Effect of the COVID-19 pandemic on Vogt-Koyanagi-Harada disease.

To determine the disease prevalence rate and clinical characteristics of Vogt-Koyanagi-Harada (VKH) disease among new patients before and after the declaration of a state of emergency (April 7, 2020) in Japan. New patients and patients with newly diagnosed VKH disease were categorized into "Before" and "After" groups based on the initial visit. The prevalence rate, sex ratio, and age of patients newly diagnosed with VKH were compared between the groups. Best-corrected visual acuity (BCVA) and recurrence rates were compared among 59 patients observed for > 12 months after receiving pulse steroid therapy. For reference, we also examined the prevalence rate of patients newly diagnosed with acute angle closure (AAC) in the Before and After groups. The prevalence rates of VKH disease among newly diagnosed patients (P < 0.05) or patients with AAC (P < 0.001) were significantly higher in the After group. No significant differences in sex ratio or age of VKH disease were observed in both groups. BCVA and recurrence rates showed no significant differences. The COVID-19 pandemic increased the prevalence of VKH disease among new patients compared with that of AAC. However, the clinical features of VKH disease were unlikely affected by the COVID-19 pandemic.

Background diseases and the number of previous intravitreal aflibercept injections on immediate intraocular pressure increase and vitreous reflux rate in phakic eyes.

AIM: To evaluate the effect of background diseases and number of previous intravitreal aflibercept injections (IVAIs) on immediate intraocular pressure (IOP) increase and vitreous reflux (VR) rate and to evaluate the correlation of both age and axial length with immediate IOP increase and VR rate. METHODS: This study included 105 patients with cystoid macular edema secondary to retinal vein occlusion, 35 patients with diabetic macular edema, 69 patients with neovascular age-related macular degeneration (nAMD), and 12 patients with myopic choroidal neovascularization, which underwent first-time IVAI. The correlation of immediate IOP increase and VR rates with the four background diseases was investigated. Moreover, the correlation of age with immediate IOP increase and VR rate as well as correlation of axial length with immediate IOP increase and VR rate were evaluated. Further, 54 patients with nAMD were treated with IVAI>10 times (multiple IVAIs). Moreover, the correlation of immediate IOP increase and VR rates with first-time and multiple IVAIs in nAMD was determined. RESULTS: The immediate IOP increase (P=0.16) and VR rates (P=0.50) were almost similar among the four background diseases. The immediate postinjection IOP and age, VR rate and age, immediate postinjection IOP and axial length, or VR rate and axial length were not correlated in the four background diseases. The immediate IOP increase (P=0.66) and VR rates (P=0.28) did not significantly differ between first-time and multiple IVAIs in nAMD. CONCLUSION: Background diseases and number of previous IVAIs have no effect on immediate IOP increase and VR rate. Further, age and axial length have no correlation on immediate IOP increase and VR rate.

Conformation of Horizontal Extraocular Muscle Insertions in Acute Acquired Concomitant Esotropia Induced by Excessive Digital Device Usage.

Purpose: Acute acquired concomitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. Convergence spasm induced by excessive near work has been suggested as a mechanism. Anatomical differences could also potentially contribute to SAACE onset. The present study investigated the conformation of horizontal recti between SAACE patients and normal subjects. Patients and Methods: In 15 SAACE patients (SAACE group), the distances between the limbus and insertion of the horizontal recti (LI distance) and the widths of horizontal recti on the insertion (insertion width) were measured. The control group consisted of 30 patients who underwent retinal detachment surgery. Differences in LI distances and insertion widths were compared between SAACE and control groups. Results: While there were no differences between the two groups for LI distances and insertion widths of lateral recti, there were significantly shorter LI distances for the medial recti in the SAACE group (P<0.05). Moreover, the SAACE group tended to exhibit larger insertion widths of the medial recti. Medial/lateral ratio of LI distances were significantly lower and insertion widths were significantly higher in the SAACE compared to the control group (P<0.05). Conclusion: Based on the observations of more anterior insertion and larger muscle widths, this suggests there are stronger forces of medial recti in SAACE. In addition to excessive accommodation followed by increases in medial recti tonus, the results also suggest that an anatomical imbalance between lateral and medial recti contributes to esotropia onset following excessive near work.

Possible association between vaccination against SARS-CoV-2 and recurrence of macular edema due to branch retinal vein occlusion: a case report.

We herein describe a patient who developed recurrence of macular edema (ME) due to branch retinal vein occlusion (BRVO) 3 days after administration of the BNT162b2 vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A man in his early 50s visited our hospital because of vision loss in his right eye. His logarithmic best-corrected visual acuity (BCVA) was -0.79 in both eyes. ME due to superior temporal BRVO was observed in his right eye, and the central foveal thickness (CFT) was 486 µm. The patient was treated with an intravitreal aflibercept injection with logarithmic BCVA of -0.79, leading to resolution of the ME with a CFT of 299 µm. Three months after the initial visit, he received a fourth dose of an mRNA vaccine. Three days later, he developed vision loss in his right eye. Although the logarithmic BCVA was maintained at -0.79, ME recurred with a CFT of 507 µm. The patient was treated with an additional dose of intravitreal aflibercept injection. The ME resolved and the logarithmic BCVA in the right eye was maintained at -0.79. This case indicates a possible association between vaccination against SARS-CoV-2 and recurrence of ME due to BRVO.

Sympathetic ophthalmia in an 85-year-old female and a 90-year-old male after a non-complicated cataract surgery: a case report.

Here, two cases involving the oldest reported patients with sympathetic ophthalmia (SO) after non-complicated cataract surgery, are reported. The first case was an 85-year-old female with bilateral decreased vision and headache. The best-corrected visual acuity (BCVA) was 0.8 in the right eye and 1.0 in the left eye at the initial visit. Pseudophakia and choroidal detachments were observed in both eyes, and retinal pigment epithelium undulation was observed by optical coherence tomography. The second case was a 90-year-old male with bilateral optic disc oedema. The BCVA was 0.09 in the right eye and 0.3 in the left eye with pseudophakic eyes. Optic disc oedema and choroidal thickening were observed in both eyes. Both patients were diagnosed with SO, and corticosteroid pulse treatments were started. The BCVA of the first case improved to 0.9 in the right eye and 1.2 in the left eye, while that of the second case reached 0.3 in the right eye and 0.6 in the left eye. No recurrence was observed in either case at 12 months after the initial visit. Both elderly patients with SO were successfully treated.

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage.

BACKGROUND: Acute acquired comitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. One suggested mechanism is convergence spasm induced by excessive near work, with refraining from digital device use considered to be an effective method for decreasing the degree of esodeviation. However, if symptoms persist and are untreated over time, recovery becomes more difficult. The present study evaluated the effects of topical cycloplegics on persistent SAACE untreated for over 1 year. METHODS: Patients with sustained SAACE that was untreated for over 1 year were evaluated. Digital device usage was discouraged and a topical cycloplegic, 0.4% tropicamide, was prescribed at bedtime. After obtaining informed consent, the 14 out of 23 enrolled patients who agreed to eye drop administration were defined as the study group, with the others serving as the controls. After a 3-month follow-up, patients who elected to undergo surgery were analyzed as the surgery group. Changes in esotropia angles, stereoacuity and diplopia complaints were evaluated after a 3-month follow-up. RESULTS: Esotropia angles decreased and stereoacuity improved after a 3-month treatment in the study group (P < 0.01). Diplopia disappeared in 13 patients (92.9%, totally disappeared or disappeared when using glasses with built-in prisms). Among 11 patients with untreated esotropia ranging from 1-3 years, decreases in esotropia angles were correlated to untreated esotropia duration (near: R = -0.6; distance: R = 0.7; both P < 0.05). Esotropia angles in the control group exhibited a tendency to increase while stereoacuity tended to deteriorate after the 3-month follow-up. As diplopia did not disappear in any patients, 7 elected to undergo surgery and were enrolled as the surgery group. While esotropia angles decreased in the study group, they were lower than the surgery group (P < 0.01), but higher than the control group (P < 0.01). Stereoacuity was worse in the control versus the study and surgery groups (both P < 0.05). CONCLUSION: Results suggest short-acting topical cycloplegics are effective in SAACE patients with long untreated periods. Decreases in esotropia angles were negatively correlated to untreated esotropia duration, which suggests the necessity of early treatment.

Changes in Aqueous Humor Lutein Levels of Patients with Cataracts after a 6-Week Course of Lutein-Containing Antioxidant Supplementation.

PURPOSE: Oxidative damage is known to be an important cause of age-related cataracts and it has been suggested that administration of antioxidants, such as lutein, may delay the onset and progression of cataracts. Our previous investigation of human aqueous humor after the intake of a lutein-containing supplement demonstrated decreases in peroxidative products. This study evaluated the transportation of lutein into aqueous humor which is an important factor when measuring the antioxidant effects of lutein on the lens. METHODS: This study enrolled 155 patients with binocular cataracts of the same grade. Serum and aqueous humor samples were collected during cataract surgery before (as pre-intake samples) and after 6 weeks of oral intake of Ocuvite + Lutein® (as post-intake samples). Lutein levels were measured with high-performance liquid chromatography. RESULTS: Lutein levels in both the serum and aqueous humor were significantly higher in the post-intake than the pre-intake samples. There were significant increases in the lutein levels in patients with lower pre-intake lutein serum levels. There was also a tendency for greater increases in patients with lower pre-intake aqueous humor lutein levels. CONCLUSIONS: These results demonstrate that oral lutein supplementation increases lutein levels, which further induce decreases in peroxidation in the aqueous humor. Furthermore, lutein supplementation may be more effective in patients with lower serum lutein levels.

Intravitreal Fasudil for Treatment of Diabetic Macular Edema with an Unfavorable Response.

PURPOSE: This study evaluates the effect of intravitreal injection of a Rho-associated protein kinase (ROCK) inhibitor, fasudil, on diabetic macular edema (DME) with an unfavorable response. METHODS: This study included 14 eyes of 13 patients (mean age: 65.7 ± 5.2 years) with DME, and eligible eyes underwent single intravitreal injection of 0.025 mg fasudil. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) were evaluated before and 1, 2, and 3 months after treatment. The standard automated perimetry (SAP) results and maximal response of the electroretinogram (ERG) were recorded before and 3 months after treatment. RESULTS: The BCVA, IOP, and CMT remained unchanged during the study period. Similarly, the mean deviation obtained by SAP and each ERG parameter did not show significant changes after the treatment. CONCLUSIONS: Although single intravitreal fasudil injection failed to show therapeutic benefits in DME, it seemed to have no negative effect on the retina.

Significant correlations between focal photopic negative response and focal visual sensitivity and ganglion cell complex thickness in glaucomatous eyes.

PURPOSE: To determine whether there are significant correlations between the focal photopic negative response (PhNR), the focal visual sensitivity and the ganglion cell complex (GCC) thickness in glaucomatous eyes. STUDY DESIGN: Single-center observational study. METHODS: Fifty-two eyes of 52 patients (71.4 ± 9.42 years) with clinically diagnosed open angle glaucoma were studied. Thirty-six age-matched normal subjects served as controls. The focal PhNR of the focal macular electroretinograms (fmERGs) were elicited by a 15° circular, a superior semicircular or an inferior semicircular stimulus centered on the fovea. The thickness of the GCC was measured in the corresponding retinal areas in the spectral-domain optical coherence tomographic images. The visual sensitivities (dB) were measured by microperimetry at the retinal area where the fmERGs were elicited and were converted to liner values (1/Lambert). RESULTS: The focal PhNR amplitudes were significantly correlated with the visual sensitivities of the full-circle (R = 0.532), the superior (R = 0.530) and inferior (R = 0.526) semicircular responses (P < 0.0001). The GCC thickness was correlated with the visual sensitivities in the same areas with stronger correlations (R = 0.700, 0.759 and 0.650, respectively; P < 0.0001). The focal PhNR amplitudes were proportionally reduced with the thinning of the GCC thickness (R = 0.494, 0.518 and 0.511, respectively; P < 0.0001). CONCLUSIONS: The significant correlations between the focal PhNR amplitudes, the focal visual sensitivities and the GCC thickness indicate that these may be good biomarkers to track the changes in the physiology and anatomy of the macular area in glaucomatous eyes.

Long-Term Observations of Thickness Changes of Each Retinal Layer following Macular Hole Surgery.

PURPOSE: To determine the long-term changes of the thickness of each retinal layer following macular hole (MH) surgery combined with internal limiting membrane (ILM) peeling. METHOD: The medical records of 42 eyes of 42 patients (41 to 86 years of age) who underwent MH surgery with ILM peeling between February 2016 and October 2018 were reviewed. A single surgeon operated on all patients, and all were followed for at least 24 months postoperatively. Spectral-domain optical coherence tomography (OCT) was performed to obtain retinal thickness maps of the parafoveal region corresponding approximately to the ILM peeled area. Each retinal layer was automatically segmented by the embedded software, and thickness maps were constructed for the total retinal layer (TRL), inner RL (IRL), middle RL (MRL), and outer RL (ORL). The averaged value of each retinal layer thickness was analyzed in the temporal/upper, temporal/lower, nasal/upper, and nasal lower quadrants. RESULTS: The TRL thickness was significantly decreased in the temporal areas postoperatively. The IRL thickness thinned progressively and significantly until 6 months without further thinning in the temporal quadrants. The MRL thickness of all areas was significantly thicker than the baseline values at 0.5 months and then gradually decreased in the temporal regions. However, the thickening in the nasal regions returned to the baseline values after 1.5 months. The ORL decreased transiently relative to the baseline values at 0.5 months in all areas. CONCLUSIONS: The ILM peeling does not affect only the thickness of the inner retina but also the middle and outer retinae in the parafoveal region. The chronological changes of the thickness after surgeries varied among the retinal layers and macular regions.

Changes in Macular Pigment Optical Density among Pseudophakic Patients following Intake of a Lutein-Containing Supplement.

INTRODUCTION: Cataract surgery has been reported as a long-term risk of reduced macular pigment optical density (MPOD). This study investigated changes in MPOD in pseudophakic patients after lutein supplementation. METHODS: Fifty-seven patients who had no ocular diseases and underwent cataract surgery with concurrent implantation of clear intraocular lenses were included. MPOD was measured before lutein supplementation and every week during 6 weeks of supplementation. Two additional measurements were conducted after the end of supplementation. RESULTS: Compared with baseline, MPOD was increased after 1 week of supplementation (p < 0.01) and remained elevated after cessation of supplementation. After 3 weeks of supplementation, MPOD in females was higher than that in males (p < 0.05). Compared with patients at the highest quintile baseline MPOD, patients of both genders at the lowest quintile had significant increases after 6 weeks of supplementation (p < 0.05). CONCLUSION: MPOD increased after lutein supplementation in patients who had undergone cataract surgery. With the same amount of lutein supplementation, MPOD increased more in patients with low MPOD at baseline; it also increased more in females than in males. Lutein supplementation is presumed to support increased MPOD, which can reduce the risk of age-related macular degeneration, especially in females with low MPOD.

Ophthalmological symptoms in a patient with reversible cerebral vasoconstriction syndrome: a case report.

BACKGROUND: Reversible cerebral vasoconstriction syndrome is characterized by severe headache with reversible segmental constriction of the cerebral arteries. We present details on a patient with reversible cerebral vasoconstriction syndrome who initially visited an ophthalmologist because of visual symptoms. CASE PRESENTATION: A 34-year-old Japanese woman complained of sustained headache and insomnia starting 2 days after her first childbirth. In addition to the severe headache, a visual field defect was also observed 10 days later. Best corrected visual acuity at the initial visit was 20/20 and 20/25 for the right and left eye, respectively. Exudative retinal detachment was noted surrounding both optic heads. Visual field testing revealed left homonymous hemianopsia, while magnetic resonance imaging demonstrated the presence of edema and infarction of the bilateral basal nuclei and right occipital lobe. The homonymous hemianopsia and exudative retinal detachment recovered immediately after treatment with a free-radical scavenger and anticoagulant. There has been no recurrence of symptoms during the 4 years of follow-up. CONCLUSIONS: We report a case of reversible cerebral vasoconstriction syndrome with ophthalmological symptoms that were reversible, including serous retinal detachment and homonymous hemianopsia.

Relationships between the vascular structure and neural function of the macula in patients with diabetes mellitus.

PURPOSE: To determine the significance of the correlation between the vascular structure and neural function of the macula in patients with diabetes mellitus. STUDY DESIGN: Single-center observational study. PATIENTS AND METHODS: Ninety eyes of 90 diabetic patients with an average (SD) age of 63.5 (3.8) years were studied. Fifty of the eyes had no clinically apparent diabetic retinopathy (non-DR), and 40 eyes had mild-to-moderate nonproliferative DR (NPDR). Thirty age-matched healthy individuals were also studied in the same way. Swept-source optical coherence tomography angiography (OCTA) was performed to obtain 3 × 3-mm en face images of the posterior pole of the eye. The vascular densities (VDs) of the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) were determined. The focal macular electroretinograms (ERGs) elicited by a 15° circular stimulus centered on the fovea were recorded. The amplitudes of the a- and b-waves, sum of the oscillatory potentials (ΣOPs), photopic negative response (PhNR), and implicit times of the individual OPs (OP1-OP3) were measured. RESULTS: The VDs of the SCP and DCP were reduced in eyes with advanced DR (P < .01 for SCP). The implicit times of OP1-OP3 were significantly prolonged in eyes with a lower VD of the SCP and DCP in the non-DR group (P < .05). The amplitudes of the ΣOPs were significantly smaller in eyes with a reduced VD of the SCP and DCP in the NPDR group (P < .05). The correlation coefficients were higher for the OP implicit times than for the ΣOP amplitudes in the non-DR group. CONCLUSIONS: The OPs of the focal macular ERG are smaller with prolonged implicit times in association with capillary loss in the macula of diabetic patients. The implicit times are the most sensitive functional parameter that reflects the early changes of the microvasculature in the macula caused by diabetes.

Chronological changes of the anterior chamber structure, axial length, and refraction in patients with Vogt-Koyanagi-Harada disease.

PURPOSE: To clarify the chronological changes in the anterior chamber structure and identify the spherical equivalent and axial length to assess the effects of steroid pulse treatment in patients with Vogt-Koyanagi-Harada disease with active uveitis. METHODS: The anterior chamber condition, including anterior chamber volume, central anterior chamber depth, peripheral anterior chamber depth, anterior chamber angle, and pupil diameter, was measured using Pentacam, and axial length was measured using IOLMaster in patients with Vogt-Koyanagi-Harada disease between June 2015 and February 2018. Furthermore, the best-corrected visual acuity, spherical equivalent, and retinal foveola thickness were also analyzed. All patients were treated with steroid pulse. All these factors were compared before and at 1 and 6 months of treatment. RESULTS: Significant changes were observed in the anterior chamber volume, central anterior chamber depth, peripheral anterior chamber depth, anterior chamber angle, axial length, best-corrected visual acuity, spherical equivalent, and retinal foveal thickness before and at 1 and 6 months of steroid pulse treatment (P < 0.001, P < 0.001, P < 0.001, P = 0.0015, P = 0.027, P < 0.001, P = 0.0043, and P < 0.001, respectively). No significant difference was observed in the pupil diameter before and at 1 month and 6 months of steroid pulse treatment (P = 0.11). CONCLUSION: The anterior chamber structure, axial length, best-corrected visual acuity, spherical equivalent, and retinal foveal thickness were dramatically changed by steroid pulse treatment in patients with Vogt-Koyanagi-Harada disease who develop active uveitis. These changes were completed within 1 month.

Retinal dysfunction of syphilitic outer retinopathy.

PURPOSE: We present our findings in two cases of retinal dysfunction caused by syphilitic outer retinopathy. CASE 1: A 59-year-old man visited our clinic complaining of blurred vision in his left eye. Optical coherence tomography (OCT) demonstrated an absence of the ellipsoid zone (EZ) in the left eye. A round yellowish-white lesion was observed in the posterior pole of the left fundus. Fundus autofluorescence (FAF) showed hyperfluorescent areas in the posterior pole of both fundi although no specific ophthalmoscopic findings were seen in the right eye. The amplitudes of the LA 3.0 1 Hz and LA 3.0 30 Hz ERG responses were reduced with better preservation of the rod responses. Based on a strong positivity to the rapid plasma reagin (RPR) assay and the Treponema pallidum hemagglutination (TPHA) test, he was diagnosed with syphilitic outer retinopathy and treated with systemic antibiotics. The treatment resulted in a restoration of the retinal structures and cone function. CASE 2: A 47-year-old man was referred to our clinic complaining of reduced vision in both eyes. Although the ocular fundus appeared normal, FAF showed a diffuse hyperfluorescent area in the posterior pole and multiple hyperfluorescent spots. Indocyanine green angiography showed multiple confluent areas of hypofluorescence. OCT demonstrated irregular EZs in both eyes. The amplitudes of the LA 3.0 1 Hz and LA 3.0 30 Hz ERG responses were slightly reduced with prolonged implicit times. These findings are comparable to the findings in patients with multiple evanescent white dot syndrome. However, the strong positivity to the RPR and TPHA tests led us to diagnose the patient with outer retinopathy caused by syphilis. Systemic administration of antibiotics resulted in the restoration of the retinal structures and retinal function. CONCLUSIONS: Syphilitic outer retinopathy affected the retinal structures and function that can be restored by antibiotic treatments.

Vitreous Reflux Frequency and Intraocular Pressure After First-Time Intravitreal Aflibercept Injections: Comparison of 30- and 32-Gauge Needles.

PURPOSE: To compare the effects of 30-gauge versus 32-gauge needles on vitreous reflux (VR) frequency and intraocular pressure (IOP) following first-time intravitreal aflibercept injections. MATERIALS AND METHODS: Overall, 116 patients (116 eyes) who received intravitreal injections using 30-gauge needles and 104 patients (104 eyes) who received the same injection using 32-gauge needles were reviewed. The medical records of 116 patients who each received an intravitreal injection using a 30-gauge needle (median age: 67.5 ± 13.9 years) and 104 patients who each received the same injection using a 32-gauge needle (median age: 66. 3 ± 10.6 years) from January 2015 to June 2019 were compared. RESULTS: No significant difference in the frequency of VR was observed between patients injected using 30-gauge needles (38/116) and patients injected using 32-gauge needles (31/104, P = 0.64). There were no significant differences in the VR rates of patients with phakic and pseudophakic eyes between those injected using 30-gauge (P = 0.94) or 32-gauge needles (P = 0.77). Axial length did not significantly differ between patients with and without VR when injected using 30-gauge (P = 0.89) and with 32-gauge needles (P = 0.69). IOP immediately after injection was significantly higher in patients injected using 30-gauge needles than in patients injected using 32-gauge needles (P < 0.01). CONCLUSION: VR frequency was not correlated with needle size, lens status, or axial length. Patients receiving injections using 30-gauge needles had higher IOP immediately after intravitreal injection.

Changes of focal macular and full-field electroretinograms after intravitreal aflibercept in patients with central retinal vein occlusion.

PURPOSE: To evaluate the physiology of the macular and whole retina after intravitreal aflibercept (IVAs) injections in patients with macular edema associated with a central retinal vein occlusion (CRVO) by electroretinography (ERG). METHODS: We studied 20 eyes of 20 patients with non-ischemic CRVO (72.0 ± 9.2 years). All patients were treated with monthly injections of IVA for the initial 3 months and then treated by the treat-and-extend (TAE) regimen for 12 months. The best-corrected visual acuity (BCVA), optical coherence tomographic images, focal macular ERGs (fmERGs), and full-field ERGs recorded before and after the treatment were compared. The fmERGs were elicited by a 15° white stimulus spot centered on the fovea. The full-field ERGs were recorded by a protocol recommended by International Society for Clinical Electrophysiology of Vision. The amplitudes and implicit times determined before and after the IVA were compared. RESULTS: The foveal thickness was significantly reduced accompanied by improvement of the BCVA after the treatments, and the improvements were maintained for at least 12 months. The amplitudes and implicit times of the fmERGs improved continuously for the 12 months. On the other hand, the reduced amplitudes of the full-field ERG, summed oscillatory potentials, and the photopic negative responses remained unchanged for the 12-month period. However, the implicit times of the maximum and cone responses were significantly shortened after the IVA. CONCLUSIONS: IVA injections by the TAE regimen led to a continuous improvement of the macular function in patients with ME associated with a CRVO. However, the function of the whole retina changed differently than the macula after the treatment.

Changes in cone-driven functions after intravitreal aflibercept injections in patients with age-related macular degeneration.

PURPOSE: To determine the changes in the cone-driven functions in patients with age-related macular degeneration (AMD) treated with intravitreal aflibercept. METHODS: We studied 44 eyes of 44 patients diagnosed with AMD whose mean age was 75 years. The contralateral unaffected eyes served as controls. All patients were initially treated with 3 consecutive monthly intravitreal aflibercept injections and thereafter with bimonthly injections for 12 months. Full-field cone electroretinograms (cone ERGs) were recorded at the baseline and at 3, 6, and 12 months after beginning the intravitreal aflibercept injections. The cone ERGs were elicited by red stimuli on a blue background. The focal macular ERGs (fmERGs) were elicited by 15 degrees white stimulus spot centered on the fovea. The amplitudes of the a- and b-waves, photopic negative response (PhNR), and sum of the oscillatory potentials (ΣOPs, sum of OP1-3 amplitudes) were analyzed. In addition, the implicit times of the a- and b-waves were also analyzed. RESULTS: The amplitudes and implicit times of all components of the fmERGs were significantly improved compared to the baseline at 3 months after beginning the intravitreal aflibercept injections (P < 0.0005-0.05). The amplitudes of the a-waves and PhNRs were further increased during the maintenance phase (P < 0.005-0.01). On the other hand, the amplitudes of the full-field a-waves and PhNR of the cone ERGs were significantly reduced at 6 and 12 months compared to the baseline. CONCLUSIONS: The macular function improved continuously during the maintenance phase of the intravitreal aflibercept injections. In contrast, the cone-driven functions of the more peripheral retina decreased with repeated injections suggesting adverse effects of the intravitreal aflibercept injections on the function of the more peripheral normal retina.

Macular function following intravitreal ranibizumab for macular edema associated with branch retinal vein occlusion: 12-month results.

PURPOSE: To evaluate the 12-month effects of intravitral ranibizumab (IVR) injections on the physiology and morphology of the macula in eyes with a branch retinal vein occlusion with macular edema (BRVOME). METHODS: We studied 13 eyes of 13 patients with a BRVOME. All patients were initially treated with IVR injections at 3 consecutive monthly intervals, the initiation phase. Additional treatments were done according to the pro re nata (PRN) regimen. The physiology of the macula was assessed by the focal macular electroretinograms (fmERGs) and the best-corrected visual acuity (BCVA). The morphology of the macular area was determined by spectral-domain optical coherence tomography. The retina was assessed at the baseline, and at 3, 6, and 12 months after beginning the IVR injections. The fmERGs were elicited by a 15° circular stimulus, and also by 15° semicircular stimuli placed on the occluded or non-occluded side of the macula. The amplitudes of the a- and b-waves, photopic negative response (PhNR), and sums of the oscillatory potentials (ΣOPs) were measured. In addition, the implicit times of the a- and b-waves were measured. RESULTS: The BCVA was improved significantly relative to the baseline after the initiation phase (P < 0.01), and it was maintained with the PRN regimen for the 12-month experimental period. The foveal thickness was also significantly decreased after the initiation phase (P < 0.005) but was then worse at 12 months during the maintenance phase (P < 0.05). The fmERGs on the occluded side were significantly reduced at the baseline, and the b-waves and ΣOPs amplitudes improved after the initiation phase. However, they decreased during the PRN period. On the non-occluded side, the amplitudes and implicit times of the a- and b-waves remained unchanged after the initiation phase, the PhNR and ΣOPs amplitudes significantly increased at 3 months compared to the baseline (PhNR, P < 0.005; ΣOPs, P < 0.005), which was maintained throughout the 12 month study period. CONCLUSIONS: The deterioration of the macular function on the occluded side during the maintenance phase suggests that there is a progression of the disease process during the PRN period in eyes with BRVOME.

Comparisons of photopic negative responses elicited by different conditions from glaucomatous eyes.

PURPOSE: To compare the clinical significance of the photopic negative response (PhNRs) elicited by different stimuli from glaucomatous eyes. STUDY DESIGN: Single-center observational study METHOD: Eighty-four eyes of 84 patients with open angle glaucoma (OAG) and 40 eyes of 40 normal subjects were studied. Cone electroretinograms (ERGs) were elicited by white stimuli on a white background (W/W) or red stimuli on a blue background (R/B). The luminance of the stimuli was 0.5, 1.0, 2.0 or 3.0 cd-s/m2, and of the background light was 10 cd/m2. The first and second troughs of the ERGs that appeared following the b-wave were designated as PhNR1 and PhNR2, respectively. The thickness of the circumpapillary retinal nerve fiber layer (cpRNFL) was measured by spectral-domain optical coherence tomography. The mean deviation (MD) was determined by standard automated perimetry. The area under the receiver operating characteristic curves (AUCs) was created to determine the diagnostic ability of the PhNRs elicited by the different stimulus conditions. RESULTS: The correlation coefficients of the amplitudes of the PhNR1 elicited by W/W stimuli to the MDs and cpRNFL thickness were generally stronger, and the regression lines steeper than for the amplitudes of the PhNR1 elicited by R/B stimuli. In contrast, the correlation coefficients of the amplitudes of the PhNR2 elicited by R/B stimuli to the MDs and cpRNFL thickness were generally stronger, and the regression lines were steeper than the amplitudes of the PhNR2 elicited by W/W stimuli. With both types of stimuli, the slopes of the regression lines became steeper when the ERG recorded with higher stimulus intensities. The AUCs were significantly larger for the PhNR2 elicited by the R/B stimuli at 3.0 cd-s/m2 than for PhNR1 and PhNR2 elicited by W/W stimuli at the same intensity when the PhNRs were used for diagnosing advanced glaucoma. CONCLUSION: The PhNR1 and PhNR2 elicited by the W/W and R/B stimuli are suitable measures to assess the function of the RGCs in eyes with OAG. The PhNR2 elicited by R/B stimuli at higher stimulus intensities is most effective in detecting functional and structural changes of the RGCs with the highest diagnostic capacity in discriminating advanced glaucoma.