganglion cell layer and inner plexiform layer during the acute phase of CSC. CONCLUSIONS: Serous retinal detachment can affect the GCA and repeatability measurements of the GCA. Clinicians should consider this finding when using the GCA measurement in the diagnosis and management of the patients with retinal contour changes such as retinal elevation including CSC.

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.

Changes in Central Macular Thickness and Retinal Nerve Fiber Layer Thickness in Eyes with Vogt-Koyanagi-Harada Disease: A 2-Year Follow-Up Study.

PURPOSE: To investigate the central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness in eyes with Vogt-Koyanagi-Harada (VKH) disease associated with optic disc swelling and serous retinal detachment through a 24-month follow-up period. METHODS: We prospectively investigated 28 eyes of 14 treatment-naïve patients with acute VKH disease associated with optic disc swelling and serous retinal detachment and 30 eyes of 15 normal individuals to compare changes in the CMT and average RNFL thickness. RESULTS: The CMT was significantly lower in the eyes of the VKH group at 12 and 24 months. The RNFL thickness was significantly higher in the eyes of the VKH group at the initial visit and at the 6- and 12-month follow-up visits, but no significant difference was found between the VKH group and control group at the 24-month follow-up visit. CONCLUSION: Significant changes in the CMT and RNFL thickness in the eyes with VKH disease were observed during the 24-month follow-up period. When diagnosing or monitoring diseases including glaucoma and neuro-ophthalmic diseases that affect the retinal thickness in patients with VKH disease, we recommend considering longitudinal changes in the retinal thickness.

Repeatability of ganglion cell-inner plexiform layer thickness measurements using spectral-domain OCT in branch retinal vein occlusion.

PURPOSE: To analyze the repeatability of thickness measurements of the central macula, ganglion cell-inner plexiform layer (GC-IPL), and retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) before and after treatment of macular edema in branch retinal vein occlusion (BRVO). METHODS: We analyzed patients with BRVO who visited our retinal clinic. The repeatability of the thickness measurements were compared using the intraclass correlation coefficient (ICC) and coefficient of variation (COV) of affected versus normal fellow eyes. RESULTS: The average thicknesses of the central macula, RNFL, and GC-IPL were 371.28 µm, 105.60 µm, and 61.88 µm, respectively, in affected eyes with macular edema before treatment, and the ICCs were 0.978, 0.919, and 0.705, respectively. The average thicknesses were 244.98 µm, 96.70 µm, and 82.70 µm, respectively, in affected eyes without macular edema after treatment, and the ICCs were 0.999, 0.975, and 0.928, respectively. After resolution of macular edema, the average thickness of the GC-IPL increased, whereas that of the central macula and RNFL significantly decreased (P < 0.05); all of the ICCs increased compared to pretreatment values. In normal fellow eyes, the average thicknesses were 250.98 µm, 93.50 µm, and 83.84 µm, respectively, and the ICCs were 0.996, 0.995, and 0.994, respectively. CONCLUSIONS: After treatment of macular edema, the repeatability and thickness of the GC-IPL increased, along with reduction in the central macular thickness. This resulted from auto-segmentation errors following macular contour changes and unstable gazes of the patients due to decreased visual acuities in BRVO with macular edema.

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.

PREVENTING PUPILLARY CAPTURE AFTER VITRECTOMY AND TRANSSCLERAL FIXATION OF AN INTRAOCULAR LENS: Iridotomy Using a Vitrectomy Probe.

PURPOSE: To investigate the effects of concurrent iridotomy using a vitreous cutter probe on the prevention of pupillary capture in patients undergoing transscleral fixation of intraocular lens implantation. METHODS: A total of 79 eyes from 79 patients, who underwent transscleral fixation of intraocular lens without preexisting vitreoretinal disorders and who were followed up for 6 months were included. Subjects were divided into a noniridotomy group (51 eyes) and an iridotomy group (28 eyes). After conventional 23-gauge vitrectomy and transscleral fixation of intraocular lens implantation in all patients, 28 patients underwent concurrent iridotomy intraoperatively. The patients were followed up to evaluate the incidence of surgery-related complications, including pupillary capture. RESULTS: There were no statistically significant differences in the preoperative demographic findings between the two groups (all P > 0.05). There was a significant difference in pupillary capture in 15 eyes (29.4%) of the noniridotomy group, compared with 1 eye (3.6%) of the iridotomy group (P = 0.007). There were no differences in postoperative best-corrected visual acuity between the two groups, and no iridotomy-related complications were observed. CONCLUSION: Concurrent iridotomy using a vitreous cutter probe is an easy, rapid, and effective procedure to prevent possible pupillary capture after combined vitrectomy and transscleral fixation of intraocular lens implantation.

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.