Predictive factors for microvascular recovery after treatments for diabetic retinopathy.

BACKGROUND: To identify factors associated with microvascular recovery after intravitreal bevacizumab or panretinal photocoagulation (PRP) in diabetic retinopathy (DR). METHODS: We retrospectively reviewed 320 eyes/patients with DR treated with intravitreal bevacizumab and/or PRP. Two consecutive fluorescein angiographies (FAs) of each eye were compared. The number of microaneurysms and the area of capillary non-perfusion were calculated automatically using ImageJ software. Microvascular recovery was defined as a marked reduction in the numbers of microaneurysms (< 20%) or a marked reduction in the area of capillary non-perfusion (< 50%) in 45-degree fields or a complete regression of new vessels in ETDRS 7 standard fields. Baseline FA findings and changes in the ocular and systemic factors were analyzed. RESULTS: Twenty-eight (8.8%) of the 320 total eyes were found to meet the criteria of microvascular recovery after the treatments. Multivariate analysis revealed the presence of diffuse capillary telangiectasis (P = .003) and late disc leaking (P = .007) on baseline FA and a reduction of glycated hemoglobin (P = .005) during the follow-up period were predictive factors of microvascular recovery after the treatments. Although the microvascular recovery group presented with a significant improvement of BCVA after the treatments, the baseline BCVA could not predict the microvascular recovery after the treatments. CONCLUSIONS: Diffuse capillary telangiectasis or late disc leaking on baseline FA and improved glycemic control positively predicted the microvascular recovery after treatments for DR.

MACULAR MICROVASCULATURE IN X-LINKED RETINOSCHISIS: Optical Coherence Tomography and Optical Coherence Tomography Angiography Study.

PURPOSE: The study aimed to evaluate the macular microvasculature of X-linked retinoschisis (XLRS) and identify correlations between vascular changes, structural changes, and functional outcome. METHODS: Genetically confirmed XLRS patients and heathy control subjects underwent complete ophthalmic examination, dilated funduscopic examination, optical coherence tomography, and optical coherence tomography angiography. Schisis distribution, outer plexiform layer discontinuation, photoreceptor layer thickness, and photoreceptor outer segment length were reviewed using optical coherence tomography. Vascular flow density and foveal thickness at foveal and parafoveal area were measured using optical coherence tomography angiography. RESULTS: A total of 17 eyes of 9 XLRS patients and 22 eyes of 11 control subjects were examined from July 2018 to August 2020. Flow density in the deep capillary plexus at foveal and parafoveal area decreased in XLRS patients compared with control subjects (P = 0.014 and 0.001, respectively), whereas foveal avascular zone area and perimeter remarkably increased (P = 0.015 and 0.001, respectively). Although outer and total retinal layers were significantly thicker in XLRS, inner retinal layer was thinner with reduced photoreceptor layer thickness and shortened photoreceptor outer segment length (P < 0.001 and P < 0.001, respectively). Foveal flow loss in deep capillary plexus, foveal avascular zone enlargement, thinner inner retina and photoreceptor layer thickness, and shortened photoreceptor outer segment length correlated with best-corrected visual acuity. CONCLUSION: X-linked retinoschisis eyes exhibit decreased flow density in the deep capillary plexus and variable foveal avascular zone with enlarged perimeter. Structural deterioration of the photoreceptor best reflects the degenerative changes, whereas microvascular alteration shows considerable correlation with functional outcome in XLRS.

ASSOCIATION BETWEEN EPIRETINAL MEMBRANE, EPIRETINAL PROLIFERATION, AND PROGNOSIS OF FULL-THICKNESS MACULAR HOLE CLOSURE.

PURPOSE: To demonstrate the effects of epiretinal membrane (ERM) and epiretinal proliferation on surgical outcomes for full-thickness macular hole. METHODS: Nested case-control study with propensity score matching. Patients operated on for full-thickness macular hole between January 2011 and March 2020 were enrolled. The primary outcome was failure of the macular hole closure, and the secondary outcome was unfavorable hole closure (V or λ type closure) at 6 months after the surgery. RESULTS: Five hundred and thirty-four eyes of 534 patients met the inclusion criteria. After 1:1 propensity score matching (127 pairs), patients demonstrating ERM were more likely to have a failure of hole closure (adjusted odds ratio, 2.71; 95% confidence interval, 1.19-6.14) and unfavorable hole closure (adjusted odds ratio, 2.07; 95% confidence interval, 1.16-3.71). Epiretinal membrane spanning the hole margin (hole marginal ERM) greatly increased the likelihood of unfavorable hole closure (adjusted odds ratio, 2.13; 95% confidence interval, 1.12-4.07). Patients with hole marginal-ERM + epiretinal proliferation were more likely to have a failure of hole closure (38.4%) compared with those with no ERM (11.8%). CONCLUSION: Patients with ERM had a higher risk for adverse surgical outcomes for full-thickness macular hole closure. The location of the ERM relative to the macular hole and the presence of epiretinal proliferation might affect the surgical outcomes for full-thickness macular hole closure.

Clinical features of cytomegalovirus retinitis after solid organ transplantation versus hematopoietic stem cell transplantation.

PURPOSE: To investigate and compare the clinical features of cytomegalovirus (CMV) retinitis after solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) and to determine the poor prognostic factors. METHODS: Patients consulted to the ophthalmology department for CMV viremia after transplantation between March 2008 and February 2018 and followed for more than 6 months were analyzed. Medical records regarding demographic, serologic, and ocular characteristics were compared between the SOT and HSCT groups. Factors associated with poor visual outcomes were determined with logistic regression. RESULTS: CMV retinitis developed in 11.3% of patients with CMV viremia following transplantation. In the SOT group (25 eyes/18 patients) and the HSCT group (33 eyes/21 patients), CMV retinitis occurred at 5.8 months and 3.7 months post-transplantation, respectively. Mortality was significantly higher in the HSCT group (52.4% vs. 5.6%, P < 0.001). During the mean 11.7 months of follow-up, visual acuity tended to be aggravated (P = 0.087) despite antiviral treatment, which was especially notable in the SOT group (P = 0.028). Six eyes (10.3%) underwent vitrectomy due to retinal detachment, most of which (5 eyes) were in the SOT group. Multivariate logistic regression analysis showed that the presence of concurrent CMV disease (OR = 14.11, P = 0.009) and foveal involvement (OR = 114.85, P = 0.001) were poor prognostic factors. CONCLUSION: Clinical manifestations of CMV retinitis differed between the HSCT and SOT group. Concurrent CMV diseases and foveal involvement were associated with poor visual outcomes in CMV retinitis following transplantation.

CENTRAL RETINAL VEIN OCCLUSION IN YOUNG PATIENTS: Clinical Characteristics and Prognostic Factors.

PURPOSE: To investigate the clinical characteristics and prognostic factors of young patients with central retinal vein occlusion (CRVO). METHODS: This retrospective cohort study involved treatment-naïve patients with CRVO. Medical records regarding basic demographics, predisposing factors, ocular characteristics, and treatments were reviewed and compared according to age at CRVO onset. RESULTS: We enrolled 263 patients, of whom 69 were younger patients. Younger patients had higher prevalence of nontraditional risk factors including physical or psychological stress (P = 0.032), hematologic abnormalities (P = 0.003), and better visual acuity at baseline and last visit (all P < 0.001) and were unlikely to undergo intravitreal injections (47.8 vs. 68.6%, P < 0.001) during follow-up. Younger patients had higher prevalence of paracentral acute middle maculopathy (28.1 vs. 4.7%, P < 0.001). Older age (odds ratio = 1.165, P = 0.028), male sex (odds ratio = 7.074, P = 0.034), coexisting renal disease (odds ratio = 7.845, P = 0.050), and poor baseline visual acuity (odds ratio = 16.069, P = 0.002) were significant risk factors for poor visual outcomes in young CRVO patients. CONCLUSION: Younger CRVO patients had a milder clinical course with fewer treatments and were more likely to have nontraditional risk factors than older patients.

One-Year Anatomical and Functional Outcomes of the Argus II Implantation in Korean Patients with Late-Stage Retinitis Pigmentosa: A Prospective Case Series Study.

PURPOSE: To report the anatomical and functional outcomes of Argus II retinal prosthesis implantation in Korean patients. METHODS: We included 5 consecutive patients with end-stage retinitis pigmentosa (RP) who underwent Argus II retinal prosthesis implantation and were followed for at least 12 months. The transcorneal electrical evoked response was utilized for patient selection. We used intraoperative optical coherence tomography (OCT) for optimal placement of the array and provided specialized vision rehabilitation training. A morphological evaluation using SD-OCT and a functional evaluation using computer-based visual function tests, a letter-reading ability test, and the Functional Low-Vision Observer Rated Assessment (FLORA) were conducted. RESULTS: Postoperatively, the array was completely apposed to the retinal surface in all eyes, except for one eye which had a preexisting macular concavity. Fibrosis-like tissues of ≥50-µm thickness developed at the interface in 2 eyes. All of the patients showed improvement in computer-based visual function tests and could read ETDRS letters at a distance of 50 cm. Three patients could read Korean words. FLORA was improved in all patients, mainly in tasks of visual mobility, daily activities, and social interactions. CONCLUSIONS: Along with good anatomical outcomes and specialized rehabilitation practices, recipients of the Argus II implant showed profound improvements in functional vision and mobility.

Applying Learning Analytics to Detect Sequences of Actions and Common Errors in a Geometry Game.

Games have become one of the most popular activities across cultures and ages. There is ample evidence that supports the benefits of using games for learning and assessment. However, incorporating game activities as part of the curriculum in schools remains limited. Some of the barriers for broader adoption in classrooms is the lack of actionable assessment data, the fact that teachers often do not have a clear sense of how students are interacting with the game, and it is unclear if the gameplay is leading to productive learning. To address this gap, we seek to provide sequence and process mining metrics to teachers that are easily interpretable and actionable. More specifically, we build our work on top of Shadowspect, a three-dimensional geometry game that has been developed to measure geometry skills as well other cognitive and noncognitive skills. We use data from its implementation across schools in the U.S. to implement two sequence and process mining metrics in an interactive dashboard for teachers. The final objective is to facilitate that teachers can understand the sequence of actions and common errors of students using Shadowspect so they can better understand the process, make proper assessment, and conduct personalized interventions when appropriate.

Diagnostic yield and clinical utility of whole exome sequencing using an automated variant prioritization system, EVIDENCE.

EVIDENCE, an automated variant prioritization system, has been developed to facilitate whole exome sequencing analyses. This study investigated the diagnostic yield of EVIDENCE in patients with suspected genetic disorders. DNA from 330 probands (age range, 0-68 years) with suspected genetic disorders were subjected to whole exome sequencing. Candidate variants were identified by EVIDENCE and confirmed by testing family members and/or clinical reassessments. EVIDENCE reported a total 228 variants in 200 (60.6%) of the 330 probands. The average number of organs involved per patient was 4.5 ± 5.0. After clinical reassessment and/or family member testing, 167 variants were identified in 141 probands (42.7%), including 105 novel variants. These variants were confirmed as being responsible for 121 genetic disorders. A total of 103 (61.7%) of the 167 variants in 95 patients were classified as pathogenic or probably to be pathogenic before, and 161 (96.4%) variants in 137 patients (41.5%) after, clinical assessment and/or family member testing. Factor associated with a variant being regarded as causative includes similar symptom scores of a gene variant to the phenotype of the patient. This new, automated variant interpretation system facilitated the diagnosis of various genetic diseases with a 42.7% diagnostic yield.

Optical coherence tomography angiography findings of type 1 diabetic patients with diabetic retinopathy, in comparison with type 2 patients.

PURPOSE: To compare optical coherence tomography angiography (OCT-A) parameters between type 1 and type 2 diabetic patients with diabetic retinopathy (DR). METHODS: A total of 70 patients with type 1 diabetes and 70 with type 2 diabetes were retrospectively analyzed. DR was graded as no DR, mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). Using OCT-A, the foveal avascular zone (FAZ) area (mm2) and vascular density (VD) (%) were calculated in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). RESULTS: In both type 1 and 2 diabetes patients, the FAZ area (mm2) in both capillary plexuses (CP) increased with DR progression, whereas the VD (%) progressively decreased. The changes in the FAZ area and the VD were significantly greater in the DCP than in the SCP in both types of diabetes patients(p < 0.001). In the analysis of decreasing slope of the VD in the DCP, attenuation was not significant until severe NPDR stage but then abruptly decreased when it progressed to PDR stage in type 1 diabetes. In type 2 diabetes, the DCP VD decreased gradually as DR stage progressed. CONCLUSIONS: As DR progression, the increasing in FAZ area and the decreasing in VD are more severe in the DCP than in the SCP in both types of diabetes. In type 1 diabetes eyes, they were remained in relatively healthy until it gets to the advanced stage of DR, while the gradual deterioration of FAZ area and VD was found from the early stage to the advanced stage of DR in type 2 diabetes.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH RETINITIS PIGMENTOSA-ASSOCIATED CYSTOID MACULAR EDEMA.

PURPOSE: To investigate the microstructure of cystoid macular edema (CME) in retinitis pigmentosa (RP) and the associated vascular changes using optical coherence tomography (OCT) angiography. METHODS: In this retrospective study, we included 42 eyes of 21 patients with RP and age-similar normally sighted controls who underwent both OCT and optical coherence tomography angiography. Using OCT, spatial distribution of CME and the retinal layer, which CME located, was examined. Optical coherence tomography angiography images of the superficial capillary plexus and deep capillary plexus were obtained. Foveal and parafoveal flow densities in each layer and foveal avascular zone area were measured. RESULTS: Of the 42 eyes with RP, 32 had CME. All CMEs were located in the inner nuclear layer and limited to the parafovea. The outer nuclear layer/ganglion cell layer was involved in 12 eyes (37.5%). Compared with RP without CME, RP with CME (RP-CME) did not show significant differences in flow density or extent of vascular disruption within the superficial capillary plexus, deep capillary plexus, or foveal avascular zone areas. CONCLUSION: RP-CME was mostly located in the inner nuclear layer of the parafoveal macula, without vascular disruption in optical coherence tomography angiography. Our findings may support the hypothesis that the pathogenesis of RP with CME differs from retinal vascular CME triggered by compromised deep capillary plexus.

Correlation between Visual Function and Structural Characteristics of the Macula in Advanced Retinitis Pigmentosa.

We aimed to correlate the visual function and structural characteristics of the retina and choroid in advanced retinitis pigmentosa (RP) patients. A cross-sectional, retrospective review was conducted of medical records of 149 RP patients who reported visual field constriction on a central 30-2 Humphrey visual field chart. Using spectral domain-optical coherence tomography, central foveal thickness (CFT), ellipsoid zone (EZ) length, macular volume (MV), and submacular choroidal thickness (SMChT) were measured. A control cohort (68 eyes of 68 patients) was included for comparing the macular structure. Quantitative correlations between visual function indices [visual field index (VFI) and best-corrected visual acuity (BCVA)] and structural indices (CFT, EZ length, and SMChT) were evaluated. Mean age was 46.3 ± 15.5 years; mean illness duration was 60.7 ± 60.0 months. SMChT was thinner than that in normal controls. Per Pearson's correlation, BCVA and VFI exhibited a progressive worsening related to age and disease duration. In multivariate linear regression, BCVA and VFI were significantly correlated with CFT, EZ length, and MV at the central 1-mm area. Among RP patients with visual field constriction within 30°, VFI and BCVA closely correlate with the degree of retinal structural change, including the CFT, EZ length, and MV. SMChT uniformly decreased in this study population and exhibited no significant correlation with BCVA or VFI degree.

ASYMMETRIC DIABETIC RETINOPATHY PROGRESSION IN PATIENTS WITH AXIAL ANISOMETROPIA.

PURPOSE: To investigate the differences in the progression of diabetic retinopathy (DR) in both eyes of patients with axial anisometropia. METHODS: A retrospective review was conducted on diabetic patients who had different axial lengths (difference greater than 1 mm) in each eye. The primary objective of this study was to analyze the differences in the progression of DR in both eyes of patients with axial anisometropia. Fundus images (fluorescein angiography and photographs of the fundus covering the Early Treatment Diabetic Retinopathy Study seven fields) were graded using the Early Treatment Diabetic Retinopathy Study DR grading system. Also, the severity of diabetic retinopathy was analyzed based on the axial length and subfoveal choroidal thickness. RESULTS: Thirty-four of 6,963 patients with DR were included after applying the exclusion and inclusion criteria. The mean age was 53.53 ± 12.20 years and duration of diabetes was 9.63 ± 7.73 years. The mean axial length of the longer and shorter eye was 26.21 ± 2.04 mm and 23.21 ± 1.73 mm, respectively (P < 0.001). In shorter eyes, 61.7% (21 of 34) of the eyes had proliferative diabetic retinopathy. In contrast to the shorter eye, only 8 of the longer eyes (8 of 34, 23.5%) had proliferative diabetic retinopathy (McNemar test, P < 0.001). In eyes with thin subfoveal choroidal thickness (<250 µm), the proliferative diabetic retinopathy ratio was significantly lower (P = 0.007). CONCLUSION: In patients with axial anisometropia, the longer eye had a lower degree of DR progression than the shorter eye. This result showed that elongation of the axial length had a protective effect against the progression of DR without individual confounding factors.

Uveoretinal Adverse Effects Presented during Systemic Anticancer Chemotherapy: a 10-Year Single Center Experience.

BACKGROUND: The present study describes our 10-year experience with uveoretinal adverse events that manifest because of chemotherapy. METHODS: A retrospective chart review was performed for all patients who presented to the ophthalmologic department while undergoing systemic chemotherapy between July 2005 and June 2015. RESULTS: A total of 55 patients (mean age, 51.2 years, 38 women [69.1%]) suspected of having uveoretinal disease owing to the use of chemotherapeutic agents alone were enrolled. Breast cancer was the predominant disease (36.4%); noninfectious anterior uveitis (21.8%) was the most common condition. Bilateral involvement was observed in 16 patients (29.1%). Although cisplatin (21.8%) was the most commonly used drug, daunorubicin, cytarabine, tamoxifen, toremifene, and imatinib were also frequently used. The median duration until ophthalmologic diagnosis was 208.5 days (range, 19-5,945 days). The proportion of patients with final visual acuity (VA) < 20/40 Snellen VA (0.5 decimal VA) was 32.7%. However, no relationship was observed between final VA < 20/40 and age, sex, therapeutic agents, and metastasis. CONCLUSION: Uveoretinal complications were mostly mild to moderate and exhibited a favorable response to conservative therapy. A considerable number of patients exhibited significant irreversible loss of vision after cessation of the causative chemotherapeutic agent. Ophthalmological monitoring is required during chemotherapy.

Improved Visual Outcome and Low Recurrence with Early Treatment with Intravitreal Anti-Vascular Endothelial Growth Factor in Myopic Choroidal Neovascularization.

PURPOSE: The aim of this study was to determine the correlation between the duration of myopic choroidal neovascularization (CNV) and treatment outcome after anti-vascular endothelial growth factor (VEGF) injections. METHODS: We performed a retrospective review of treatment-naïve myopic CNV patients who were treated with anti-VEGF and followed for at least 24 months to identify factors predicting final outcome and recurrence. RESULTS: Among 106 eyes, a shorter duration of CNV was a significant predictor of a better final best-corrected visual acuity, even after controlling for other factors (p = 0.042). When divided into 3 groups according to CNV duration before treatment (<2, 2-8, and 8-24 weeks), the recurrence rate (19, 25, and 52%, respectively; p = 0.006) and number of injections (3.5, 4.0, and 5.5, respectively; p = 0.021) were significantly lower in eyes with a shorter duration of CNV. CONCLUSIONS: Early anti-VEGF treatment of myopic CNV decreased the recurrence rate and number of injections and improved visual outcome.

Minimally Invasive Microincision Vitrectomy Surgery with an Intraoperative Dexamethasone Implant for Refractory Diabetic Macular Edema.

PURPOSE: To evaluate the 1-year results of 25-gauge microincision vitrectomy surgery (MIVS25) combined with intraoperative dexamethasone (DEX) implant for persistent diabetic macular edema (DME). METHODS: This study enrolled patients who had a history of DME for ≥12 months and underwent MIVS25 and DEX implant injection. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed postoperatively. RESULTS: Eighteen eyes were included in the analysis. Preoperatively, logMAR BCVA was 0.90 and CRT was 594 µm on average. CRT decreased until the 3-month follow-up visit and tended to increase at 6 months, but stabilized at 12 months with additional treatments in five eyes at 5 months postoperatively. Statistically significant improvement in BCVA was noted 1 month after treatment and at each subsequent follow-up visit (p < 0.001). CONCLUSION: MIVS25 combined with DEX implant injection might be utilized as an effective and safe alternative treatment for intractable DME.

Development and progression of diabetic retinopathy and associated risk factors in Korean patients with type 2 diabetes: the experience of a tertiary center.

The aim of this study was to evaluate the incidence of and risk factors for the development of diabetic retinopathy (DR) and progression to proliferative DR (PDR) in Korean patients. Patients diagnosed with type 2 diabetes and followed for more than 5 years at a university-based clinic since 2000 were consecutively enrolled in this retrospective cohort study. Based on the DR classification at the initial and final visits, the incidence and progression of DR was determined and patient characteristics were compared according to DR progression. Hazard ratios of each putative risk factor for DR progression were calculated with a multivariate Cox proportional hazard model. Rate of DR development and progression to PDR were 32.1/1,000 and 26.2/1,000 person-years, respectively. A longer duration of diabetes and higher mean HbA1c level were significant risk factors for the development of DR. Regarding progression to PDR, higher mean HbA1c level, higher standard deviation of HbA1c, and higher urine albumin-to-creatinine ratio were significant risk factors. The rates of development of DR and progression to PDR in Koreans with type 2 diabetes are lower than those reported over the last decade. An inadequate blood glycemic control is the common risk factor for development and progression of DR.

Recurrent cholesterol granuloma of the orbit.

A 40-year-old woman presented with a 1-year history of left proptosis and hypoglobus. Eight years ago, she had undergone the surgical removal of left orbital cholesterol granuloma by Krönlein lateral orbitotomy. MRI showed a lesion of high T1-signal intensity and heterogeneous T2-signal intensity, which did not demonstrate gadolinium enhancement. The lesion was excised via a sub-brow skin incision, and careful drilling and curettage of the affected bony surface of the superolateral orbit were also performed. The diagnosis of orbital cholesterol granuloma was made by histopathologic examination. There was no evidence of tumor recurrence after 2 years of follow up. The authors present a rare case of recurrent cholesterol granuloma of the orbit and its successful surgical treatment with complete excision of the tumor and the surrounding bony base.

Ocular pulse amplitude as a dynamic parameter and its relationship with 24-h intraocular pressure and blood pressure in glaucoma.

Abnormal ocular blood flow (OBF) has been suspected as one of the underlying mechanisms of glaucoma. The ocular pulse amplitude (OPA) is considered a possible surrogate parameter for ocular blood flow (OBF) measurement and has been studied in its association with glaucoma. Although there have been several studies that reported various ocular and systemic factors in association with OPA, all of these studies were based on a single measurement of these factors as well as OPA. The purpose of this study was to determine the 24-h (h) dynamic variability and any associations between OPA and intraocular pressure (IOP) and blood pressure (BP) variables using 24-h data collected from untreated patients with normal-tension glaucoma (NTG). One hundred and forty-four patients with NTG were consecutively enrolled. All patients underwent 24-h monitoring of IOP, OPA, and BP variables. A cosinor model was used to describe the patterns and statistical significance of the 24-h OPA rhythm, as well as the IOP and BP variables. Associations between 24-h OPA data, IOP and BP variables, and ocular and demographic factors were also assessed using the generalized estimating equation. Over the course of 24-h, OPA (p = 0.007) demonstrated significant dynamic diurnal rhythms that were similar to the other dynamic variables (all p < 0.05). Based on the 24-h data, IOP (p < 0.001), arterial pulse pressure (p = 0.034), and the spherical equivalent (p < 0.001) positively correlated with the OPA, whilst male sex (p < 0.001) negatively correlated with the OPA. These results indicate that OPA is primarily influenced by IOP as well as arterial pulse pressure, spherical equivalent, and gender. In conclusion, OPA is a dynamic ocular parameter that demonstrates a 24-h short-time fluctuation in NTG patients.

Bilateral Multiple Retinal Detachments Associated with Diffuse Large B-Cell Lymphoma: Masquerading as Vogt-Koyanagi-Harada Disease.

PURPOSE: We report a case of intraocular involvement in diffuse large B-cell lymphoma masquerading as Vogt-Koyanagi-Harada disease. METHODS: A 48-year-old woman presented with blurred vision in both eyes, fever, and hearing disturbance and underwent a complete ophthalmologic and systemic evaluation. RESULTS: Ophthalmologic examination showed bilateral exudative retinal detachment and signs of Vogt-Koyanagi-Harada disease. However, considering her generalized symptoms, systemic evaluation was performed before administering systemic steroid pulse therapy. In a systemic investigation, the patient was diagnosed with intraocular involvement in diffuse large B-cell lymphoma. After systemic chemotherapy, her bilateral visual acuity improved to 20/25 and the bilateral serous retinal detachment resolved. CONCLUSION: In cases with prominent systemic symptoms, comprehensive systemic evaluation should be performed to rule out severe systemic conditions, such as malignancies.

Factors Affecting Intensive Aflibercept Treatment Response in Diabetic Macular Edema: A Real-World Study.

Objective: To investigate the systemic and ocular factors that affect the response to intensive aflibercept treatment in diabetic macular edema (DME) in a real-world setting. Methods: This retrospective cohort study evaluated 30 eyes of 23 patients with DME who underwent intensive intravitreal aflibercept injections (five monthly loading doses). Treatment response was assessed by central retinal thickness (CRT) and best-corrected visual acuity (BCVA) at each monthly visit. The patients were categorized as good (<300 µm) and suboptimal (≥300 µm) responders based on CRT after the loading phase. Baseline systemic and ocular factors associated with treatment response were investigated. Results: The mean CRT and BCVA significantly improved after five loading injections (486.87 ± 95.46 to 334.90 ± 69.47 µm and 0.51 ± 0.30 to 0.35 ± 0.25 LogMAR, respectively, all p < 0.05). During 12 months of follow-up, 16 eyes (53.33%) maintained CRT without additional treatment. Eyes with diabetes mellitus (DM) for ≥15 years, estimated glomerular filtration rate (eGFR) < 80 mL/min/1.73 m2, serum creatinine ≥ 0.95 mg/dL and potassium ≥ 4.7 mmol/L, and presence of epiretinal membrane (ERM) were more likely to have a suboptimal response to the treatment. Conclusions: Five monthly loading doses of intravitreal aflibercept injection provided significant anatomical and visual improvements in patients with DME. Patients with longer DM duration, lower eGFR, higher serum creatinine or potassium levels, or ERM were predisposed to a suboptimal treatment response. Individual response to intensive aflibercept treatment for DME can be predicted by these systemic and ocular risk factors.