OUTCOME OF INTRAVITREAL AFLIBERCEPT FOR REFRACTORY PIGMENT EPITHELIAL DETACHMENT WITH OR WITHOUT SUBRETINAL FLUID AND SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To investigate the outcomes of intravitreal aflibercept in refractory pigment epithelial detachment (PED) with or without subretinal fluid (SRF) in patients with neovascular age-related macular degeneration. METHODS: A prospective, nonrandomized, interventional case series involved 40 patients with persistent vascularized PED previously treated with at least 3 injections of intravitreal bevacizumab or ranibizumab. Intravitreal aflibercept was administered as 3 initial loading doses every 4 weeks, followed by pro re nata retreatment every 8 weeks over 48 weeks. Pigment epithelial detachment was classified into solid-, hollow-, or mixed-type according to the reflective properties visualized using optical coherence tomography. The mean changes in best-corrected visual acuity, central subfield thickness, and the volumes of SRF and PED were analyzed. RESULTS: The PED volume (baseline: 0.43 ± 0.55 mm) significantly reduced to 0.23 ± 0.32 mm at Week 8 (P = 0.003) and increased to 0.36 ± 0.41 mm at Week 48 (P = 0.345). The SRF volume (baseline: 0.52 ± 0.64 mm) significantly reduced to 0.24 ± 0.43 mm at Week 48 (P = 0.021). The mean baseline best-corrected visual acuity was 20/75 (47.5 letters); it showed no significant difference at Week 48 (+4.4 letters; P = 0.125). The baseline central subfield thickness was 323.2 ± 92.3 µm; it significantly reduced to 281.2 ± 90.7 µm at Week 48 (P = 0.001). In solid-type PEDs, there were poorer improvements in central subfield thickness, best-corrected visual acuity, and the volumes of the SRF and PED, with newly developed intraretinal cysts. CONCLUSION: Intravitreal aflibercept in treatment-resistant neovascular age-related macular degeneration led to significant reduction in PED and SRF volume, central subfield thickness, and best-corrected visual acuity preserved, over 12 months. However, solid-type PED showed less improvement than hollow- or mixed-type PED.

CORRELATION BETWEEN PREOPERATIVE EN FACE OPTICAL COHERENCE TOMOGRAPHY OF PHOTORECEPTOR LAYER AND VISUAL PROGNOSIS AFTER MACULAR HOLE SURGERY.

PURPOSE: To investigate the correlation between preoperative en face spectral domain optical coherence tomography findings of the photoreceptor layer with restoration of foveal microstructure and visual acuity in repaired macular holes. METHODS: Medical records of 106 patients with surgically closed macular holes were retrospectively reviewed. Preoperative OCT slabs of the external limiting membrane (ELM) and ellipsoid zone (EZ) were generated using embedded tools. All patients were classified into two groups according to the presence of preoperative retinal pigment epithelium protrusion seen as hyperreflective spots in EZ slab. Visual acuity, homogenous reflectivity, and glial proliferation in the ELM and EZ slabs were followed for 12 months. RESULTS: Baseline hyperreflective spots in the EZ slab was observed in 51 (48.1%) eyes. Postoperative homogenous reflectivity and glial proliferation were related to the presence of baseline hyperreflective spots. Vision improvement was significantly greater in the absence of hyperreflective spots group from 9 months after the operation. In logistic regression analysis, the area of hyperreflective spots was significantly associated with foveal homogenous reflectivity at 12 months (P = 0.004). CONCLUSION: Preoperative hyperreflective spots in en face EZ slab might be indicative of functional and anatomical restoration after macular hole surgery.

AGE-RELATED CLINICAL OUTCOME AFTER MACULAR HOLE SURGERY.

PURPOSE: To evaluate functional and anatomical retinal recovery according to patient age using spectral domain optical coherence tomography in eyes with surgically closed macular holes. METHODS: We retrospectively studied 83 eyes with anatomically closed idiopathic macular holes after surgery confirmed by spectral domain optical coherence tomography. Patients were divided into four subgroups based on age (Group 1: ≤ 60, Group 2: 61-65, Group 3: 66-70, Group 4: > 70). Best-corrected visual acuity and reconstruction of the external limiting membrane and ellipsoid zone after surgery were documented for 12 months. RESULTS: Mean patient age was 64.5 ± 9.8 years (range 44-81). Mean visual improvement in logMAR units (ETDRS letter score) at 12 months was worse in older age subgroups (Group 1: 0.4 ± 0.3 [20], Group 2: 0.4 ± 0.3 [20], Group 3: 0.2 ± 0.3 [10], Group 4: 0.1 ± 0.3 [5], P = 0.001). When age was more than 65 years, total number of eyes with restored retinal microstructure after surgery was lower (22 eyes, 53.7%; 32 eyes, 76.2%; P = 0.018) and time (months) to structural recovery was longer (10.2, 7.1, P < 0.001) than age under 65 years. Visual improvement corresponded to recovery of the outer retinal layers. In multivariate analysis, patients of older age (odds ratio, 0.91; 95% CI, 0.89-0.93) had less visual improvement at month 12. CONCLUSION: Poor visual outcomes and delayed microstructural recovery occurred in older subjects after anatomically closed macular hole surgery. Older age may be indicative of poor clinical outcome in repaired macular holes.

Morphologic changes in the retina after selective retina therapy.

PURPOSE: To investigate structural changes in the retina by histologic evaluation and in vivo spectral domain optical coherence tomography (SD-OCT) following selective retina therapy (SRT) controlled by optical feedback techniques (OFT). METHODS: SRT was applied to 12 eyes of Dutch Belted rabbits. Retinal changes were assessed based on fundus photography, fluorescein angiography (FAG), SD-OCT, light microscopy, transmission electron microscopy (TEM), and scanning electron microscopy (SEM) at each of the following time points: 1 h, and 1, 3, 7, 14 and 28 days after SRT. BrdU (5'-bromo-2'-deoxy-uridine) incorporation assay was also conducted to evaluate potential proliferation of RPE cells. RESULTS: SRT lesions at1 h after SRT were ophthalmoscopically invisible. FAG showed leakage in areas corresponding to SRT lesions, and hyperfluorescence disappeared after 7 days. SD-OCT showed that decreased reflectivity corresponding to RPE damage was restored to normal over time in SRT lesions. Histologic analysis revealed that the damage in SRT lesions was primarily limited to the retinal pigment epithelium (RPE) and the outer segments of the photoreceptors. SEM and TEM showed RPE cell migration by day 3 after SRT, and restoration of the RPE monolayer with microvilli by 1 week after SRT. At 14 and 28 days, ultrastructures of the RPE, including the microvilli and tight junctions, were completely restored. The outer segments of the photoreceptors also recovered without sequelae. Interdigitation between the RPE and photoreceptors was observed. BrdU incorporation assay revealed proliferation of RPE on day 3 after SRT, and peak proliferation was observed on day 7 after SRT. CONCLUSION: Based on multimodal imaging and histologic assessment, our findings demonstrate that SRT with OFT could selectively target the RPE without damaging the neurosensory retina. Therefore, the use of SRT with OFT opens the door to the possibility of clinical trials of well-defined invisible and nondestructive retina therapy, especially for macular disease.

VISUAL AND MORPHOLOGIC OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR DIABETIC MACULAR EDEMA BASED ON OPTICAL COHERENCE TOMOGRAPHY PATTERNS.

PURPOSE: To evaluate the visual and morphologic outcomes of intravitreal ranibizumab (IVR) in eyes with diabetic macular edema (DME) based on the morphologic pattern on optical coherence tomography. METHODS: A prospective and consecutive series of 55 eyes with DME was classified according to OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD). Patients received three consecutive monthly injections of IVR and as needed thereafter. The primary outcome was the number of treatments undertaken by DME type over 12 months. Best-corrected visual acuity, retinal thickness, and microstructural changes were also evaluated. RESULTS: The eyes were classified as DRT (n = 23), CME (16), or SRD (16). The mean number of injections over 12 months was significantly different among the groups: DRT (3.69), CME (5.33), and SRD (5.09; P = 0.028). Best-corrected visual acuity of SRD (20/60) was significantly worse than that of the other types (DRT = 20/38; CME = 20/43; P = 0.015) after 12 months. CONCLUSION: Vision gains and retinal anatomy improvement were maintained in all three types during the first year of IVR administration. Especially, DRT maintained a good response to ranibizumab in a fewer number of injections. Disruption of the photoreceptor integrity at the baseline was correlated with poorer visual outcome and occurred more frequently in SRD.

TOPOGRAPHIC CHANGES IN MACULAR GANGLION CELL-INNER PLEXIFORM LAYER THICKNESS AFTER VITRECTOMY WITH INDOCYANINE GREEN-GUIDED INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC MACULAR HOLE.

PURPOSE: To evaluate the topographic changes in macular ganglion cell-inner plexiform layer (GCIPL) thickness after vitrectomy with indocyanine green-guided internal limiting membrane (ILM) peeling in eyes with idiopathic macular hole. METHODS: This is a retrospective analysis of 58 consecutive eyes with surgically closed macular hole after vitrectomy with indocyanine green-guided ILM peeling. Further, 31 eyes that had undergone vitrectomy without ILM peeling were used as the control group. The macular GCIPL thickness was measured with spectral domain optical coherence tomography before vitrectomy and at 1 month and 6 months after vitrectomy. RESULTS: The preoperative mean GCIPL thickness was 78.79 µm and mean thickness at 1 month and 6 months after surgery significantly reduced progressively to 70.93 µm and 67.64 µm (P < 0.001 and P < 0.001, respectively). The postoperative mean GCIPL thickness was significantly lower than that of the group without ILM peeling at 1 month and 6 months postoperatively (P < 0.001, P < 0.001, respectively). The GCIPL thickness in the temporal area was significantly lower than in the nasal area at 1 month and 6 months postoperatively (P < 0.001, P < 0.001, respectively). CONCLUSION: A reduction of the macular GCIPL thickness was observed after vitrectomy with indocyanine green-guided ILM peeling for idiopathic macular hole, especially in the temporal area.

VARIATIONS IN CHOROIDAL THICKNESS AFTER HIGH-DOSE SYSTEMIC CORTICOSTEROID TREATMENT IN CHILDREN WITH CHRONIC GLOMERULONEPHRITIS.

PURPOSE: To study changes in choroidal thickness (CT) after high-dose systemic corticosteroid treatment using spectral domain optical coherence tomography. METHODS: The authors reviewed medical records for 64 eyes of 32 children who receiving high-dose corticosteroid therapy with chronic glomerulonephritis and no ocular disease. Choroidal thickness was measured in a prospective manner in the same subfoveal area using an enhanced depth imaging technique with spectral domain optical coherence tomography at the same time daily. The possible correlation between CT and various factors was evaluated. RESULTS: Choroidal thickness decreased significantly during methylprednisolone pulse treatment. Mean decrease in CT was 15.42 ± 8.86 µm (range, 14-30 µm). In 10 eyes of 5 children with multiple hospitalizations and pulse treatments, a temporary decrease in CT was observed with methylprednisolone pulse treatment and after recovery without methylprednisolone pulse treatment. In multiple regression analysis, the number of previous methylprednisolone pulse treatments was the only factor associated with the mean amplitude of CT decrease (P = 0.011). CONCLUSION: High-dose systemic corticosteroid treatment significantly reduces CT. The effect of reducing the CT does not last after cessation of the treatment. The relation of central serous chorioretinopathy with corticosteroid treatment may not be based on the effect of corticosteroid treatment on CT.

Diurnal variation in choroidal thickness in relation to sex, axial length, and baseline choroidal thickness in healthy Korean subjects.

PURPOSE: To investigate diurnal variations in choroidal thickness (CT) in relation to various factors in healthy Korean subjects using spectral-domain optical coherence tomography. METHODS: A prospective study was conducted on 100 healthy volunteers who each underwent measurements of CT in the same subfoveal area using an enhanced depth imaging technique with spectral-domain optical coherence tomography at 8 AM, 11 AM, 2 PM, and 5 PM. Possible correlations between the diurnal variation of CT and other factors, such as sex, axial length (AL), baseline CT (8 AM), blood pressure, and intraocular pressure, were evaluated. RESULTS: One hundred volunteers with a mean age of 30.1 years were scanned. A significant pattern of diurnal variation was observed, with a mean CT of 278.28 ± 91.78 µm at 8 AM, 271.57 ± 89.08 µm at 11 AM, 266.39 ± 86.18 µm at 2 PM, and 264.92 ± 87.10 µm at 5 PM in a right eye. Right eye and left eye had a similar trend of diurnal cycle. Based on sex, AL, and baseline CT, the pattern of diurnal variation was greater and the amplitude significantly was greater in men, AL ≤ 24 mm and baseline CT ≥ 300 µm (men vs. women: P = 0.048, AL ≤ 24 mm vs. AL > 24 mm: P = 0.036, baseline CT ≥ 300 µm vs. baseline CT < 200 µm: P = 0.002, baseline CT ≥ 300 µm vs. 200 µm ≤ baseline CT < 300 µm: P = 0.008). There were no significant correlations between the diurnal variation of CT and systolic blood pressure, diastolic blood pressure, or intraocular pressure. CONCLUSION: In men as well as in those with a shorter AL and thick baseline CT, a greater pattern of diurnal variation with significantly greater amplitude was observed.

Visual prognostic value of photopic negative response and optical coherence tomography in central retinal vein occlusion after anti-VEGF treatment.

OBJECTIVE: To investigate the potential of optical coherence tomography (OCT) and photopic negative response (PhNR) for predicting visual outcome after intravitreal bevacizumab in patients with macular edema secondary to central retinal vein occlusion (CRVO). METHODS: Thirty-two consecutive patients with macular edema secondary to unilateral CRVO who were treated with three times of 6 weeks interval intravitreal bevacizumab were enrolled. LogMAR visual acuity (Va), OCT and PhNR were done before and 4 weeks after first and third injection. Stepwise multiple regression analysis was conducted between pre-treatment Va, central retinal thickness, b wave amplitude, PhNR amplitude, PhNR relative amplitude (affected eye/unaffected fellow eye, % presentation) and post-treatment Va at 4 weeks after the third injection. The predictive values of pre-treatment parameters for good visual outcome (0.2 ≤ LogMAR Va) were assessed using receiver-operating characteristics (ROC) analysis. RESULTS: In multiple regression analysis, pre-treatment Va (ß = 0.615, P = 0.001) and PhNR relative amplitude (ß = -0.352, P = 0.032) were correlated significantly with post-treatment Va. In ROC analysis, pre-treatment Va showed a 80 % sensitivity and 80 % specificity for predicting good visual outcome, at a cutoff value of 0.52 LogMAR. Pre-treatment PhNR relative amplitude demonstrated a 88 % sensitivity and 75 % specificity for predicting good visual outcome, at a cutoff value of 40.00 %. CONCLUSIONS: The PhNR relative amplitude can be a useful prognostic factor for visual outcome after intravitreal bevacizumab therapy in patient with macular edema secondary to CRVO. Patients with larger pre-treatment PhNR relative amplitude with better pre-treatment Va showed a better post-treatment visual outcome.

Changes of parafoveal retinal nerve fiber layer thickness analyzed by spectral-domain optical coherence tomography after pars plana vitrectomy.

PURPOSE: To use spectral-domain optical coherence tomography to evaluate the postoperative retinal nerve fiber layer (RNFL) thickness changes in eyes undergoing vitrectomy. METHODS: This is a retrospective study of 44 patients (44 eyes) who underwent monocular vitrectomy for an epiretinal membrane (19 eyes), macular hole (12 eyes), or vitreous hemorrhage (13 eyes). Quantitative analysis of the peripapillary RNFL by spectral-domain optical coherence tomography was performed before surgery and for 6 months postoperatively on both eyes. RESULTS: Mean patient age was 62.72 ± 9.11 years. Mean preoperative RNFL thickness did not differ significantly between vitrectomized eyes (88.33 ± 13.23 µm) and nonvitrectomized fellow eyes (87.49 ± 13.18 µm; P > 0.05). In vitrectomized eyes, the preoperative mean RNFL thickness in the superior quadrant was significantly different from that at 6 months after surgery (P = 0.02). Vitrectomized eyes with a macular hole showed significant changes in the mean RNFL thickness in the inferior quadrant (P = 0.04). CONCLUSION: Retinal nerve fiber layer thickness was reduced in some of the quadrants of the vitrectomized eye during the 6-month postoperative follow-up period. Spectral-domain optical coherence tomography can be clinically useful for detection of localized RNFL defects in patients who underwent vitrectomy. Future prospective studies with more patients and longer follow-up duration are required.

New profiles of posterior pole retinal thickness map in healthy Korean eyes measured by spectral-domain optical coherence tomography.

PURPOSE: To analyze posterior pole retinal thickness using the new Spectralis HRA + OCT protocol and compare two commercially available spectral-domain optical coherence tomography instruments (Spectralis HRA + OCT and Cirrus HD-OCT) in young healthy eyes. METHODS: Retinal thickness in 178 young healthy eyes was measured using the volume scan mode and Posterior Pole Asymmetry Analysis of the Spectralis HRA + OCT and the macular cube 512 × 128 protocol of the Cirrus HD-OCT. Topologic differences in posterior pole retinal thickness between the two spectral-domain optical coherence tomographies were compared, and the relationship between retinal thickness and age or refractive error/axial length was assessed. RESULTS: Mean retinal thickness measurements in all 9 Early Treatment Diabetic Retinopathy Study Report areas were significantly greater with the Spectralis HRA + OCT than with the Cirrus HD-OCT (P < 0.001). Retinal thickness measured with the new Spectralis HRA + OCT protocol positively correlated with refractive error (P < 0.05) and negatively correlated with axial length (P < 0.05), mainly in the temporal areas. As axial length increased and refractive error decreased, retinal thickness decreased significantly at the outer temporal areas compared with the nasal areas (P < 0.05). Foveal thickness measured with the Spectralis HRA + OCT correlated significantly with refractive error (r = -0.151; P = 0.022) and axial length (r = 0.352; P < 0.001). CONCLUSION: Posterior pole retinal thickness measurements in young healthy eyes should provide more detailed standard values for diagnosing and managing retinal disease.

Association between fundus autofluorescence and visual outcome in surgically closed macular holes.

PURPOSE: To investigate the association between fundus autofluorescence (FAF) and visual acuity, recovery of foveal microstructure, and FAF in surgically closed macular holes. METHODS: Twenty-six eyes with surgically closed macular hole were classified into two groups based on foveal FAF: normal autofluorescence (NAF) or increased autofluorescence (IAF). The association between foveal FAF and visual acuity was analyzed. In addition, we examined the relationship between recovery of the foveal microstructure assessed by spectral domain optical coherence tomography and FAF after macular hole surgery. RESULTS: At 1 month and 6 months after surgery, there were 9 NAF eyes and 17 IAF eyes. There were no differences between NAF and IAF eyes at 1 month and 6 months after surgery. Preoperative best-corrected visual acuity (logarithm of the minimum angle of resolution) did not differ between groups. Best-corrected visual acuity was significantly higher in the NAF group than in the IAF group at 1 month postoperatively (0.59 ± 0.34 vs. 0.91 ± 0.36, P = 0.044) and tended to be higher at 6 months (0.37 ± 0.38 vs. 0.69 ± 0.53, P = 0.126). Restoration of photoreceptor external limiting membrane differed significantly in 8 NAF eyes (89%) and 4 IAF eyes (24%) at postoperation 1 month (P = 0.001). After 6 months, external limiting membrane was restored in all 9 NAF eyes (100%) and in only 11 IAF eyes (65%) (P = 0.042). CONCLUSION: Fundus autofluorescence findings observed in surgically closed macular holes correlated with visual improvement and photoreceptor status. Eyes with visual improvement had restoration of normal foveal autofluorescence and retinal microstructure, whereas eyes with persistent foveal hyperautofluorescence did not achieve complete restoration of the retinal microstructure, and visual improvement was not as significant.

Morphological change of inner retinal layer on spectral-domain optical coherence tomography following macular hole surgery.

BACKGROUND/AIMS: To investigate the morphological changes of the inner retinal layer by spectral-domain optical coherence tomography (OCT) after idiopathic full-thickness macular hole (MH) surgery. METHODS: In a retrospective study, the authors evaluated 52 eyes of 49 patients with MH closed following vitrectomy. All patients were followed postoperatively for more than 6 months. Cross-sectional and retinal surface images were obtained using Cirrus high-definition OCT before and after surgery. In 24 of the 52 eyes, fundus autofluorescence (FAF) was analyzed. RESULTS: The incidence of dissociated optic nerve fiber layer (DONFL) increased gradually over time after surgery. 57.7% had defects of only the retinal nerve fiber layer (RNFL) and 30.8% had defects in the inner plexiform layer at 6 months after surgery. Postoperative best-corrected visual acuity did not differ significantly based on the depth of the DONFL (p = 0.299). There were no changes in FAF in the area with DONFL. CONCLUSIONS: DONFL is characterized by progressive defects that are not limited to RNFL thickness. The healing process after vitrectomy for MH is not limited in the RNFL affecting deeper structural changes. Further investigations are required to evaluate the pathophysiological mechanism of inner retinal change after MH surgery.

Atypical vitelliform macular dystrophy misdiagnosed as chronic central serous chorioretinopathy: case reports.

BACKGROUND: To report two cases of atypical vitelliform macular dystrophy misdiagnosed as chronic central serous chorioretinopathy. CASE PRESENTATION: Two patients with incidentally discovered abnormalities of the retina without specific symptoms were referred to our hospital for consultation. Bilateral macula atrophic lesions were observed and optical coherence tomography revealed serous retinal detachment in the macula. Fluorescein angiography showed multiple leakages around the central hypofluorescent area and indocyanine green angiography showed partially dilated choroidal vessels. Fundus autofluorescence (FAF) showed a decreasing pattern of autofluorescence in the subretinal fluid area, and increasing autofluorescence at the border of the serous retinal detachment. Both patients were diagnosed with chronic central serous chorioretinopathy. Photodynamic therapy and intravitreal bevacizumab injection were administered for engorged choroidal vessels during follow-up, but neither patient showed improvement in symptoms or ophthalmologic findings. Based on re-evaluation by fundus photography, optical coherence tomography, fluorescein angiography, and comparison of the results of FAF with the first visit, vitelliform macular dystrophy was suspected and a definite diagnosis was made by electrooculography and genetic testing. CONCLUSION: In patients with continuous serous retinal detachment without response to photodynamic therapy or intravitreal bevacizumab injection, careful fundus exam and FAF can be used to diagnose atypical vitelliform macular dystrophy.

Intravitreal ranibizumab for macular edema secondary to retinal vein occlusion.

BACKGROUND/AIMS: To investigate the effects of intravitreal ranibizumab treatment for macular edema (ME) secondary to retinal vein occlusion (RVO) and the relationship between spectral-domain optical coherence tomography (SD-OCT) findings and visual outcome after successful resolution of ME. METHODS: Forty consecutive eyes with ME secondary to branch RVO (BRVO; 29 eyes of 29 patients) or central RVO (CRVO; 11 eyes of 11 patients) were included in a prospective study and treated with 3 initial intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Retreatment was based on visual acuity changes and OCT findings. Patients with complete resolution of ME were classified into two groups according to final best-corrected visual acuity (BCVA) of better than 0.30 logMAR (group 1) or poorer than 0.30 logMAR (group 2), and SD-OCT findings were analyzed at baseline and at 12 months. RESULTS: In patients with BRVO, mean BCVA at 12 months (0.19 ± 0.18) was significantly better than that at baseline (0.76 ± 0.37; p = 0.000). The mean number of injections was 4.4 ± 1.2. In patients with CRVO, the mean BCVA at 12 months (0.39 ± 0.23) was slightly improved from that at baseline (0.84 ± 0.68), but the difference was not significant (p = 0.063). Patients with CRVO received a mean number of 6.1 ± 1.4 injections of ranibizumab. Baseline SD-OCT more frequently detected the foveal inner/outer segment (IS/OS) line and external limiting membrane (ELM) in group 1 (p = 0.003) than in group 2 (p = 0.012). Preservation of the foveal IS/OS line (odds ratio = 5.400; p = 0.036) and ELM (odds ratio = 7.312; p = 0.016) at baseline correlated with good final visual outcome. CONCLUSION: Intravitreal ranibizumab injections effectively treat ME secondary to RVO. Good visual outcome was associated with preservation of the foveal IS/OS line and ELM at baseline.

Imported intraocular gnathostomiasis with subretinal tracks confirmed by western blot assay.

We report a case of intraocular gnathostomiasis diagnosed by western blot assay in a patient with subretinal tracks. A 15-year-old male patient complained of blurred vision in the right eye, lasting for 2 weeks. Eight months earlier, he had traveled to Vietnam for 1 week and ate raw wild boar meat and lobster. His best-corrected visual acuity was 20/20 in both eyes and anterior chamber examination revealed no abnormalities. Fundus examination showed subretinal tracks in the right eye. Fluorescein angiography and indocyanine green angiography showed linear hyperfluorescence of the subretinal lesion observed on fundus in the right eye. Ultrasound examination revealed no abnormalities. Blood tests indicated mild eosinophilia (7.5%), and there was no abnormality found by systemic examinations. Two years later, the patient visited our department again for ophthalmologic evaluation. Visual acuity remained 20/20 in both eyes and the subretinal tracks in the right eye had not changed since the previous examination. Serologic examination was performed to provide a more accurate diagnosis, and the patient's serum reacted strongly to the Gnathostoma nipponicum antigen by western blot assay, which led to a diagnosis of intraocular gnathostomiasis. This is the first reported case of intraocular gnathostomiasis with subretinal tracks confirmed serologically using western blot in Korea.

A Smartphone-Based Near-Vision Testing System: Design, Accuracy, and Reproducibility Compared With Standard Clinical Measures.

BACKGROUND AND OBJECTIVE: Ophthalmologic telemedicine has emerged during the COVID-19 pandemic. The objective of this study is to assess the accuracy and reproducibility of a smartphone-based home vision monitoring system (Sightbook) and to compare it with existing clinical standards. PATIENTS AND METHODS: Near Snellen visual acuity (VA) was measured with Sightbook and compared with conventional measurements for distance and near VA at an academic medical center ophthalmology clinic in 200 patients with a variety of different specified preexisting ocular conditions. Measurements of contrast sensitivity were also compared by using an existing commercially available chart system in 15 normal patients and 15 patients with age-related macular degeneration. RESULTS: Sightbook VA tests were reproducible (SD = ±0.054 logMAR), and correlation with standard VA methods was significant (R > 0.87 and P < .001). Sightbook contrast sensitivity measurements were reproducible (SD/mean ratio, 0.02 to 0.04), yielding results similar to those of standard tests (R2 > 0.87 and P < .001). CONCLUSIONS: Smartphone-based VA and contrast sensitivity are highly correlated with standard charts and may be useful in augmenting limited inoffice care. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:79-84.].

Photodynamic therapy combined with intravitreal injection of vascular endothelial growth factor antibody for polypoidal choroidal vasculopathy.

BACKGROUND/AIMS: To evaluate the efficacy of photodynamic therapy (PDT) combined with intravitreal injection of anti-vascular-endothelial-growth-factor (anti-VEGF) antibody in patients with polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-two eyes of 22 patients with PCV followed for 12 months after combination therapy with PDT and anti-VEGF were retrospectively reviewed. Patients received intravitreal anti-VEGF (1.25 mg bevacizumab or 0.5 mg ranibizumab) within 7 days after PDT. Retreatment with PDT and intravitreal anti-VEGF injections, or with intravitreal anti-VEGF alone, was performed when indicated. The main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS: Mean logMAR BCVA was 0.43 at baseline and 0.45, 0.36, 0.30 and 0.28 at 1, 3, 6 and 12 months, respectively, after the initial combination therapy. Mean BCVA was significantly improved at 6 and 12 months after treatment (p < 0.05). Mean CFT was 269.4 µm at baseline and 180.1, 136.7, 127.5 and 139.6 µm at 1, 3, 6 and 12 months, respectively, after the initial combination therapy. CFT decreased significantly throughout the follow-up period. At 12 months, mean BCVA improved by 1.5 lines, and mean CFT decreased by 129.8 µm. Polypoidal lesions disappeared in 7 of the 13 eyes in which indocyanine green angiography was performed at 12 months. No changes in the branching vascular network were observed in any of these 13 eyes. Patients were treated with PDT a mean of 1.3 times and injected with intravitreal anti-VEGF a mean of 3.4 times over the 12-month period. CONCLUSION: Combined PDT and intravitreal anti-VEGF may improve visual acuity and decrease CFT at 12 months. Large long-term prospective studies are needed to evaluate the efficacy and safety of combination therapy.

Effect of intravitreal bevacizumab based on optical coherence tomography patterns of diabetic macular edema.

AIM: To compare the effects of intravitreal bevacizumab on different morphologic patterns of diabetic macular edema (DME) classified using optical coherence tomography (OCT). MATERIALS AND METHODS: Medical records for 65 eyes of 48 patients were retrospectively reviewed, and each subject was classified as one of three DME types according to the OCT features: diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD). Subjects were given three monthly intravitreal injections of bevacizumab (1.25 mg/0.05 ml). The clinical course of best-corrected visual acuity (BCVA) with a logarithm of the minimum angle of resolution chart and central foveal thickness (CFT) using OCT was monitored for 12 months after the injections. On follow-up, injections were repeated if DME remained or was aggravated. RESULTS: Of the 65 eyes with DME, 29 eyes were of the DRT type, 21 of the CME type, and 15 of the SRD type. Before the injection, CFT and BCVA were, respectively, 377.1 ± 145.9 µm and 0.54 ± 0.36 in the DRT type, 427.7 ± 143.1 µm and 0.59 ± 0.42 in the CME type, and 485.1 ± 187.1 µm and 0.65 ± 0.27 in the SRD type; there was no significant difference in CFT and BCVA between DME types (p > 0.05). At 6 months, the changes in BCVA and CFT differed significantly between OCT types (p < 0.05). At 12 months, changes in CFT and BCVA from baseline were not significantly different between groups (p > 0.05). The DRT type was associated with a greater reduction in the CFT and greater BCVA improvement than the CME or SRD types. CONCLUSIONS: Three monthly injections of intravitreal bevacizumab seem to be effective treatment in the first 6 months, but the therapeutic effect is temporary and repeated injections of bevacizumab should be considered to maintain the therapeutic effect after 6 months. In addition, intravitreal injection of bevacizumab was more effective in the DRT type than in the CME or SRD types of DME.

Two-year results of photodynamic therapy combined with intravitreal anti-vascular endothelial growth factor for polypoidal choroidal vasculopathy.

BACKGROUND/AIMS: To evaluate the 2-year efficacy of photodynamic therapy (PDT) combined with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in patients with polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-two eyes of 22 patients with PCV followed up for ≥24 months after PDT and anti-VEGF combination therapy were retrospectively reviewed. The patients received intravitreal anti-VEGF (1.25 mg bevacizumab or 0.5 mg ranibizumab) within 7 days after PDT. Eyes were retreated with PDT and anti-VEGF injection, or with only anti-VEGF injection, when indicated. Main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS: The mean baseline BCVA (0.43±0.33 logarithm of the minimum angle of resolution, logMAR) was 0.28±0.24 at 12 months (p<0.05 vs. baseline) and 0.39±0.28 at 24 months (not significant). At 24 months, BCVA improved by ≥0.3 logMAR in 27.3% of the eyes, did not significantly decrease in 59.1%, and decreased by ≥0.3 logMAR in 13.6%. The mean CFT was 269.4±134.5 µm at baseline and significantly decreased to 139.6±45.8 µm (12 months) and 199.6±72.9 µm (24 months). PDT was administered 1.45±0.86 times and anti-VEGF injected 4.45±1.36 times over the 24-month period. CONCLUSION: Combined PDT and anti-VEGF injection were effective for 2 years in PCV patients. Visual acuity significantly improved during year 1, but the benefit diminished in year 2. Further investigations are required to determine how to prolong the therapeutic effect of combination therapy for PCV.