CFH and VIPR2 as susceptibility loci in choroidal thickness and pachychoroid disease central serous chorioretinopathy.

Central serous chorioretinopathy (CSC) is a common disease affecting younger people and may lead to vision loss. CSC shares phenotypic overlap with age-related macular degeneration (AMD). As recent studies have revealed a characteristic increase of choroidal thickness in CSC, we conducted a genome-wide association study on choroidal thickness in 3,418 individuals followed by TaqMan assays in 2,692 subjects, and we identified two susceptibility loci: CFH rs800292, an established AMD susceptibility polymorphism, and VIPR2 rs3793217 (P = 2.05 × 10-10 and 6.75 × 10-8, respectively). Case-control studies using patients with CSC confirmed associations between both polymorphisms and CSC (P = 5.27 × 10-5 and 5.14 × 10-5, respectively). The CFH rs800292 G allele is reportedly a risk allele for AMD, whereas the A allele conferred risk for thicker choroid and CSC development. This study not only shows that susceptibility genes for CSC could be discovered using choroidal thickness as a defining variable but also, deepens the understanding of differences between CSC and AMD pathophysiology.

MACULAR ATROPHY FINDINGS BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY COMPARED WITH FUNDUS AUTOFLUORESCENCE IN TREATED EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To compare the areas of choriocapillaris (CC) nonperfusion and macular atrophy (MA) in treated exudative age-related macular degeneration. METHODS: This was a prospective, observational, cross-sectional study. Forty-four eyes exhibiting MA (42 patients with age-related macular degeneration), with a dry macula, underwent fundus autofluorescence and optical coherence tomography angiography. The area of MA detected by fundus autofluorescence and CC nonperfusion detected by optical coherence tomography angiography was measured using image analysis software. The rates of concordance between the MA and CC nonperfusion areas were calculated. We qualitatively and quantitatively compared the areas of MA and CC nonperfusion in age-related macular degeneration eyes. RESULTS: The mean areas of MA and CC nonperfusion were 5.95 ± 4.50 mm and 10.66 ± 7.05 mm, respectively (paired t-test, P < 0.001). In 39 eyes (88.6%), the CC nonperfusion area was larger than the MA area, and the mean CC nonperfusion area was significantly larger than the mean MA area. Fundus autofluorescence matching optical coherence tomography angiography showed that the CC nonperfusion area was almost included in the MA area. The mean concordance rate for the MA area inside the CC nonperfusion area was 87.7 ± 13.9%. CONCLUSION: The MA and CC nonperfusion areas markedly overlapped. The area of CC nonperfusion correlated with the MA area. Choroidal ischemia might be involved in the pathogenesis of MA in treated age-related macular degeneration.

CLINICAL FEATURES OF TREATED AND UNTREATED TYPE 1 IDIOPATHIC MACULAR TELANGIECTASIA WITHOUT THE OCCURRENCE OF SECONDARY CHOROIDAL NEOVASCULARIZATION FOLLOWED FOR 2 YEARS IN JAPANESE PATIENTS.

PURPOSE: To evaluate the clinical features of Type 1 idiopathic macular telangiectasia (IMT) followed up for 2 years. METHODS: Forty-nine patients with unilateral Type 1 IMT were examined. Thirty-one IMT eyes were treated with direct laser photocoagulation and/or intravitreal bevacizumab; the remaining 18 eyes, with good vision or slight macular edema, were untreated. Changes in best-corrected visual acuity and central retinal thickness between baseline and 24 months after the initial visit were examined. RESULTS: Of 49 eyes, nine were treated with direct laser photocoagulation, 12 with laser photocoagulation and intravitreal bevacizumab, 10 with intravitreal bevacizumab monotherapy, whereas 18 did not receive any treatment. The mean logarithm of the minimum angle of resolution best-corrected visual acuity was 0.20 ± 0.19 (median, 20/29) and 0.13 ± 0.22 (median, 20/25) at baseline and 24 months, respectively (P = 0.023). The mean central retinal thickness was 375.0 ± 94.5 µm and 315.3 ± 78.5 µm at baseline and 24 months, respectively (P < 0.001). Retinal vein occlusion and retinal macroaneurysm occurred in six eyes and one eye, respectively, during follow-up. CONCLUSION: Treatment with laser photocoagulation and/or intravitreal bevacizumab may be effective for Type 1 IMT, 36.7% of IMT eyes required no treatment over a 2-year follow-up, and other retinal vascular events were not uncommon.

Paravascular inner retinal abnormalities in healthy eyes.

PURPOSE: To investigate the prevalence and characteristics of paravascular inner retinal abnormalities in healthy eyes. MATERIALS AND METHODS: In this prospective observational case series, we included 178 healthy eyes (178 patients) with no ocular diseases. Eyes with co-existing ocular diseases, e.g., epiretinal membrane, glaucoma, or high myopia, were excluded from the current study. The posterior pole and paravascular areas of the temporal arcade vessels were comprehensively examined by dense radial scanning of optical coherence tomography (OCT) with the extended field imaging technique. RESULTS: On fundus photography, no inner retinal abnormalities were detected along the temporal arcade vessels. On OCT sections, paravascular inner retinal abnormalities were seen in 77 (43.3%) eyes. In 71 (39.9%) eyes, inner retinal cystoid or fissure-like spaces that had no connection to the vitreous cavity were seen adjacent to the temporal arcade vessels. Most of these lesions were detected only on several consecutive OCT sections. In four (2.2%) eyes, inner retinal cleavages with openings to the vitreous cavity were seen adjacent to the temporal arcade vessels. These lesions were more frequently detected in the inferior hemisphere and along the major retinal veins. No eyes showed typical broad defects of the inner retinal tissue. There were no significant differences in age, gender, visual acuity, refractive error, or axial length between eyes with or without paravascular inner retinal abnormalities. CONCLUSIONS: Paravascular cystoid or fissure-like spaces were frequently seen in the inner retina of healthy eyes. However, we detected no typical paravascular inner retinal defects in healthy eyes.

ASSOCIATION BETWEEN PARAFOVEAL CAPILLARY NONPERFUSION AND MACULAR FUNCTION IN EYES WITH BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To investigate the parafoveal perfusion status of the superficial and deep capillary layer in eyes with resolved branch retinal vein occlusion, and to study its effects on retinal sensitivity. METHODS: In 27 enrolled eyes (27 patients) with resolved branch retinal vein occlusion, superficial and deep capillaries in the macular area (3- × 3-mm, centered on the fovea) were examined with optical coherence tomography angiography. Retinal sensitivity was examined with fundus-monitored microperimetry. RESULTS: Optical coherence tomography angiography clearly showed the parafoveal superficial and deep capillaries individually. On the affected side of retina, 25 eyes (92.6%) showed capillary nonperfusion; 23 (85.2%) in the superficial layer and 22 (81.5%) in the deep layer. Capillary nonperfusions of both layers frequently overlapped and appeared to be connected with each other. Mean (±SD) retinal sensitivity at the superficial capillary nonperfusion was 19.2 ± 6.3 dB, significantly lower than that at the superficial capillary perfusion (24.4 ± 2.8 dB, P < 0.001). Similarly, mean retinal sensitivity at the deep capillary nonperfusion was 20.8 ± 5.0 dB, significantly lower than that at deep capillary perfusion (24.3 ± 2.8 dB, P = 0.0016). Mean retinal sensitivity with superficial capillary nonperfusion was significantly lower than that with deep capillary nonperfusion (P = 0.0226). CONCLUSION: Optical coherence tomography angiography visualized parafoveal capillary nonperfusion in superficial and deep layers individually in eyes with resolved branch retinal vein occlusion. Retinal sensitivity was significantly reduced at these capillary nonperfusions.

Prevalence, characteristics, and pathogenesis of paravascular inner retinal defects associated with epiretinal membranes.

PURPOSE: To investigate the prevalence, detailed characteristics, and pathogenesis of paravascular inner retinal defects (PIRDs) in eyes with epiretinal membranes (ERMs). METHODS: In this prospective observational case series, we included 81 eyes of 81 patients with idiopathic ERMs, without high myopia. The retinal structure surrounding the PIRDs was assessed using sequential thin sectioning of optical coherence tomography. The PIRDs were classified into three grades. Typical defects of the inner retinal tissue were defined as grade 3. Inner retinal cleavages with openings to the vitreous cavity and no apparent defect of the inner retinal tissue were defined as grade 2. Inner retinal cleavages or cystoid spaces with no connection to the vitreous cavity were defined as grade 1. RESULTS: Of 81 eyes with ERMs, 31 (38.3 %) had PIRDs along the temporal arcade vessels (grade 1 in six eyes, grade 2 in four eyes, and grade 3 in 21 eyes). PIRDs were frequently accompanied by broad defects of the inner retinal tissue (grade 3). Although some ERMs directly adhered to the edge of a PIRD or the retinal vessels, PIRDs were often located outside the area of adhesion to the ERM. In some OCT sections, vitreous traction on the inner retina seemed to contribute to the progression of PIRDs. Visual field abnormalities corresponded to the location of the PIRDs in 44.4 % of eyes with grade 3 PIRDs. CONCLUSIONS: Deviation of retinal vessels due to the traction of the ERMs may contribute to the pathogenesis of PIRDs. PIRDs often cause visual field abnormalities corresponding to the location of the defect.

A method to decrease the frequency of unintentional slippage after vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: To investigate a method for preventing retinal slippage after standard vitrectomy for rhegmatogenous retinal detachment. METHODS: Eighty six eyes with bullous rhegmatogenous retinal detachment underwent successful standard vitrectomy. Patients were divided into 2 groups. In Group 1, 44 patients started face-down positioning at approximately 10 minutes after the end of the surgery. In Group 2, 42 patients started face-down positioning immediately at the end of the surgery. Postoperative retinal slippage was determined by fundus autofluorescence at 1 month postoperatively. Statistical analysis examined several factors to determine the association between the start time of the face-down positioning and retinal slippage. RESULTS: Retinal slippage occurred in 63.6% of Group 1 and in 24.0% of Group 2 patients. This difference was statistically significant (P = 0.004, Fisher's exact probability test). Both the extent of retinal slippage (P = 0.029) and the face-down position (P < 0.001) were significantly associated with the retinal slippage. CONCLUSION: Earlier implementation of face-down positioning may prevent retinal slippage after surgery in eyes with rhegmatogenous retinal detachment treated by standard vitrectomy.

[Normal values of retinal sensitivity determined by macular integrity assessment].

PURPOSE: To investigate the macular sensitivity of healthy eyes of a wide age range as determined by macular Integrity Assessment (MAIA), and to investigate factors affecting macular sensitivity. SUBJECTS AND METHODS: A total of 120 eyes of 120 healthy volunteers with a best-corrected visual acuity of 20/20 or better, and of a mean age of 43.1 years. Macular sensitivity was examined by a standard grid, a 37-stimuli grid covering the central 10 degrees of the retina including one centering point. RESULTS: The central sensitivity (CS) was 28.9 dB for subjects under 20 years, 27.2 dB for subjects between 20 to 60 years, and 24.5 dB for subjects over 60 years. The average sensitivity (AS) was 29.6 dB for subjects under 20 years, and after that the sensitivity was 28.7 dB and 26.3 dB. Both CS and AS in subjects over 60 years exhibited a significantly lower sensitivity than in subjects under the age of 20 (p = 0.01). Regression analysis results indicated that the sensitivity gradually decreased by approximately 0.6 dB every 10 years (p = 0.01). The age and development of axial length were statistically significant factors influencing the decline in sensitivity (p = 0.01). When each stimulus position was investigated, the center (0 degrees) was significantly lower (26.4 dB) than surrounding stimulus positions (1 degree: 28.9 dB, 3 degrees: 28.7 dB, 5 degrees: 27.8 dB) (p = 0.01). CONCLUSION: The macular sensitivity in healthy Japanese subjects calculated by MAIA exhibited a significantly low value with aging, and sensitivity decreased with the advance in the development of axial length. The sensitivity of surrounding stimulus positions was higher than in the center (0 degrees).

Correlation of increased fundus autofluorescence signals at closed macula with visual prognosis after successful macular hole surgery.

PURPOSE: To study the significance of the increased fundus autofluorescence (FAF) signals at closed macula with spectral-domain optical coherence tomography and visual prognosis after successful surgery in eyes with idiopathic full-thickness macular holes (MHs). METHODS: Seventy-eight eyes of 78 consecutive patients with full-thickness MHs underwent successful standard vitrectomy, with internal limiting membrane peeling and followed by 10% sulfur hexafluoride gas injection. Simultaneous FAF and optical coherence tomography images were recorded at 10 days, and 1, 3, and 6 months postoperatively, using a combined spectral-domain optical coherence tomography-fluorescein angiography device (Spectralis™/HRA Heidelberg Retina Angiograph 2). The appearance of increased FAF in the macula postoperatively and the relationship of FAF and optical coherence tomography findings to best-corrected visual acuity were examined. RESULTS: Stage 2, 3, and 4 MHs were present in 31, 29, and 18 eyes, respectively. The median patient age was 66 years, with a range of 54 to 79 years. In all patients, the MHs were successfully closed, and the preoperative increased FAF corresponding to MH disappeared 10 days after surgery. In 36 eyes (46.2%), however, hyperautofluorescence again appeared in the macular area 1 month postoperatively. This hyperautofluorescence was significantly associated with the recovery of the external limiting membrane lines at the fovea 1 month after surgery (P = 0.001, multiple logistic regression analysis). Also, this recovery of the external limiting membrane lines 1 month postoperatively was significantly associated with the recovery of photoreceptor inner and outer segment junction line 3 months postoperatively at the fovea (P < 0.001, Fisher exact test). Moreover, a good best-corrected visual acuity of 20/28 or better at 6 months after surgery was significantly associated with hyperautofluorescence in the macula 1 month postoperatively, the recovery of the photoreceptor inner and outer segment lines at the fovea 3 months postoperatively, and preoperative good visual acuity (P < 0.05, multiple logistic regression analysis). CONCLUSION: In full-thickness MHs, 46.2% of our patients showed increased FAF in the macula 1 month after successful MH surgery. This hyperautofluorescence could be a sign of good visual prognosis postoperatively.

Relationship between progression of visual field damage and choroidal thickness in eyes with normal-tension glaucoma.

BACKGROUND: To measure choroidal thickness in normal eyes and in patients with normal-tension glaucoma using enhanced depth imaging optical coherence tomography and evaluate the association between choroidal thickness and progression of visual field damage. DESIGN: Cross-sectional comparative study. PARTICIPANTS: A total of 62 eyes of 62 normal subjects and 45 eyes of 45 normal-tension glaucoma patients were examined. METHODS: The choroid was measured at the fovea and 3 mm nasal and temporal from the fovea. In the separate study, both eyes of the patients with normal-tension glaucoma were included in the analyses. Visual fields were measured with automated perimetry. Changes in mean deviation per year (dB/year), that is, mean deviation slope, were calculated. MAIN OUTCOME MEASURES: Difference in the choroidal thickness between the normal subjects and the patients with normal-tension glaucoma. The relationship between mean deviation slope and the choroidal thickness in eyes with normal-tension glaucoma was analysed. RESULTS: Compared with normal subjects, the choroidal thickness was significantly thinner in eyes with normal-tension glaucoma at 3 mm nasal from the fovea (P = 0.02). There was a significant correlation between the choroidal thickness at 3 mm nasal from the fovea and the mean deviation slope (Pearson's r = 0.413; P < 0.001). CONCLUSION: The decrease in the thickness of the choroid at 3 mm nasal from the fovea in eyes with normal-tension glaucoma may be associated with progressive visual field loss. Thus, choroidal abnormalities may play a role in the pathogenesis of normal-tension glaucoma.

[Changes in subfoveal choroidal thickness of epiretinal membrane and macular hole before and after microincision vitrectomy surgery].

PURPOSE: To evaluate the subfoveal choroidal thickness (SCT) of the epiretinal membrane (ERM) and macular hole (MH) both before and after microincision vitrectomy surgery. SUBJECTS AND METHODS: A total of 104 eyes of 104 subjects (64 ERM, 40 MH, mean age 68.9 years) were evaluated. All subjects underwent vitrectomy with internal limiting membrane peeling. SCT was measured before vitrectomy and 1 week, 1 month and 3 months postoperatively. SCT was measured by enhanced depth imaging OCT (EDI-OCT) using a Heiderberg Spectralis. RESULTS: The SCT of ERM was 202.6 microm before vitrectomy, and 201.8 microm at 1 week, 198.8 microm at 1 month, and 196.4 microm at 3 months postoperatively. There were no significant differences between the times of measurement. MH was 182.5 microm before vitrectomy, and 186.7 microm at 1 week, 189.4 microm at 1 month, and 187.4 microm at 3 months. There were also no significant differences between any other factors. The SCT between the ERM and MH was not significantly different at any time. We examined the correlation between the changes in SCT and the changes in age, refractive error and intraocular pressure (IOP), but found no significant correlation. CONCLUSION: The SCT hat not changed either before or after microincision vitrectomy surgery, and there was no siginificant correlation between SCT and any other factor.

Estimating ranibizumab injection numbers and visual acuity at 12 months based on 2-month data on branch retinal vein occlusion treatment.

Anti-vascular endothelial growth factor treatment for macular edema secondary to branch retinal vein occlusion generally provides good visual acuity (VA) improvement but may require repeated injections for years. To reduce the number of patients who suffer from avoidable VA loss caused by treatment drop-out, providing prospects of the correlation between expected vision improvement and required number of injections at the early stages of treatment may be helpful. In this post hoc analysis of the phase IV, randomized, open-label ZIPANGU study, we investigated the correlation between the data from Month 2 and Month 12 in terms of VA and required ranibizumab injection numbers. Fifty-nine patients were evaluated (ranibizumab monotherapy, 29; combination therapy, 30). In the monotherapy group, patients who received 1 and 3 injections by Month 2 received a mean total of 2.8 and 8.3 injections during the year, respectively. Data from the combination group were similar. The correlation coefficients for VA scores at Months 2 and 12 were 0.60 and 0.51 for the monotherapy and combination groups, respectively (both p < 0.01). Based on VA and injection numbers at Month 2 of treatment, physicians could provide rough prospects on patients' expected final VA and required number of injections.

[Medium-term effects of intravitreal bevacizumab for macular edema associated with central retinal vein occlusion].

PURPOSE: To report the medium term effects of intravitreal injection of bevacizumab for central retinal vein occlusion (CRVO) with macular edema. PATIENTS AND METHODS: Twenty-two eyes of 22 patients receiving intravitreal injections of 1.25 mg/0.05 ml of bevacizumab (IVB) were included. All patients were followed up for 6 months or longer after the final IVB. The visual acuity and central retinal thickness (CRT) were measured at baseline, one week and every three months after the first IVB. RESULTS: The mean follow-up after the final IVB was 12.5 months (6-30 months). The mean visual acuity (baseline : 0.63 +/- 0.39) temporarily improved at one week (0.38 +/- 0.33 : p=0.0002), but there was no significant visual improvement at the final visit (0.73 +/- 0.67 : p=1.0). The mean CRT significantly decreased at one week, three months and six months after IVB and at the last visit. There were no differences in either visual or anatomical outcomes between the ischemic type and non-ischemic type. CONCLUSION: Intravitreal injections of bevacizumab should be initially considered as a possible treatment in eyes with macular edema associated with central retinal vein occlusion.

Correlations among age, sex, axial length, and subfoveal choroidal thickness in the choriocapillaris structure analyzed using multiple en face image averaging optical coherence tomography angiography.

PURPOSE: To analyze the structure of the choriocapillaris in healthy eyes by using averaged en face images acquired using swept source optical coherence tomography angiography and to examine the changes in the macular profile in relation to age, sex, axial length, and choroidal thickness. METHODS: This prospective, cross-sectional study included 81 eyes of 81 subjects without ophthalmologic or systemic diseases who underwent a full ophthalmologic examination, including 3 × 3-mm macular optical coherence tomography angiography. Four to nine choriocapillaris en face images were registered and averaged. The averaged images were then binarized and analyzed. RESULTS: The averaged choriocapillaris images showed a continuous capillary meshwork, whereas the unaveraged images had a granular appearance. The mean total area and size of flow voids were 0.99 ± 0.20 mm2 and 567.8 ± 201.5 µm2, respectively, and these values correlated positively with age (p = 0.002, R = 0.336 and p = 0.026, R = 0.247, respectively). Age-related gains in the mean total area and flow void size were 4.20 × 10-3 mm2 and 3.07 µm2 per year, respectively. However, the mean total area and flow void size had no significant correlation with axial length, subfoveal choroidal thickness, or sex. CONCLUSIONS: Multiple averaged en face swept source optical coherence tomography angiography is more effective than a single optical coherence tomography angiography scan for better visualizing the choriocapillaris. The total area and size of flow voids within a 3 × 3-mm macular area positively correlated with age. This technique can be useful for investigating the changes arising in macular diseases.

The randomized ZIPANGU trial of ranibizumab and adjunct laser for macular edema following branch retinal vein occlusion in treatment-naïve patients.

The ZIPANGU study assessed the efficacy and safety of ranibizumab as a one loading dose + pro re nata (one + PRN) regimen with/without focal/grid laser among treatment-naïve patients suffering from macular edema (ME) following branch retinal vein occlusion (BRVO). ZIPANGU was a phase IV, prospective, randomized, open-label, active-controlled, 12-month, two-arm, multicenter study. Treatment-naïve patients with visual impairment (19-73 letters) caused by ME, defined as central subfield thickness (CSFT) > 300 µm, due to BRVO were randomly assigned to ranibizumab monotherapy (n = 29) or combination therapy (ranibizumab + focal/grid short-pulse laser, n = 30). The primary endpoint was the number of ranibizumab injections. Secondary endpoints were mean changes in best-corrected visual acuity (BCVA) and CSFT, and safety. There were no statistically significant differences in the mean number of ranibizumab injections between monotherapy (4.3 injections) vs. combination (4.1 injections) therapy, or in CSFT. BCVA improvement in the monotherapy arm (22.0 letters) was better than the combination therapy arm (15.0 letters) (p = 0.035). Overall, both regimens appeared to be safe and well tolerated. One + PRN ranibizumab is safe and efficacious in treatment-naïve patients with ME secondary to BRVO. A conjunctive laser treatment did not lead to better functional outcomes or fewer ranibizumab injections.

Unintentional displacement of the retina after standard vitrectomy for rhegmatogenous retinal detachment.

OBJECTIVE: To study unintentional displacement of the retina after standard vitrectomy for rhegmatogenous retinal detachment (RRD). DESIGN: Prospective interventional case series. PARTICIPANTS: Forty-three eyes of 43 consecutive patients with cystic RRD involving 1 or more quadrants underwent successful standard vitrectomy with 20% sulfur hexafluoride gas injection. Neither scleral buckling nor retinotomy was performed. METHODS: Fundus autofluorescence (FAF) imaging was subsequently recorded to detect displacement of the retina using the Topcon TRC-50DX (Topcon, Tokyo, Japan) at 10 days and 1, 3, and 6 months postoperatively. Fluorescein angiography was also recorded using standard techniques for patients with abnormal FAF findings. Cyclotorsion and vertical deviation were measured postoperatively. MAIN OUTCOME MEASURES: The proportion of eyes with postoperative retinal displacement detected by FAF imaging. RESULTS: The mean age of these 43 patients was 60 years with a range of 39 to 77 years. Of the 43 eyes, retinal detachment involved 1 quadrant in 2 eyes, 2 quadrants in 31 eyes, 3 quadrants in 8 eyes, and 4 quadrants in 2 eyes. After complete reattachment of the retina, FAF photography demonstrated hyperfluorescent lines superiorly parallel to retinal vessels within the vascular arcade in 27 of the 43 eyes (62.8%). Fluorescein angiography did not demonstrate any abnormalities corresponding to the linear autofluorescence. This autofluorescence was hypothesized to originate from increased metabolic activity of the retinal pigment epithelium that had been preoperatively located under the major retinal vessels and was postoperatively exposed to light because of downward displacement of the retina. Of the 27 eyes with retinal displacement, 1 to 5 degrees of extorsion were seen in 16 eyes (59.3%), and 1 to 4 degrees of vertical deviation were seen in 13 eyes (48.1%). None of the 27 patients had diplopia or slant. The extent of retinal detachment (P = 0.019) and the macular status (on or off) (P = 0.016) were significantly associated with postoperative displacement of the retina. CONCLUSIONS: In eyes with RRD treated with standard vitrectomy and gas injection, the retina may move downward after the surgery. If the extent of retinal detachment is large, or macular detachment is present, unintentional postoperative retinal translocation may easily occur. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Retinal oximetry in branch retinal vein occlusion.

PURPOSE: To measure retinal oxygen saturation (SO2 ) in eyes with branch retinal vein occlusion (BRVO). METHODS: Retinal oximetry was performed using the Oxymap T1 retinal oximeter in 50 eyes (50 patients) with resolved BRVO. SO2 was calculated in each major retinal artery and vein in four quadrants. The superior or inferior hemisphere with BRVO was categorized as the affected hemisphere and the other as the unaffected hemisphere. RESULTS: Oxymap T1 allowed us to measure SO2 in major retinal vessels. Both arterial and venous SO2 in the affected hemisphere were significantly higher than those in the unaffected hemisphere. However, there was no significant difference in arteriovenous (A-V) difference in SO2 between the affected and unaffected hemispheres. Of the 50 included eyes, 32 had non-ischemic BRVO and 18 had ischemic BRVO. In the affected hemisphere, arterial SO2 was significantly higher in ischemic BRVO (106.9 ± 8.8%) than in non-ischemic BRVO (101.3 ± 9.2%, p = 0.044). There were no significant differences in venous SO2 between non-ischemic and ischemic BRVO. Consequently, the A-V difference in SO2 was significantly higher in ischemic BRVO (51.9 ± 13.9%) than in non-ischemic BRVO (43.4 ± 11.5%, p = 0.028). In multiple regression analysis, the type of perfusion (non-ischemic or ischemic) had associations with arterial SO2 (ß = 0.365, p = 0.013) and with A-V differences in SO2 in the affected hemisphere (ß = 0.406, p = 0.006). CONCLUSION: In ischemic BRVO, arterial SO2 and the A-V difference in SO2 in the affected hemisphere were significantly higher than in non-ischemic BRVO.

Genome-wide association analyses identify two susceptibility loci for pachychoroid disease central serous chorioretinopathy.

The recently emerged pachychoroid concept has changed the understanding of age-related macular degeneration (AMD), which is a major cause of blindness; recent studies attributed AMD in part to pachychoroid disease central serous chorioretinopathy (CSC), suggesting the importance of elucidating the CSC pathogenesis. Our large genome-wide association study followed by validation studies in three independent Japanese and European cohorts, consisting of 1546 CSC samples and 13,029 controls, identified two novel CSC susceptibility loci: TNFRSF10A-LOC389641 and near GATA5 (rs13278062, odds ratio = 1.35, P = 1.26 × 10-13; rs6061548, odds ratio = 1.63, P = 5.36 × 10-15). A T allele at TNFRSF10A-LOC389641 rs13278062, a risk allele for CSC, is known to be a risk allele for AMD. This study not only identified new susceptibility genes for CSC, but also improves the understanding of the pathogenesis of AMD.

One-year outcomes of fixed treatment of intravitreal aflibercept for exudative age-related macular degeneration and the factor of visual prognosis.

The aim of this study was to investigate the efficacy of periodic intravitreal aflibercept (IVA) in exudative age-related macular degeneration, and to explore the predictive factors for visual outcome.This is a prospective interventional case series.Fifty-two eyes of 52 treatment-naïve age-related-macula-degeneration patients were enrolled. All participants received IVA bimonthly following 3 monthly loading dose. The primary endpoint was change in best corrected visual acuity (BCVA) and central retinal thickness (CRT), and the secondary outcomes included changes in subfoveal choroidal thickness (SCT), macular atrophy (MA), and retinal average sensitivity (AS) determined by microperimetry at 12 months compared with baseline. The predictive factors for the change of BCVA were examined.Of 52 enrolled patients, 4 patients were drop out. Remaining 48 patients were examined. Mean logMAR BCVA significantly improved from 0.42 ±â€Š0.37 at baseline to 0.29 ±â€Š0.34 at 12 months (P = .008). Mean CRT and SCT significant reduced from 285.6 ±â€Š135.2 µm, 247.9 ±â€Š96.7 µm at baseline to 233.4 ±â€Š98.0 µm, 208.1 ±â€Š94.6 µm at 12 months, respectively (P < .001). At 12 months, 35 eyes of 48 eyes (72.3%) were archived dry macula. MA occurred in 7 eyes of 35 eyes with dry macula at 12 months (20.0%). AS was significant improved (P = .027) between baseline (median: 15.7 dB) and 12 months (median: 19.5 dB). The BCVA of the cases with MA involved fovea was significant worse. Age was significantly predicted for the BCVA at 12 months.IVA administered over 1 year improved BCVA, AS, and morphological findings, and the predictive factors for BCVA were age and MA-involved fovea.