RISK FACTORS FOR PUPILLARY OPTIC CAPTURE FOLLOWING SUTURELESS FLANGED INTRAOCULAR LENS FIXATION FOR INTRAOCULAR LENS DISLOCATION.

PURPOSE: To identify risk factors for pupillary optic capture after sutureless flanged intraocular lens (IOL) fixation for IOL dislocation. METHODS: This retrospective comparative study enrolled consecutive patients who underwent flanged IOL fixation using 25-gauge pars plana vitrectomy. One hundred twenty-six eyes (126 patients) were divided into two groups according to the presence or absence of pupillary optic capture. A swept-source anterior segment optical coherence tomography and a rotating Scheimpflug camera were used to analyze and compare surgical parameters, including axial length, anterior chamber depth, differences in scleral tunnel angle and length, and IOL tilt and decentration, between the two groups. RESULTS: Compared with the nonpupillary optic capture group (106 eyes, 84.1%), the pupillary optic capture group (20 eyes, 15.9%) had larger differences in the nasal and temporal scleral tunnel angles and larger horizontal tilt (P < 0.05). Multivariate regression analysis demonstrated that these factors correlated with the occurrence of pupillary optic capture (P < 0.05). CONCLUSION: To prevent pupillary optic capture after flanged IOL fixation, surgeons should avoid asymmetry in the angles of the nasal and temporal scleral tunnels, which causes horizontal IOL tilt and subsequent pupillary capture.

COMPARISON OF SURGEON MUSCULAR PROPERTIES BETWEEN STANDARD OPERATING MICROSCOPE AND DIGITALLY ASSISTED VITREORETINAL SURGERY SYSTEMS.

PURPOSE: To quantitatively analyze surgical ergonomics between standard operating microscope (SOM) and digitally assisted vitreoretinal surgery (DAVS) systems. METHODS: The surgeon conducted procedures on 110 patients; 52 patients underwent a combined phacoemulsification and pars plana vitrectomy (Phaco-PPV group, 24 using SOM and 28 using DAVS), and 58 patients underwent phacoemulsification (Phaco group, 30 using SOM and 28 using DAVS). The surgeon's muscle tone and stiffness in the sternocleidomastoid and the two positions of the upper trapezius (UT), which are 2-cm intervals along the UT muscle fibers, UT1 and UT2, were measured at preoperative, intraoperative, and postoperative time points. RESULTS: In the Phaco-PPV group using the SOM, intraoperative muscle tone and stiffness were higher than preoperative and postoperative values in the sternocleidomastoid ( P < 0.001, respectively), UT1 ( P < 0.001, respectively), and UT2 ( P < 0.001 and P < 0.01, respectively). In the Phaco group using the SOM, intraoperative muscle tone and stiffness were higher than pre- and postoperative values in the sternocleidomastoid ( P < 0.001, respectively) and UT1 ( P < 0.001 and P < 0.01, respectively). By contrast, when the surgeon used the DAVS, there were no differences in muscle properties at any measurement site or during any time point in the Phaco-PPV and Phaco groups ( P > 0.05). CONCLUSION: This study provides quantitative measurement of retina surgeon ergonomics, suggesting that compared with a SOM, the DAVS can reduce intraoperative muscle fatigue.

Long-term surgical outcomes of Ahmed valve implantation in refractory glaucoma according to the type of glaucoma.

BACKGROUND: We evaluated the long-term efficacy and surgical outcomes of Ahmed glaucoma valve (AGV) implantation in patients with refractory glaucoma by glaucoma type. METHODS: In total, 135 eyes of 135 patients diagnosed with refractory glaucoma and underwent AGV implantation between 2002 and 2018 were reviewed retrospectively. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of antiglaucoma medications were investigated at baseline and follow-up. The cumulative probability of qualified success according to the glaucoma type was evaluated at 12, 24, 36, and 60 months postoperatively. RESULTS: The mean IOP of all patients was 35.7 ± 11.7 mmHg, which was significantly reduced 12.7 ± 7.0 mmHg at 1 week, 16.2 ± 7.5 mmHg at 2 weeks, 17.6 ± 6.8 mmHg at 1 month, 17.5 ± 6.4 mmHg at 3 months, 16.1 ± 6.0 mmHg at 6 months, 16.7 ± 8.0 mmHg at 12 months, 16.4 ± 6.6 mmHg at 24 months, 15.6 ± 5.0 mmHg at 36 months, and 15.6 ± 5.6 mmHg at 60 months after surgery (p < 0.001, respectively). The mean number of antiglaucoma medications was 3.7 ± 1.3, which significantly decreased to 0.4 ± 0.9 at 1 week, 0.3 ± 0.8 at 2 weeks, 0.7 ± 0.9 at 1 month, 1.1 ± 1.1 at 3 months, 1.4 ± 1.0 at 6 months, 1.5 ± 1.1 at 12 months, 1.6 ± 1.2 at 24 months, 1.7 ± 1.2 at 36 months, and 1.8 ± 1.3 at 60 months after surgery (p < 0.001, respectively). The mean BCVA significantly improved from postoperative 2 weeks. Although 71 (52.6%) eyes had postoperative complications, the cumulative probability of surgical success was 72.6% at 12 months, 66.7% at 24 months, and 63.7% at 36 and 60 months. According to the glaucoma type, the success rate of AGV implantation was more than 50% even after 60 months follow-up, except subgroup of neovascular glaucoma (NVG) due to retinal vein occlusion (RVO). CONCLUSIONS: AGV implantation in patients with refractory glaucoma was, after long-term follow-up, successful overall. Therefore, AGV implantation can be an effective surgical option to reduce the IOP and number of antiglaucoma medications and to improve visual acuity for various glaucoma types.

ASSESSMENT OF HYPERREFLECTIVE FOCI AFTER BEVACIZUMAB OR DEXAMETHASONE TREATMENT ACCORDING TO DURATION OF MACULAR EDEMA IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To evaluate the association between hyperreflective foci (HRF) on spectral domain optical coherence tomography and therapeutic effect of intravitreal bevacizumab (IVB) or intravitreal dexamethasone implants (IVD) according to macular edema (ME) duration in branch retinal vein occlusion. METHODS: Consecutive treatment-naive patients received IVB or IVD for at least 6 months. Each group was subdivided according to ME duration (<3 months vs. ≥3 months). Hyperreflective foci and best-corrected visual acuity were compared. RESULTS: Of 139 eyes (139 patients), 69 received IVB and 70 received IVD. At baseline, eyes with ME ≥ 3 months had more outer and total retinal HRF than eyes with ME < 3 months (P < 0.001 and P = 0.001). At 6 months, the IVD group exhibited a greater reduction in outer retinal HRF than the IVB group in both ME duration subgroups (P = 0.015 and P < 0.001). In the ME ≥ 3 months group, IVD resulted in greater best-corrected visual acuity improvement than IVB (P = 0.017). CONCLUSION: Increased outer retinal HRF at baseline in eyes with ME ≥ 3 months together with a greater reduction in HRF at 6 months and better visual outcomes after IVD suggests that the inflammatory aspect of disease should be considered in the treatment of ME. Thus, IVD injection could be more appropriate for patients with a longer ME duration after branch retinal vein occlusion.

Title: efficacy of intravitreal dexamethasone implant on hard exudate in diabetic macular edema.

BACKGROUND: To investigate the effect of intravitreal dexamethasone implant (DEX implant) on hard exudate (HE) accompanying diabetic macular edema (DME). METHODS: This study was a non-comparative non-randomized 1-year prospective interventional study. Patients with DME and HE were treated using DEX implant two or three times. Color fundus photography and optical coherence tomography (OCT) were performed at every visit. HE area was measured semi-automatically from the fundus photographs. RESULTS: Thirty-five patients completed the study. Eleven patients (31.4%) received two injections, while the remaining received three times. HE area (primary outcome) significantly decreased from 1.404±2.094 mm2 (baseline) to 0.212±0.592 mm2 (last visit), which was 24% of the baseline HE area (P<0.001). HE1500 (HE within 1500 µm from the fovea) area also decreased significantly from 0.382±0.467 mm2 to 0.066±0.126 mm2 (P<0.001). Furthermore, anaverage best corrected visual acuity (BCVA) improvement of 4.4 Early Treatment Diabetic Retinopathy Study (ETDRS) letters was observed (from 49.9±18.3 to 54.3±20.4 letters) (P= 0.008). Central macular thickness (CMT) decreased from 455.8±23.6 µm to 366.8±31.1 µm (P=0.009). Repetitive measurements for entire study duration was analyzed using generalized estimating equations (GEE), where BCVA was related to age, CMT, and HE1500 area in multivariate analyses. CONCLUSION: DEX implant could reduce and suppress HE in DME for one year with two or three injections. And centrally located HE area (HE1500 area) is related to vision. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02399657 , Registered 26 March 2015.

A 1-Year Prospective Comparative Study of Sutureless Flanged Intraocular Lens Fixation and Conventional Sutured Scleral Fixation in Intraocular Lens Dislocation.

PURPOSE: To compare surgical outcomes of sutureless flanged intraocular lens (IOL) fixation and conventional sutured scleral fixation (SF) for secondary IOL implantation in patients with IOL dislocation. METHODS: This is a prospective, comparative cohort study on 103 consecutive patients (103 eyes) with IOL dislocation who underwent vitrectomy with IOL removal and sutured SF (53 eyes) or flanged IOL fixation (50 eyes). Operating time, best-corrected visual acuity (BCVA), refractive difference, IOL tilt and decentration using swept-source anterior segment OCT, and postoperative complications were measured for 12 months. RESULTS: Operating time was significantly shorter for the flanged IOL fixation than for sutured SF (19.4 ± 4.6 vs. 48.9 ± 5.2 min, p < 0.001). BCVA in both groups improved at 1, 3, 6, and 12 months postoperatively (p < 0.05). BCVA in the 2 groups was similar during the 12 months of observation. The refractive difference, IOL tilt, IOL decentration, and incidence of postoperative complications were also not different in the 2 groups. CONCLUSION: Sutured SF and flanged IOL fixation had similar visual outcomes and IOL stability in patients with IOL dislocation. However, the operating time for flanged IOL fixation was less than half that of the sutured SF. This technique is an efficient alternative for treating IOL dislocation.

Correlation between macular edema recurrence and macular capillary network destruction in branch retinal vein occlusion.

BACKGROUND: The aim of this study was to evaluate the correlation between changes in the macular capillary network and macular edema (ME) recurrence with branch retinal vein occlusion (BRVO) using swept-source optical coherence tomography angiography (SS-OCTA). METHODS: We reviewed the data for 43 patients with treatment-naïve ME associated with BRVO. Patients who received intravitreal bevacizumab injection were divided into two groups based on ME recurrence at 6 months after edema resolution. The perifoveal capillary morphology and the macular capillary vessel density (VD) were retrospectively analyzed using en face SS-OCTA after ME resolution. RESULTS: The perifoveal capillary ring loss in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was more common in the ME recurrence group (n = 22) than in the no ME recurrence group (p = 0.047 and p = 0.002). Relative to the findings in the no ME recurrence groups, the destruction of the perifoveal capillary ring was more severe in the DCP (30.0° vs 87.3°, p = 0.001) than in the SCP (17.3° vs 69.5°, p = 0.006) in the ME recurrence group. The hemi-VD disparity between the affected and the unaffected areas in the SCP and DCP showed significant differences (p = 0.031 and p = 0.017), while macular VD showed no differences between the groups. CONCLUSIONS: Destruction of the perifoveal capillary ring and hemi-VD disparity could be related to ME recurrence in BRVO. Therefore, these factors may be helpful in predicting ME recurrence.

One-Year Results of Treatment of Diabetic Macular Edema with Aflibercept Using the Treat-and-Extend Dosing Regimen: the VIBIM Study.

INTRODUCTION: The purpose of this study was to report the one-year results of treatment of diabetic macular edema (DME) with aflibercept using a treat-and-extend regimen (TER). METHODS: This was a prospective, multicenter, single-arm study planned for 2 years. The eyes received 5 consecutive intravitreal injections of 2 mg of aflibercept every 4 weeks, and the interval between injections was then adjusted by 2 weeks based on changes in the central subfield macular thickness (CSMT). If the CSMT was worse, stable, or better, the interval was shortened, extended, or maintained, respectively. The primary outcome measure was the change in best-corrected visual acuity (BCVA) from baseline to 104 weeks, and the secondary outcome was the change in BCVA from baseline to 52 weeks. RESULTS: Of the 48 patients enrolled, 46 completed a 1-year visit. BCVA improved significantly by 9.1 letters (95% confidence interval: 5.3-13.0 letters) from 56.2 letters at baseline (p < 0.001), and CSMT decreased by -171.7 µm from 489.4 to 317.7 µm (p < 0.001). The proportion of eyes having 20/40 or better vision increased from 17.4 to 41.3%, and the proportion of eyes that gained ≥15 letters was 28.3%. The mean number of injections was 8.5 times for 52 weeks. Worsening of macular edema did not occur in 76.1% of eyes during the extension period, and the interval between injections was extended to 12 weeks in 73.9% of eyes at 52 weeks. CONCLUSIONS: The TER showed 1-year efficacy comparable to that of the fixed dosing regimen of pivotal trials, and its flexible dosing would prevent overtreatment.

Characteristics of Ocular Manifestations of Patients with Coronavirus Disease 2019 in Daegu Province, Korea.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has reportedly affected almost 23 million people, with more than 800 thousand deaths globally. There have been a few reports on the ocular manifestations of COVID-19 patients in China but no reports in Korea. The present study aimed to examine ocular manifestations of COVID-19 patients in Korea. METHODS: COVID-19 patients admitted from March 2020 to April 2020 at Keimyung University Dongsan Hospital and Keimyung University Daegu Dongsan Hospital were reviewed retrospectively for ocular manifestations. During the period of hospitalization, ocular symptoms as well as blood test results were noted and analyzed. Patients were then divided into the first-episode and relapsed group and ocular symptoms were analyzed in the groups. RESULTS: A total of 103 patients were included in this study. Among them, 71patients were in the first-episode group and 32 patients in the relapsed group. No significant differences were determined in terms of positivity of ocular symptoms between the first-episode group (12 patients, 16.9%) and the relapsed group (10 patients, 31.3%, P > 0.05). Symptoms of positive upper respiratory infection and lower creatine phosphokinase were determined to be related to positive ocular symptoms. Conjunctival congestion was noted in seven patients. In the subgroup analysis, the conjunctival congestion-positive patients exhibited higher positivity of upper respiratory infection symptoms (100%) as compared with those in the negative group (40%, P = 0.017). CONCLUSION: Positive upper respiratory infection symptoms and lower creatine phosphokinase were determined to be related to ocular symptoms in COVID-19 patients. Among these patients, positive upper respiratory infection symptoms were associated with conjunctival congestion.

Angiographic features of drug-induced bilateral angle closure and transient myopia with Ciliochoroidal effusion.

BACKGROUND: To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. METHODS: This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM). RESULTS: Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from - 0.5 to - 17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels). CONCLUSIONS: The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.

ANGIOPOIETIN-LIKE 4 CORRELATES WITH RESPONSE TO INTRAVITREAL RANIBIZUMAB INJECTIONS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To investigate whether the aqueous angiopoietin-like 4 (ANGPTL4) level correlates with clinical features in neovascular age-related macular degeneration (AMD). METHODS: The control and study groups consisted of all consecutive patients who received senile cataract surgery or intravitreal ranibizumab injection for treatment-naïve neovascular AMD, respectively. The AMD group received 3 monthly ranibizumab injections followed by monthly pro re nata for at least 12 months. Aqueous ANGPTL4 and vascular endothelial growth factor (VEGF) were measured at baseline and 4 weeks after the first injection. In the AMD group, best-corrected visual acuity, lesion area by fluorescein angiography, and central subfield thickness were measured at baseline and at 12 months. RESULTS: The AMD group (30 eyes) had higher baseline aqueous ANGPTL4 and VEGF levels than those of the control group (32 eyes) (both P < 0.001). Four weeks after the first injection, VEGF in the patients with AMD had dropped significantly (P < 0.001). Baseline ANGPTL4 correlated with the lesion area at baseline and at 12 months (P < 0.05, respectively), and also correlated with the frequency of anti-VEGF injections during 12 months (P = 0.008). CONCLUSION: Aqueous ANGPTL4 levels correlated with the lesion area and anti-VEGF treatment frequency. Angiopoietin-like 4 may be a potential diagnostic and/or therapeutic biomarker in the neovascular AMD.

Efficacy of fixed-dosing aflibercept for treating polypoidal choroidal vasculopathy: 1-year results of the VAULT study.

PURPOSE: To investigate fixed-dosing aflibercept for treating polypoidal choroidal vasculopathy (PCV). METHODS: This phase IV, prospective, single-arm, interventional case series was conducted in eight centers. Forty treatment-naïve PCV patients were administered three monthly doses of intravitreal aflibercept (2.0 mg) and an injection every 2 months thereafter. Best-corrected visual acuity (BCVA) and central subfield macular thickness (CSMT) were measured at each visit. Fluorescein and indocyanine green angiography (ICGA) were performed at baseline, 3 and 12 months. The primary outcome measure was the proportion of patients who maintained BCVA (<15 letters loss) at 12 months. Changes in BCVA, macular appearance, and polypoidal lesion appearance were also examined. RESULTS: Thirty-five eyes (87.5 %) had maintained BCVA at 12 months. Average BCVA was significantly higher at 12 months (20/53, 64.2 letters) than at baseline (20/80, 55.1 letters, 9-letter gain; P < .001). Mean CSMT was significantly lower at 12 months (253.6 µm) than at baseline (365.2 µm, P < .001). The macula was dry in 32 (76.2 %), 27 (64.3 %), and 24 eyes (60.0 %) at 3, 6, and 12 months respectively. Fourteen eyes (33.3 %) had a fluid recurrence or increase at 6 months, and they had a significantly lower vision gain (P = .005) than other patients at 12 months. Complete polyp regression occurred in 26 eyes (66.7 %) at 12 months. CONCLUSIONS: Fixed-dosing aflibercept showed favorable outcomes in PCV patients at 12 months. However, some patients had worse outcomes because of fluid recurrence during maintenance dosing, and these patients would require additional treatments.

Structural Changes of the Macula on Optical Coherence Tomography after Vitrectomy for Proliferative Diabetic Retinopathy.

PURPOSE: This study aimed to evaluate the relationship between macular structural changes and visual prognosis after pars plana vitrectomy (PPV) for proliferative diabetic retinopathy. METHODS: The study included 60 eyes that had undergone PPV. Macular optical coherence tomography (OCT) findings were classified into 5 groups preoperatively and 10 groups postoperatively. Best-corrected visual acuity (BCVA) were analyzed according to pre- and postoperative OCT. RESULTS: From the preoperative OCT, normal fovea with/without traction, normal fovea with preretinal hemorrhage, and tractional retinal detachment involving fovea showed an increase in BCVA after PPV (all p < 0.05). Normal fovea, epiretinal membrane and macular thickening were common after surgery. Normal fovea, epiretinal membrane and edema outside of the fovea showed good visual prognosis (BCVA >20/50). Subfoveal fibrosis, macular hole, loss of foveal depression, and serous foveal detachment showed poor visual prognosis (BCVA <20/100). CONCLUSION: Macular structural changes were various after PPV, and visual prognosis correlated with these changes.

Spectral-domain optical coherence tomography findings of tractional retinal elevation in patients with diabetic retinopathy.

PURPOSE: To evaluate the clinical and morphological characteristics as well as the surgical outcomes of tractional retinal elevation (TRE) in patients with proliferative diabetic retinopathy (PDR) by analyzing spectral-domain optical coherence tomography (SD-OCT). METHODS: SD-OCT images of 26 eyes (24 patients) who visited our clinic because of TRE and PDR from August 2011 to August 2014 were reviewed. According to the presence or absence of tractional retinal detachment (TRD), patients were classified into group 1 (without TRD) or group 2 (with TRD), and the clinical characteristics and surgical outcomes of the two groups were compared. Furthermore, we categorized the SD-OCT morphological components into sponge, cystoid, saw tooth, bridging columnar, and TRD and compared the characteristics among patients who had different components. RESULTS: Group 1 had 18 eyes and group 2 had eight eyes. No differences in age, best corrected visual acuity (BCVA), or spherical equivalent were observed between the two groups, but group 2 had longer axial length than that of group 1 (p = 0.02). A large variety of combined OCT findings was found in group 1 compared to that in group 2. TRD was the least combined form with the other morphological components. Although 92 % of eyes with the bridging columnar component had the cystoid component, TRD and tractional retinoschisis (TRS, bridging columnar morphology) were combined in only one eye. CONCLUSION: Diabetic TRE may progress to TRD or TRS, which are mutually exclusive. They may progress to TRD in eyes with a long axial length, and cystoid macular edema seems to develop into TRS.

Recurrence of macular edema in eyes with branch retinal vein occlusion changes the diameter of unaffected retinal vessels.

PURPOSE: To measure unaffected retinal vessel diameter in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) after intravitreal injection with bevacizumab (IVB). METHODS: Patients with BRVO-induced ME who responded to IVB were assessed at baseline and 1, 3, and 6 months. In both eyes, the diameters of the largest arteriole and venule in all quadrants (except occlusion quadrant) were measured by using a computer-assisted method. The same vessels chosen at baseline were measured at each follow-up examination. RESULTS: Forty-two eyes were participated. At baseline, venular diameters of unaffected quadrants in eyes with BRVO were larger than the venules in the corresponding quadrant of the fellow eyes (p < 0.05, respectively). The venular diameters in all quadrants of the affected eyes decreased significantly relative to baseline after IVB (p < 0.05 respectively). Twenty-two eyes (52.4 %) developed recurrent ME. On recurrence at 3 (n = 15, 35.7 %) or 6 months (n = 7, 16.7 %), the unaffected venular diameters increased significantly (p < 0.05 respectively). These diameters again decreased significantly after a second IVB (p < 0.05 respectively). CONCLUSION: Unaffected retinal venular diameters associate with the course of BRVO with ME. This may help elucidate the pathological mechanism underlying BRVO.

VARIATION OF 24-HOUR INTRAOCULAR PRESSURE IN SILICONE OIL-FILLED EYES.

PURPOSE: To evaluate the variation of 24-hour intraocular pressure (IOP) in silicone oil (SO)-filled eyes. METHODS: Prospective, nonrandomized comparative case series of 42 eyes of 21 patients, each with an SO-filled eye after vitrectomy. The fellow eyes served as controls. Each subject slept the usual 8 hours, and IOPs were measured at 4-hour intervals over 24 hours, twice before sleep (5:30 and 9:30 PM), twice during sleep (1:30 and 5:30 AM), and twice after sleep (9.30 AM and 1:30 PM). Intraocular pressure was measured in the sitting position using a Goldmann applanation tonometer. The SO-filled eyes and fellow eyes were compared with respect to diurnal-to-nocturnal and nocturnal-to-diurnal IOP changes. RESULTS: At all 6 time points, SO-filled eyes had higher mean IOPs than fellow eyes (all P < 0.05). For both groups, mean nocturnal IOP was higher than mean diurnal IOP (both P < 0.001). Changes in diurnal-to-nocturnal IOP and nocturnal-to-diurnal IOP between SO-filled eyes and fellow eyes did not differ significantly (P > 0.05, respectively). The peak IOP occurred in the nocturnal period for all fellow eyes and for 94.7% of SO-filled eyes. CONCLUSION: The IOP of SO-filled eyes varied over a 24-hour period, peaking largely in the nocturnal period, as observed for the IOP of fellow eyes.

Does Intravitreal Dexamethasone Implant Fragmentation Affect Clinical Outcomes in Macular Edema from Branch Retinal Vein Occlusion?

PURPOSE: The aim of this study was to evaluate the effect of intravitreal dexamethasone implant fragmentation on clinical outcomes in branch retinal vein occlusion (BRVO)-induced macular edema (ME). METHODS: All consecutive patients receiving an intravitreal dexamethasone implant for BRVO-induced ME were divided into two groups depending on whether the implant was intact or had fragmented into two or more pieces on postoperative day 1. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central subfield thickness (CST) on spectral-domain optical coherence tomography were measured for 6 months. RESULTS: Among 68 patients, the implant was fragmented in 6 (8.8%) and intact in 62 (91.2%) eyes. The two groups did not differ in BCVA and CST at any time point (all p > 0.05). There was no difference in the ME recurrence rate, frequency of IOP elevation, and cataract progression between the two groups (all p > 0.05). CONCLUSION: Fragmentation seemed not to influence clinical outcomes of intravitreal dexamethasone implantation during 6 months or to alter the frequency of adverse events.

Aqueous Levels of Angiopoietin-like 4 and Semaphorin 3E Correlate with Nonperfusion Area and Macular Volume in Diabetic Retinopathy.

OBJECTIVE: To investigate the aqueous levels of angiopoietin-like 4 (ANGPTL4), semaphorin 3E (Sema3E), and vascular endothelial growth factor (VEGF) in patients with diabetic retinopathy and to ascertain their association with diabetic retinopathy phenotypes. DESIGN: Prospective, nonrandomized, comparative case series. PARTICIPANTS: Of all 104 consecutive patients (104 eyes) who had intravitreal anti-VEGF injections from April 2012 through April 2013 for diabetic macular edema (DME), 51 had severe nonproliferative diabetic retinopathy (NPDR) and 53 had proliferative diabetic retinopathy (PDR). The controls were 54 consecutive nondiabetic patients who had undergone cataract surgery (54 eyes) during the same period. METHODS: The ANGPTL4, Sema3E, and VEGF levels in aqueous humor samples obtained before intravitreal injections were measured by enzyme-linked immunosorbent assay. Capillary nonperfusion area (NPA) was calculated from encircled angiography using the 7 standard field images described in the Early Treatment Diabetic Retinopathy Study protocol. Total macular volume (TMV) was measured by spectral-domain optical coherence tomography. MAIN OUTCOME MEASURES: Aqueous ANGPTL4, Sema3E, and VEGF levels in severe NPDR, PDR, and control groups and their correlations with each other, NPA, and TMV. RESULTS: The severe NPDR and PDR groups had higher aqueous levels of ANGPTL4 and VEGF than the control group (all P < 0.001). The PDR group had higher ANGPTL4 and VEGF levels than the severe NPDR group (both P < 0.001). The aqueous ANGPTL4 levels of all diabetic retinopathy patients correlated positively with NPA (r = 0.820, P = 0.003) and TMV (r = 0.824, P < 0.001). The control group had higher aqueous Sema3E levels than the NPDR and PDR groups (both P < 0.001). Aqueous Sema3E levels correlated negatively with VEGF levels in all subjects (r = -0.57, P = 0.025). CONCLUSIONS: The ANGPTL4 may be a candidate target in DME treatment and a biomarker of ischemic-induced retinopathy, including diabetic retinopathy.

Age-related macular degeneration: prevalence and risk factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011.

OBJECTIVE: To investigate the prevalence and risk factors of age-related macular degeneration (AMD) in the Korean population. DESIGN: A cross-sectional study using a complex, stratified, multistage, probability-cluster survey, which can produce nationally representative estimates. PARTICIPANTS: Using the database of Korean National Health and Nutrition Examination Survey from 2008 through 2011, 14 352 participants 40 years of age or older with gradable fundus photographs were included. METHODS: Age-related macular degeneration was determined by fundus photograph. Prevalences of AMDs were estimated. Risk factor analyses were conducted using logistic regression analyses (LRAs). MAIN OUTCOME MEASURES: Prevalence and risk factors of AMD. RESULTS: The prevalence of AMD was 6.62% (95% confidence interval [CI], 6.15%-7.09%) in the Korean population: 6.02% (95% CI, 5.56%-6.48%) were early AMD and 0.60% (95% CI, 0.45%-0.75%) were late AMD. The prevalence of early AMD in women (6.73%; 95% CI, 6.11%-7.35%) was higher than that in men (5.25%; 95% CI, 4.61%-5.89%; P<0.001), and the prevalence of late AMD in women (0.37%; 95% CI, 0.22%-0.52%) was lower than that in men (0.85%; 95% CI, 0.59%-1.12%; P<0.001). However, in multiple LRAs both early and late AMD had no association with gender, house income, residence, sun exposure, or systemic comorbidities, including hypertension, diabetes mellitus, and cardiovascular diseases. Early AMD had positive associations with older age groups (P<0.001), lower education (P = 0.027), occupation (P<0.001), anemia (P = 0.027), hepatitis B surface antigen carrier status (P<0.001), not being overweight (body mass index [BMI], P = 0.032; waist circumference, P = 0.041, in separate analyses), and higher serum high-density lipoprotein (HDL) level (P = 0.046), but not with smoking status. Late AMD had positive associations with age groups (P<0.001), current smokers (P = 0.022), and lower BMI (P = 0.037). CONCLUSIONS: The results suggest that there are 1.21 million individuals with early AMD and 121 000 individuals with late AMD in Korea. Nonoverweight status and higher HDL levels, generally assumed as positive health indicators, as well as anemia and hepatitis B infection had harmful associations with AMD in our study, implying a possible different pathophysiologic process of AMD in Asians compared with that of white persons.