Choroidal venous overload in Vogt‒Koyanagi‒Harada disease.

BACKGROUND/OBJECTIVES: This study aimed to investigate the change of choroidal venous overload in Vogt‒Koyanagi‒Harada (VKH) disease. Clinical records of 52 patients with VKH disease (52 eyes) and 24 control subjects (24 eyes) who underwent multimodal imaging, including fluorescein angiography (FA) and indocyanine green angiography (ICGA), were retrospectively reviewed. SUBJECTS/METHODS: Imaging data were assessed for signs associated with choroidal venous overload, e.g., choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and intervortex venous anastomosis (IVA). Dual FA and ICGA scoring for active posterior segment inflammation was performed. Clinical and imaging features associated with choroidal venous overload were compared between early- and late-stage VKH disease. RESULTS: Choroidal perfusion delay, choroidal vascular hyperpermeability, dilated choroidal veins, and IVA were more prevalent in eyes with VKH disease (69.2%, 67.3%, 61.5%, and 65.4%, respectively) than in control eyes (25.0%, 20.8%, 25.0%, and 37.5%, respectively) (p < 0.05). All eyes with IVA in the early-stage of VKH disease had got other 3 signs. All choroidal venous overload signs were more prevalent in patients with early-stage (20 eyes) than in those with late-stage VKH disease (32 eyes) (p < 0.05). The number of choroidal venous overload signs were inversely related to disease duration (p < 0.001) and proportionally related to the total ICGA score (p < 0.001). IVA was significantly associated with the total ICGA score in logistic regression (p = 0.014). CONCLUSIONS: Choroidal venous overload occurs early in VKH disease. Angiographic signs of choroidal venous overload may be useful markers to assess the status of VKH disease.

Advanced age-related macular degeneration and risk factors in eyes with pachydrusen.

The risk of progression to advanced age-related macular degeneration (AMD) varies depending on the type of drusen. This retrospective longitudinal study included 248 eyes of 156 patients with pachydrusen without advanced AMD at baseline. Macular neovascularization (MNV) and geographic atrophy (GA) were evaluated. Risk factors for progression to advanced AMD were determined using multivariate Cox regression analysis. The mean age at baseline was 65.4 ± 9.1 years, and the mean follow-up duration was 6.40 ± 3.58 years. The mean total number of pachydrusen and macular pachydrusen were 4.10 ± 2.85 and 2.27 ± 1.81 per eye, respectively. Pachydrusen was accompanied by other types of drusen in 4.8% (12 eyes) of eyes at baseline. During follow-up, MNVs occurred in 2.8% (seven eyes), including polypoidal choroidal vasculopathy (PCV six eyes); however, no GA occurred. Regarding risk factors for progression to neovascular AMD, age (p = 0.023) and macular pigmentary changes (p = 0.014) were significantly associated with MNV development. The cumulative incidence of MNV was significantly higher in the group with macular pigmentary changes (17.39% vs. 0.57% at 10 years; p = 0.0005). The number of macular pachydrusen and the presence of MNV in the fellow eye did not show a statistically significant relationship with MNV development. Age and macular pigmentary changes are risk factors for MNV development in the eyes with pachydrusen. Eyes with pachydrusen appear to have a risk profile for advanced AMD that is different from that of AMD eyes with drusen or drusenoid deposits other than pachydrusen.

Enhancing foveal avascular zone analysis for Alzheimer's diagnosis with AI segmentation and machine learning using multiple radiomic features.

We propose a hybrid technique that employs artificial intelligence (AI)-based segmentation and machine learning classification using multiple features extracted from the foveal avascular zone (FAZ)-a retinal biomarker for Alzheimer's disease-to improve the disease diagnostic performance. Imaging data of optical coherence tomography angiography from 37 patients with Alzheimer's disease and 48 healthy controls were investigated. The presence or absence of brain amyloids was confirmed using amyloid positron emission tomography. In the superficial capillary plexus of the angiography scans, the FAZ was automatically segmented using an AI method to extract multiple biomarkers (area, solidity, compactness, roundness, and eccentricity), which were paired with clinical data (age and sex) as common correction variables. We used a light-gradient boosting machine (a light-gradient boosting machine is a machine learning algorithm based on trees utilizing gradient boosting) to diagnose Alzheimer's disease by integrating the corresponding multiple radiomic biomarkers. Fivefold cross-validation was applied for analysis, and the diagnostic performance for Alzheimer's disease was determined by the area under the curve. The proposed hybrid technique achieved an area under the curve of [Formula: see text]%, outperforming the existing single-feature (area) criteria by over 13%. Furthermore, in the holdout test set, the proposed technique exhibited a 14% improvement compared to single features, achieving an area under the curve of 72.0± 4.8%. Based on these facts, we have demonstrated the effectiveness of our technology in achieving significant performance improvements in FAZ-based Alzheimer's diagnosis research through the use of multiple radiomic biomarkers (area, solidity, compactness, roundness, and eccentricity).

Macular lesions associated with age-related macular degeneration in pachydrusen eyes.

BACKGROUND: To investigate the prevalence of macular lesions associated with age-related macular degeneration (AMD) in eyes with pachydrusen. METHODS: Clinical records and multimodal imaging data of patients over 50 years old with drusen or drusenoid deposits were retrospectively assessed, and eyes with pachydrusen were included in this study. The presence of AMD features, including drusen or drusenoid deposits, macular pigmentary abnormalities, geographic atrophy (GA), and macular neovascularization (MNV), were evaluated. RESULTS: Out of 967 eyes of 494 patients with drusen or drusenoid deposits, 330 eyes of 183 patients had pachydrusen (34.1%). The mean age was 66.1 ± 9.3 years, and the subfoveal choroidal thickness (SFCT) was 292.7 ± 100.1 µm. The mean number of pachydrusen per eye was 2.22 ± 1.73. The majority of eyes with pachydrusen had no other drusen or drusenoid deposits (95.2%). Only 16 eyes (4.8%) had other deposits, including soft drusen (10 eyes, 3.0%), cuticular drusen (3 eyes, 0.9%), and reticular pseudodrusen (RPD; 3 eyes, 0.9%). Macular pigmentary abnormalities accompanied pachydrusen in 68 eyes (27.4%). None of the eyes had GA, and 82 eyes (24.8%) had MNV. The majority of MNV was polypoidal choroidal vasculopathy (PCV; 65 eyes, 19.7%), followed by type 1 (10 eyes, 3.0%), type 2 (5 eyes, 1.5%), and type 3 MNV (2 eyes, 0.6%). CONCLUSIONS: Eyes with pachydrusen in Korean population have several characteristic AMD lesions in low frequencies. These findings indicate that pachydrusen might have diagnostic and prognostic values that are different from those of other drusen or drusenoid deposits.

Microperimetric evaluation for different methods of epiretinal membrane surgery.

PURPOSE: To investigate the anatomic and functional outcomes using microperimetry for the surgical methods for idiopathic epiretinal membranes (ERM). METHODS: This retrospective study included 41 eyes from 41 patients. All patients underwent combined epiretinal membrane and cataract surgery. Best-corrected visual acuity (BCVA), optical coherence tomography, and microperimetry were performed before and 6 months and 1 year after surgery. The patients were divided into 3 groups; "ERM removal only without indocyanine green (ICG) staining", "ERM and internal limiting membrane (ILM) removal without ICG staining", and "ERM and ILM removal with ICG staining". RESULTS: Preoperatively, the ages, BCVAs, central macular thickness (CMT), and mean retinal sensitivities of central 6° (MRSs) of the groups were not significantly different (p > 0.05). Postoperatively, the MRSs of the "ERM removal only without ICG staining" and "ERM and ILM removal without ICG staining" groups were not significantly different (p > 0.05). The MRSs of the "ERM and ILM removal without ICG staining" and "ERM and ILM removal with ICG staining" groups were not significantly different (p > 0.05). However, the MRSs of the "ERM and ILM removal with ICG staining" group significantly reduced than "ERM removal only without ICG staining" group (p < 0.05). CONCLUSION: This retrospective study found reduced retinal sensitivity in ERM and ILM removal with ICG staining group compared to ERM removal only without ICG staining. Further studies with larger sample sizes are required.

Response to brolucizumab treatment for refractory serous pigment epithelial detachment secondary to polypoidal choroidal vasculopathy.

PURPOSE: To report the efficacy and safety of brolucizumab in the treatment of refractory serous pigment epithelial detachment (PED) secondary to polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-six eyes of 26 patients were included. Intravitreal brolucizumab 6.0 mg was administered, followed by pro re nata (PRN) retreatment at monthly follow-ups. All patients underwent spectralis domain optical coherence tomography (SD-OCT), fluorescein angiography, and indocyanine green angiography before the first brolucizumab injection. SD-OCT was repeated at follow-up visits. The height and width of the serous PEDs, measured using SD-OCT, were analyzed. RESULTS: The number of previous anti-VEGF injections was 12.3 ± 15.0. During brolucizumab treatment, anatomical improvement was achieved and maintained in the height and width of the PEDs (p < 0.05). However, the visual outcome did not improve significantly (p > 0.05). A good response was achieved in 69.2% of eyes at 1 month and at the last visit. Relapse and complete resolution were observed in 27.8 and 23.1% of patients, respectively. The number of brolucizumab injections was 2.00 ± 0.85. Intraocular inflammation, vascular obstruction, and retinal pigment epithelial tears were not observed. CONCLUSION: Intravitreal brolucizumab may be an effective and safe treatment option for refractory serous PEDs in patients with PCV.

Evaluation of the microperimetry in eyes with cuticular drusen.

Retinal sensitivity may vary by subtypes of cuticular drusen. This retrospective study included 52 eyes of 32 patients with cuticular drusen. All the patients underwent assessment of best-corrected visual acuity (BCVA), spectral-domain optical coherence tomography (SD-OCT), color fundus photography, fluorescein angiography, fundus autofluorescence, and microperimetry. The area occupied by drusen was counted using microperimetry. The cuticular drusen subtype was classified into 3 groups based on the SD-OCT findings. Age, BCVA, pattern standard deviation, area occupied by drusen, pupil size, and the false-positive rate were not significantly different (p > 0.05) according to the cuticular drusen type. The mean retinal sensitivity (MRS) (p = 0.063) and mean deviation (MD) (p = 0.098) showed marginally significant differences among the groups. In the subgroup analyses, type 1 and type 3 cuticular drusen showed significant differences in the MD (- 1.8 ± 2.1 vs - 5.1 ± 5.3; p = 0.011) and MRS (25.1 ± 2.2 vs 21.3 ± 5.7; p = 0.016) without differences in age, BCVA, or the area occupied by drusen (p > 0.05). The results indicate that depending on the subtypes of cuticular drusen type, the deterioration of retinal sensitivity is more likely to occur than decreased vision.

Ten-year clinical outcomes after implantation of a posterior chamber phakic intraocular lens for myopia.

PURPOSE: To report the long-term clinical outcomes, including efficacy and safety, of implantable collamer lens (ICL) implantation to treat myopia. SETTING: Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. DESIGN: Retrospective case series. METHODS: Medical records of patients who had ICL implantation were reviewed. The preoperative and postoperative visual acuity, spherical equivalent (SE), endothelial cell density (ECD), and intraocular pressure (IOP) were analyzed. The postoperative vault and complication rate, including cataract and glaucoma, were evaluated. Patients were placed in the lens opacity group or clear lens group based on whether lens opacity developed postoperatively. RESULTS: One hundred ten eyes (60 patients) were analyzed. The mean preoperative age was 30.3 years ± 8.3 (SD). The mean SE was -12.01 ± 3.70 diopters (D) preoperatively and -0.65 ± 1.09 D 10 years postoperatively. The mean vault height was 562.4 ± 175.9 µm 6 months postoperatively, decreasing to 352.9 ± 171.8 µm at 10 years. There were no significant changes in the ECD and IOP at any timepoint. Lens opacities developed in 21 eyes (12.1%) during the 10-year follow-up. The mean vault in the lens opacity group was significantly lower than in the clear lens group after 4 years. No patient who had ICL implantation when they were 30 years or younger developed lens opacity or required phacoemulsification. CONCLUSIONS: The results indicate that ICL implantation provided long-term stability and good refractive outcomes. Performing this surgery in young patients, especially those 30 years or younger, may be safe in terms of long-term cataract formation.

Central serous chorioretinopathy in elderly subjects: angiographic and tomographic characteristics.

PURPOSE: To investigate the angiographic, tomographic, and clinical characteristics of idiopathic central serous chorioretinopathy (CSC) in elderly patients. METHODS: The patients were divided into two groups according to a cutoff age of 60 years at baseline. Patients underwent spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Angiographic and tomographic features were compared between the two groups (young vs. elderly group). RESULTS: Of 176 patients, 26 patients (15.1%) were 60 years or older. Complete resolution of subretinal fluid after treatment was noted in 72.0% of the elderly group and 90.8% of the young group (P = 0.021). The elderly group showed worse baseline and final vision, more bilateral involvement, and lower male preponderance than the young group (P < 0.05, respectively). The elderly group was also associated with a higher frequency of retinal pigment epithelium depigmentation, foveal thinning, and double-layer sign compared with the young group (P < 0.05, respectively). CONCLUSION: CSC in elderly patients was associated with a lower resolution of serous detachment, increased impairment of retinal pigment epithelial layers, foveal thinning, and worse visual outcome, suggesting a chronic insult to the choroidal vessels involving more severe damage to the outer retinal layers.

Correction to: Risk factors of presenile nuclear cataract in health screening study.

Following publication of the original article [1], the authors notified us of that due to miscommunication during proofing their given names were not presented in their full form, but only using the initials.

Risk factors of presenile nuclear cataract in health screening study.

BACKGROUND: To identify risk factors for the development of presenile nuclear cataract in health screening test. METHODS: The cross sectional study included a total of 532 eyes of 266 participants aged 30 to 49 years of Samsung Medical Center from February 2013 to April 2015. Presence of nuclear cataract was defined when the log MAR visual acuity with correction was greater than or equal to 0.2 and one or more of the following were met: Pentacam Nuclear Staging (PNS) grading score ≥ 1, average value of nuclear density ≥ 15%, maximum value of nuclear density ≥ 30%. Possible risk factors were obtained from blood tests and questionnaires of a health screening test of Samsung Medical Center. Association between nuclear cataract and risk factors was investigated using univariate and multivariate logistic regression analysis by generalized estimating equation (GEE) models. RESULTS: Five factors were significantly associated with presenile nuclear cataract: current smoking [odds ratio (OR) = 2.80, 95% confidence interval (CI), 1.10-7.12, p = 0.0310], non-exercise and high amount of daily physical exercise (OR = 3.99, 95% CI, 1.27-12.52, p = 0.0178; OR = 2.92, 95% CI, 1.38-6.22, p = 0.0053), asthma (OR = 8.93, 95% CI, 1.12-71.15, p = 0.0386), tuberculosis (OR = 4.28, 95% CI, 1.36-13.50, p = 0.0131), and higher total iron binding capacity (OR = 1.01, 95% CI, 1.00-1.02, p = 0.0059). CONCLUSIONS: Presenile nuclear cataract is related to current smoking, non-exercise or high amount of physical exercise, asthma, tuberculosis, and iron deficiency status. The association of non-exercise group and presenile nuclear cataract seems to be related to co-morbidity. Patients with asthma, tuberculosis, or iron deficiency anemia are recommended to receive frequent ophthalmic examination to detect cataract.

Characteristics of primary extranodal marginal zone B-cell lymphoma in Korea: conjunctiva versus other ocular adnexa.

AIMS: To compare the clinical characteristics and prognosis of primary conjunctival versus other ocular adnexal extranodal marginal zone B-cell lymphoma (EMZL). METHODS: Retrospective review of clinical records for all consecutive patients with primary ocular adnexal EMZL treated from March 1995 to December 2015. RESULTS: 198 patients were evaluated including 81 with primary conjunctival and 117 with other ocular adnexal EMZL. Conjunctival EMZL was found at a younger age (40.3±10.3vs 54.3±13.4 years, p<0.0001) with a female predilection (75.3%vs35.9%, p<0.0001) and had a higher rate of bilaterality (40.7%vs11.1%, p<0.0001) and a lower rate of systemic involvement (1.2%vs9.4%, p=0.030) compared with other ocular adnexal EMZLs. Conjunctival EMZL also showed a higher rate of complete response to primary treatment (98.8%vs89.5%, p=0.016) than other ocular adnexal EMZLs; however, recurrence and lymphoma-related death rates were not different between the two groups (p>0.05). Kaplan-Meier estimates for disease-specific survival at 5 and 10 years were 98.2% and 98.2% in conjunctival and 98.6%, respectively, and 95.2% in other ocular adnexal EMZLs. Univariate analysis showed that systemic involvement was negatively associated with conjunctival tumour location and positively associated with age (OR=0.35 and OR=1.05, p=0.045 and p=0.012, respectively), and treatment response was positively associated with conjunctival tumour location and negatively associated with age (OR=3.02 and OR=0.95, p=0.035 and p=0.009, respectively). CONCLUSIONS: Conjunctival EMZL shows unique demographic characteristic compared with other ocular adnexal EMZLs. Long-term follow-up is required due to late recurrence in ocular adnexal EMZL.

Transcanalicular Diode Laser-Assisted Revision Surgery for Failed Dacryocystorhinostomy With or Without Distal or Common Canalicular Obstruction.

PURPOSE: To report the outcomes of transcanalicular diode laser-assisted revision surgery for failed dacryocystorhinostomy with/without distal or common canalicular obstruction. METHODS: The medical records and recorded videos of consecutive transcanalicular diode laser-assisted revision surgeries performed for failed dacryocystorhinostomy between May 2011 and May 2015 were reviewed. Cases of unavailability of video and cases lost to follow up after surgery were excluded from the study. With respect to the level of obstruction, lacrimal drainage systems were divided into Group 1 (obstruction at the level of the ostium) and Group 2 (obstruction at the level of the distal or common canaliculus). Data associated with anatomical and functional success were analyzed. RESULTS: Revision dacryocystorhinostomy surgeries were performed on 68 patients during the study period. Transcanalicular diode laser-assisted revision surgeries were performed on 48 eyes of 39 patients. Mean follow-up period after revision surgery was 13.3 ± 12.6 months. Overall, anatomical success rate was 83.3% (40/48) and functional success rate was 68.8% (33/48). Anatomical success rates and functional success rates in the 2 groups showed no significant difference (80.0% [24/30] vs. 86.7% [13/15], p = 0.699; 70.0% [21/30] vs. 66.7% [10/15], p = 1.000, respectively). CONCLUSIONS: Transcanalicular diode laser-assisted revision surgery may be an alternative technique for failed dacryocystorhinostomy. Distal or common canalicular obstruction did not affect the outcomes of revision surgeries.

Buffering zone of implantable Collamer lens sizing in V4c.

BACKGROUND: The purpose of this study was to identify factors related to the unexpected vault in V4c implantable collamer lens (ICL; STAAR Surgical) implantation. METHODS: V4c ICLs were implanted in 43 eyes of 43 patients for the correction of myopia. The implanted V4c ICL sizes were determined individually with our previous V4 ICL sizing nomogram based on the sulcus-to-sulcus diameter (STS), and the V4 ICL sizes were then converted to V4c ICL sizes with a size-converting table. We defined the "normal-sizing group" as having a pre-converted ICL size larger than the STS, and the "under-sizing group" as having a pre-converted ICL size smaller than the STS. Refractive outcomes, safety and parameters related to postoperative vault were compared between the two groups. RESULTS: The value of "actual ICL size - STS" differed significantly between the normal-sizing and under-sizing groups (p < 0.001), but postoperative vault did not differ significantly (p = 0.442). The demographics, implanted ICL characteristics, effectiveness indexes, safety indexes, and parameters related to postoperative vault did not differ significantly between the two groups (p > 0.05). Two patients in the normal-sizing group exhibited over-vaulting; these patients had shallow anterior chambers and were implanted with high-dioptric-power ICLs. CONCLUSIONS: The achievement of acceptable vault in both normal-sizing and under-sizing groups indicates the existence of a buffering zone in V4c ICL sizing. The smaller size of V4c ICLs should be considered in patients susceptible to over-vaulting, such as those with shallow anterior chambers and high-dioptric-power ICLs.

Heritability of the morphology of optic nerve head and surrounding structures: The Healthy Twin Study.

BACKGROUND: Optic nerve head (ONH) and surrounding structures such as ß-zone peripapillary atrophy (PPA) are important structures in glaucomatous pathogenesis. Thus, for understanding genetic components in glaucoma pathogenesis, it is necessary to evaluate the heritability of ONH and surrounding structures. The present study investigated the genetic influences on ONH and surrounding structures such as ß-zone PPA and retinal vessels. METHODS: A total of 1,205 adult twins and their family members (362 monozygotic (MZ) twin subjects (181 pairs), 64 dizygotic (DZ) twin subjects (32 pairs), and 779 singletons from 261 families), were part of the Korean Healthy Twin Study. ONH parameters including the vertical cup-to-disc ratio, the presence, the area and the location of ß-zone PPA and the angular location of retinal vein were measured. The genetic influences on the structures were evaluated using variance-component methods. RESULTS: The intraclass correlation coefficient (ICC) values of axial length were highest among the parameters. The ICCs of the area and location of PPA were similar to those of vertical cup-to-disc ratio. However, retinal vessel angular locations showed low ICC values even in MZ twins. After age and sex adjustment, for axial length, vertical cup-to-disc ratio, the presence, area and location of PPA, the estimated narrow-sense heritability was 0.85, 0.48, 0.76, 0.50 and 0.65 in the right eye and 0.84, 0.47, 0.72, 0.46 and 0.72 in the left eye, respectively. The estimated narrow-sense heritability of angular location of the superior and inferior vein was 0.17 and 0.12 in the right eye and 0.13 and 0.05 in the left eye, respectively. CONCLUSIONS: ONH and surrounding structures such as vertical cup-to-disc ratio and the presence, the area and the location of ß-zone PPA seemed to be determined by the substantial genetic influence, whereas the venous angular location did not.