Clinical characteristics of super stable polypoidal choroidal vasculopathy after initial remission with anti-VEGF monotherapy.

PURPOSE: To define a "super stable" subset of polypoidal choroidal vasculopathy (PCV) patients that have a long period of remission following anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Twenty-one eyes that showed no recurrence for over 18 months following anti-VEGF monotherapy were included in the "super stable PCV group" and compared with 37 eyes with recurring disease. Patient demographics, visual acuity, and imaging data from optical coherence tomography (OCT) and fluorescein angiography/indocyanine green angiography were compared between the two groups at baseline and at 3 months after treatment initiation. RESULTS: The super stable group maintained remission for a mean duration of 31.0 months following a mean of 4.1 anti-VEGF injections. The super stable group was younger at baseline (64.6 ± 8.8 vs. 71.4 ± 7.9 years, P < 0.05) with a higher ratio of females (52.4% vs. 24.3%, P < 0.05) compared with the control group. The super stable group had a higher percentage of eyes with a single polyp, as opposed to multiple polyps (66.7% vs. 32.4%, P < 0.05), and the diameter of the largest polyp was smaller (328.4 ± 98.2 vs. 398.3 ± 112.2 µm, P < 0.05). Baseline choroidal thickness was greater in the super stable group (357 ± 102.7 vs. 293.2 ± 94.6 µm, P < 0.05). At 3 months after treatment, OCT features including central retinal thickness, pigment epithelial detachment (PED) size, and presence of subretinal fluid showed superior response in the super stable group. The reduction in PED height was almost 3 times as large in the super stable group (- 250.1 ± 228.5 µm vs. - 84.4 ± 221.1 µm, P < 0.05). Binary logistic regression further showed that factors such as age, polyp configuration, PED diameter at 3 months, and change in PED height at 3 months were associated with super stable remission. CONCLUSION: Identifying super stable PCV patients can prevent overtreatment and lessen treatment burden.

SIGNIFICANT REDUCTION OF PERIPAPILLARY CHOROIDAL THICKNESS IN PATIENTS WITH UNILATERAL BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To evaluate changes in peripapillary choroidal thickness in patients with branch retinal vein occlusion (BRVO) over 12 months, using spectral-domain optical coherence tomography with enhanced depth imaging. METHODS: This retrospective, interventional case series included 20 treatment-naive patients with unilateral BRVO with at least 12 months follow-up. The peripapillary choroidal thickness was measured over 12 months. RESULTS: In BRVO-affected eyes, the mean peripapillary choroidal thickness was 213.5 ± 51.7 µm (126.1[FIGURE DASH]326.9 µm) at baseline and 129.6 ± 39.3 µm (65.9[FIGURE DASH]197.1 µm) at 12 months. In nonaffected contralateral eyes, the mean peripapillary choroidal thickness was 194.1 ± 39.8 µm (158.5[FIGURE DASH]238.3 µm) at baseline and 156.6 ± 56.2 µm (125.9[FIGURE DASH]213.9 µm) at 12 months. The mean peripapillary choroidal thickness decreased significantly over 12 months in both BRVO-affected and nonaffected eyes (P < 0.001, both eyes). Although the mean peripapillary choroidal thickness was not significantly different between groups at baseline (P = 0.472), it was significantly lower in BRVO-affected eyes than in nonaffected eyes at 12 months (P = 0.036). CONCLUSION: Peripapillary choroidal thickness decreased significantly over 12 months in BRVO-affected eyes and nonaffected eyes in patients with unilateral BRVO.

SIGNIFICANT REDUCTION OF BOTH PERIPAPILLARY AND SUBFOVEAL CHOROIDAL THICKNESS AFTER PANRETINAL PHOTOCOAGULATION IN PATIENTS WITH TYPE 2 DIABETES.

PURPOSE: To evaluate changes in peripapillary choroidal thickness (PCT) and subfoveal choroidal thickness (SFCT) after panretinal photocoagulation (PRP) for diabetic retinopathy. METHODS: This retrospective interventional study included 59 treatment-naive eyes of 33 patients who underwent PRP and completed ≥12 months of follow-up. Peripapillary choroidal thickness and SFCT were measured at baseline and 1, 3, 6, and 12 months post-PRP. Differences between baseline and 12 months (ΔSFCT and ΔPCT) and percentage changes (ΔSFCT or ΔPCT/baseline × 100%) were determined. RESULTS: Mean SFCT was 287.7 ± 76.7 µm (139.0-469.0 µm) at baseline and 225.8 ± 62.0 µm (102.5-379.5 µm) 12 months post-PRP (P < 0.001). Mean PCT was 161.2 ± 16.5 µm (75.3-308.1 µm) at baseline and 128.4 ± 41.8 µm (73.0-212.9 µm) 12 months post-PRP (P < 0.001). ΔSFCT was -61.3 ± 28.7 µm (-139.5 to -17.0 µm), and %SFCT was 21.2 ± 7.2% (6.8% to 36.1%). ΔPCT was -36.4 ± 23.2 µm (-149.1 to 5.4 µm), and %PCT was 22.4 ± 12.0% (2.5% to 62.6%). Diabetic retinopathy severity was the only factor significantly correlated with %SFCT (ß = 0.500, P = 0.004) and %PCT (ß = 0.152, P = 0.024). CONCLUSION: Both PCT and SFCT reduced significantly after PRP. Diabetic retinopathy severity was significantly correlated with post-PRP changes of peripapillary and SFCT.

Baseline polyp size as a potential predictive factor for recurrence of polypoidal choroidal vasculopathy.

PURPOSE: To investigate the predictive factors for recurrence of polypoidal choroidal vasculopathy (PCV). METHODS: The medical records of 78 consecutive patients (78 eyes) with treatment-naïve PCV who responded to first-line treatment and completed at least a 3-year follow-up after the first remission were retrospectively analyzed. In this comparative cohort study, baseline characteristics were compared between the patients who had at least one recurrence (the recurrence group) and those without recurrence (the non-recurrence group) during at least 3-year follow-up periods. In addition, possible predictive factors for recurrence of PCV were investigated by using Cox regression analysis. RESULTS: Within 3 years of the first remission, 50 eyes (64 %) showed at least one recurrence (mean 1.5; 1 to ∼2 times). There were no significant differences in the baseline characteristics between the recurrence group and the non-recurrence group. However, the largest polyp diameter was significantly different: the mean largest polyp diameter (524 ± 340 µm) was significantly larger in the recurrence group compared to that of the non-recurrence group (352 ± 173 µm; P = 0.038). Cox regression analysis showed that the largest polyp diameter at baseline significantly correlated with recurrence of PCV (B = 1.470, P = 0.015). CONCLUSIONS: The largest polyp diameter at baseline may be predictive for PCV recurrence, as it was significantly larger in patients who had at least one recurrence.

Gas-mediated vitreomacular adhesion release with intravitral ranibizumab injections for exudative age-related macular degeneration.

PURPOSE: To evaluate the efficiency of gas-assisted vitreomacular adhesion (VMA) release combined with intravitreal ranibizumab injections for exudative age-related macular degeneration (AMD) patients. MATERIALS AND METHODS: This prospective, interventional case series included a total of 23 eyes of 22 patients. The eyes were treated with intravitreal injection of 0.3 mL of perfluoropropane (C3F8) gas and concomitant intravitreal ranibizumab injection to stimulate VMA release. After three initial loading injections, additional intravitreal ranibizumab injections were performed pro re nata. Over a 12-month period, monthly examinations were performed for best-corrected visual acuity (BCVA, logMAR; logarithm of the minimum angle resolution), optical coherence tomography, and dilated fundus examinations. RESULTS: After gas injection, 22 eyes (95.7 %) showed complete VMA release at 1 week. Complete VMA was achieved in all eyes at 2 months after VMA release, without serious ocular adverse events except one patient who developed a retinal tear. Mean BCVA was 0.61 ± 0.37 logMAR (20/81 Snellen equivalents) at baseline and 0.46 ± 0.30 logMAR (20/57 Snellen equivalents) at 12 months (P = 0.135). Mean central macular thickness was 357.9 ± 128.6 µm at baseline and 245.6 ± 60.0 µm at 12 months (P = 0.188). Mean numbers of intravitreal ranibizumab injections were 4.8 ± 2.4 times during 12 months (4 to 8 injections). CONCLUSION: Gas-assisted VMA release can be used as an efficient alternative for exudative AMD patients with obvious VMA.

Ramipril inhibits high glucose-stimulated up-regulation of adhesion molecules via the ERK1/2 MAPK signaling pathway in human umbilical vein endothelial cells.

Ramipril has recently been shown to have anti-atherogenic properties. However, the specific mechanisms underlying these effects remain unclear. The purpose of this study was to determine the effects of ramipril on induction of adhesion molecules in human umbilical vein endothelial cells (HUVECs) using high-glucose (HG) conditions and to investigate possible underlying molecular mechanisms. The effects of ramipril on expression of intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 production, and ERK phosphorylation were examined in HG-induced HUVECs with inhibitors targeting the mitogen-activated protein kinase (MAPK) signaling pathway. HG induced the expression of the adhesion molecules ICAM-1 and VCAM-1. Pretreatment with ramipril drastically inhibited ICAM-1 and VCAM-1 production in a time- and dose-dependent manner. Moreover, upon investigating the effects of ramipril on the MAPK/extracellular signal-regulated kinase (ERK) signaling pathway, we found that ramipril completely inhibited HG-induced phosphorylation of ERK1/2. ERK inhibitors completely prevented the inhibitory effect of HG. This study demonstrated that ramipril reduces HG-stimulated induction of ICAM-1 and VCAM-1 expression via MAPK signaling, which may be useful for inhibition of atherosclerosis.

Visual outcome and prognostic factors after surgery for a secondary epiretinal membrane associated with branch retinal vein occlusion.

PURPOSE: To assess the visual outcome and prognostic factors after surgery for a secondary epiretinal membrane (ERM) due to branch retinal vein occlusion (BRVO). METHODS: Medical records of 33 patients (33 eyes) were retrospectively reviewed. All patients underwent vitrectomy and completed at least one year of follow-up. Patients characteristics, including baseline best-corrected visual acuity (BCVA; logMAR, logarithm of the minimum angle resolution), fluorescein angiography and optical coherence tomography findings were analyzed. RESULTS: Twenty eyes (60.6%) were non-ischemic and nine eyes (27.3%) had ischemic maculopathy. The mean BCVA was 0.82 ±0.56 logMAR (20/132 Snellen equivalent) at baseline and 0.43 ±0.37 logMAR (20/53 Snellen equivalent) at 1 year (p = 0.001). At 1 year three eyes (9.1%) had visual loss with 0.3 logMAR or more deterioration than baseline whereas 16 eyes (48.5%) gained vision. The mean central macular thickness (CMT) was 407.3 ±138.8 µm at baseline and 274.71 ±40.5 µm at 1 year after surgery (p = 0.001). Photoreceptor integrity was intact in 20 eyes (60.6%). Photoreceptor integrity (B = 0.248, p = 0.001) at baseline was significantly correlated with visual outcome after surgery. CONCLUSION: Surgery for a secondary ERM associated with BRVO led to a relatively favorable visual outcome. The integrity of photoreceptors at baseline seems to be useful in predicting visual outcome in these patients.

Association of Spectral-Domain Optical Coherence Tomography Findings with Visual Outcome of Macula-Off Rhegmatogenous Retinal Detachment Surgery.

PURPOSE: To identify prognostic factors for the visual outcome for patients with macula-off rhegmatogenous retinal detachment (RRD). METHODS: The medical records of 27 patients (27 eyes) with macula-off RRD were retrospectively investigated. In addition to clinical characteristics, spectral-domain optical coherence tomography (SD OCT) images were analyzed. RESULTS: The central foveal thickness at baseline was 923 ± 499.5 µm, and the mean height of the subretinal fluid was 697.8 ± 463.6 µm. Dropout of backreflection at the fovea was detected on preoperative SD OCT in 8 patients (29.6%). The external limiting membrane was disrupted in 5 patients (18.5%) as was the photoreceptor integrity in 9 patients (33.3%) at 12 months. On multiple regression analysis, backreflection integrity was the only predictive factor for postoperative visual outcome (B = 0.179, p = 0.020). CONCLUSIONS: Backreflection integrity on preoperative SD OCT seems to be helpful in predicting the postoperative visual outcome in macula-off RRD patients.

Diffuse unilateral subacute neuroretinitis in a healthy Korean male: the first case report in Korea.

A 52-yr-old male was referred for progressive visual loss in the left eye. The decimal best-corrected visual acuity (BCVA) was 0.01. Fundus examination revealed diffuse retinal pigment epithelial degeneration, focal yellow-white, infiltrative subretinal lesion with fuzzy border and a live nematode within the retina. Diffuse unilateral subacute neuroretinitis (DUSN) was diagnosed and the direct laser photocoagulation was performed to destroy the live nematode. During eight months after treatment, BCVA gradually improved to 0.2 along with the gradual restoration of outer retinal layers on SD-OCT. We report on the first case of DUSN in Korea. DUSN should be included in the differential diagnosis of unexplained unilateral visual loss in otherwise healthy subjects.

Clinical and spectral-domain optical coherence tomography findings in patients with focal choroidal excavation.

OBJECTIVE: To describe the clinical and spectral-domain optical coherence tomography (SD-OCT) findings in patients with focal choroidal excavation (FCE). DESIGN: Retrospective case series. PARTICIPANTS: Forty-one eyes of 38 patients with FCE identified in 2 tertiary medical centers in Korea. METHODS: Clinical features, SD-OCT findings, and associated macular disorders of FCE were analyzed and detailed. MAIN OUTCOME MEASURES: Statistical associations among clinical features, including lesion type, size, and choroidal thickness, and frequency of association with central serous chorioretinopathy (CSC), choroidal neovascularization (CNV), and polypoidal choroidal vasculopathy (PCV). RESULTS: Mean patient age was 50.1 years (range, 25-76 years). The mean spherical equivalent of refractive error was -3.7 diopters (range, -10.0 to +1.5 diopters). Three patients (8%) had bilateral lesions, and 1 patient (3%) had 2 distinct lesions in the same eye. The mean FCE width and depth were 757 µm and 107 µm, respectively, with a positive correlation between width and depth (P = 0.003). The mean subfoveal choroidal thickness of FCE eyes was 284 µm, which was not statistically different from that of age-, sex-, and refractive error-matched normal subjects. Choroidal thickness in FCE was less in eyes with hyperreflective choroidal tissue under the excavation that was present in 22 eyes (54%) versus eyes without excavation (128 vs. 190 µm, respectively; P = 0.009). Twelve FCEs (29%) were the nonconforming type, revealing separation between the photoreceptor tips and the retinal pigment epithelium on SD-OCT. Nonconforming FCE was associated with visual symptoms (P < 0.001) and the presence of concurrent CSC (P = 0.001). Ten eyes (24%) were associated with CSC, and 9 eyes (22%) were associated with CNV, including 1 eye with PCV features. One eye with FCE and type 1 CNV developed a new excavation, and the excavated area in 1 eye with PCV enlarged slightly during follow-up. CONCLUSIONS: Focal choroidal excavation is a relatively common entity and frequently associated with choroidal diseases, including CSC, CNV, and PCV. Although FCE is classically thought to be a congenital malformation, acquired FCE forms possibly exist.

Long-term progression of retinal vasculitis in Behçet patients using a fluorescein angiography scoring system.

BACKGROUND: To evaluate the long-time progression of retinal vasculitis in Behçet patients using the fluorescein angiography (FA) scoring system. METHODS: Retrospective study was conducted for 71 eyes of 43 patients who met the study criteria. All patients completed at least 2 years of follow-up. FA was taken during the periods of active retinal vasculitis and the quiescent phase, and analyzed using a FA scoring system. Among nine categories, the four most prevalent FA signs were evaluated: optic disc hyperfluorescence (score 0-3), macular edema (score 0-4), retinal vascular staining and/or leakage (score 0-7), and capillary leakage (score 0-10). RESULTS: Mean number of total active inflammations was 2.6 ± 1.5 times during mean 55.0 ± 20.0 months. Mean scores at the first active inflammation were 1.8 ± 1.0 for optic disc hyperfluorescence, 2.4 ± 1.0 for macular edema, 5.3 ± 2.1 for retinal vascular staining and/or leakage, and 5.8 ± 3.2 for capillary leakage. Mean total FA score was 17.4 ± 6.8. Mean scores at the first quiescent phase were 0.6 ± 0.4 for optic disc hyperfluorescence, 1.1 ± 1.2 for macular edema, 3.8 ± 1.9 for retinal vascular staining and/or leakage, and 3.5 ± 3.5 for capillary leakage. Mean total FA score was 9.1 ± 5.0. Mean scores for each active inflammation and quiescent phase were not significantly changed, and mean FA scores were significantly reduced in quiescent phase (P = 0.003 for optic disc hyperfluorescence, P = 0.005 for macular leakage, P = 0.010 for retinal vascular staining and/or leakage, P = 0.008 for capillary leakage, and P = 0.018 for total FA score; paired t-test). CONCLUSIONS: Retinal vasculitis of Behçet patients did not significantly progress during long-term follow-up.

Two-year outcome after combination therapy for polypoidal choroidal vasculopathy: comparison with photodynamic monotherapy and anti-vascular endothelial growth factor monotherapy.

PURPOSE: To compare treatment outcomes of photodynamic therapy (PDT), anti-vascular endothelial growth factor (VEGF) therapy and PDT combined with anti-VEGF therapy for polypoidal choroidal vasculopathy (PCV). PROCEDURES: A total of 62 eyes of 62 patients who had completed at least 2 years of follow-up were retrospectively reviewed; 19 eyes received PDT only, 23 had anti-VEGF therapy only and 20 underwent combination therapy. Best-corrected visual acuity at baseline and each follow-up visit was investigated as a primary outcome measure. RESULTS: At year 2, the PDT and combination groups maintained significant visual improvement (p = 0.041 and p = 0.021), whereas the anti-VEGF group failed to do so (p = 0.673) when compared with the baseline. The combination group showed better visual outcome during follow-up, and significantly better visual outcome than the PDT group (p = 0.038) and the anti-VEGF group (p = 0.012) at year 2. CONCLUSIONS: Combination therapy leads to significantly better visual outcome than PDT and anti-VEGF monotherapy and is therefore a superior method for treating PCV, with a favorable visual outcome.

Spectral-domain optical coherence tomography (SD-OCT) patterns and response to intravitreal bevacizumab therapy in macular edema associated with branch retinal vein occlusion.

BACKGROUND: To evaluate the baseline spectral-domain optical coherence tomography (SD-OCT) characteristics of macular edema (ME) due to branch retinal vein occlusion (BRVO) for visual outcome after intravitreal bevacizumab injection. METHODS: Fifty-nine patients treated in one eye with intravitreal bevacizumab for ME due to BRVO were retrospectively reviewed. Stepwise multiple regression analysis was used to evaluate the relative contribution of several variables, including SD-OCT characteristics such as photoreceptor inner segment/outer segment (IS/OS) integrity and external limiting membrane (ELM status), baseline best-corrected visual acuity (BCVA), and baseline central retinal thickness (CRT) with final visual outcome. RESULTS: Thirty-one patients (52.5 %) had disrupted photoreceptor IS/OS integrity. The mean BCVA improved significantly from 0.50 logMAR (20/63 Snellen equivalent) to 0.10 logMAR (20/25 Snellen equivalent) in the intact photoreceptor group (p = 0.000, paired t-test). However, the mean BCVA was improved in the disrupted photoreceptor group, from 1.10 logMAR (20/252 Snellen equivalent) to 0.94 logMAR (20/174 Snellen equivalent), which was not statistically significant (p = 0.177, paired t-test). ELM was disrupted in 23 patients (39.0 %). The mean BCVA improved significantly from 0.63 logMAR (20/85 Snellen equivalent) to 0.26 logMAR (20/36 Snellen equivalent) in the intact ELM group (p = 0.000, paired t-test), however, not significantly improved in the disrupted ELM group, from 1.09 logMAR (20/246 Snellen equivalent) to 1.01 logMAR (20/205 Snellen equivalent) (p = 0.563, paired t-test). The strongest individual predictor of final BCVA among patients with ME due to BRVO was the integrity of photoreceptor IS/OS layer on SD OCT (r (2) = 0.514, p = 0.000, stepwise multiple regression), but the most efficient model was the combination of the photoreceptor IS/OS integrity, ELM status, and baseline BCVA (r(2) = 0.671, p = 0.000, stepwise multiple regression). The strongest predictor of final BCVA was the status of photoreceptor IS/OS integrity (ß = 0.532, p = 0.000, stepwise multiple regression), followed by ELM status (ß = 0.325, p = 0.006, stepwise multiple regression), and the baseline BCVA (ß = 0.238, p = 0.013, stepwise multiple regression). CONCLUSION: Our results suggest that baseline SD-OCT characteristics, the status of photoreceptor IS/OS and ELM can be helpful in predicting the final visual outcome after intravitreal bevacizumab injection in these patients.

Ocular risk factors for recurrence of myopic choroidal neovascularization: long-term follow-up study.

PURPOSE: To investigate factors associated with long-term recurrence of myopic choroidal neovascularization (CNV) after treatment with photodynamic therapy (PDT) and/or intravitreal antivascular endothelial growth factor injections. METHODS: Seventy-six eyes with myopic CNV completed at least a 48-month follow-up after treatments. The baseline characteristics of the eyes were compared, including age, gender, refractive errors, axial lengths, location of CNV, lacquer cracks, chorioretinal atrophy, dark rim, great linear dimension, and prior PDT. RESULTS: During mean follow-up of 71.21 ± 26.43 months, 35 eyes (46.1%) experienced at least 1 recurrence. Mean interval between initial treatment and first recurrence was 24.15 ± 18.10 months. Presence of lacquer crack (P = 0.022, χ(2) test), absence of dark rim (P = 0.031, χ(2) test), and prior PDT (P = 0.041, χ(2) test) were significantly different between the eyes with and without recurrence. Among baseline characteristics, presence of lacquer crack (ß = 1.272, P = 0.012) prior PDT (ß = 1.607, P = 0.027), and absence of dark rim (ß = -0.758, P = 0.020) were significantly associated with the recurrence of myopic CNV after treatment by multiple logistic regression. CONCLUSION: Long-term follow-up revealed recurrence of myopic CNV in 46.1% of the patients after treatment. Presence of lacquer cracks, prior PDT, and absence of dark rim were risk factors for recurrence of myopic CNV.

New insights into the pathoanatomy of diabetic macular edema: angiographic patterns and optical coherence tomography.

PURPOSE: To describe the pathoanatomy of diabetic macular edema in optical coherence tomography and its correlation with fluorescein angiography patterns. METHODS: Sixty eyes of 56 patients were analyzed. Diabetic macular edema was classified into typical focal leakage (from microaneurysm), typical diffuse leakage (the capillary plexus), or combined/questionable leakage using fluorescein angiography and retinal thickness profiles. The leakage and pooling patterns in fluorescein angiography were matched to the corresponding optical coherence tomography images and analyzed. RESULTS: Focal leakage shows swelling predominantly in the outer plexiform layer (OPL). Deeply located microaneurysms directly leak into the loose fiber portion of OPL (Henle layer) through the "fluid conductivity barrier" (synaptic portion of OPL). Diffuse leakage caused swelling predominantly in the inner nuclear layer and secondarily in the OPL. The deep capillary plexus is located between the two "fluid barriers" (inner plexiform layer and OPL); thus, diffuse leakage is primarily related with swelling in the inner nuclear layer. In the combined/questionable leakage, partial sections consisting of inner nuclear layer swelling and much larger areas of OPL/outer nuclear layer swelling are noticed. CONCLUSION: Based on the concept of the fluid conductivity barrier, we revealed a correlation between the intraretinal location of the leakage source and where the fluid accumulated within the retinal layers.

Elevated aqueous endothelin-1 concentrations in advanced diabetic retinopathy.

PURPOSE: Endothelin-1 (ET-1) is a potent vasoconstrictor which seems to be involved in the pathogenesis of diabetic retinopathy (DR). However, studies on intraocular ET-1 in DR have been limited. Thus, we investigated aqueous ET-1 levels in patients with DR. METHODS: A total 85 subjects were included in this prospective study. Those were classified into three groups: advanced DR group included those with severe nonproliferative DR or proliferative DR, whereas early DR group included those with mild nonproliferative DR or moderative nonproliferative DR. Those who underwent cataract surgery and had no concomitant ocular disease were included in the control group. Aqueous humor levels of ET-1 were obtained before intravitreal bevacizumab injection (IVB) and after 1 month for the DR patients, and at the time of cataract surgery for the control group. RESULTS: Advanced DR group included 40 eyes (47.1%), whereas early DR group did 19 eyes (22.4%), and control group (26 eyes, 30.5%). Mean aqueous ET-1 level was 10.1±4.1 pg/mL (6.0-21.0 pg/mL) in advanced DR group, 1.9±0.7 pg/mL (0.6-2.8 pg/mL) in early DR group, and 2.1±1.0 pg/mL (0.7-3.9 pg/mL) in control group (P < 0.001). Advanced DR group was further subdivided into severe nonproliferative DR (15 eyes, 12.8%) and proliferative DR (25 eyes, 34.3%). Mean aqueous ET-1 level was 10.1±4.3 pg/mL (6.0-20.1 pg/mL) in patients with severe nonproliferative DR, and 10.0±4.0 pg/mL (6.0-21.0 pg/mL) in those with proliferative DR (P = 0.928) at baseline. Mean ET-1 level at 1 month after intravitreal injection was 2.5±1.0 pg/mL (0.3-4.8 pg/mL) in patients with severe proliferative DR and 2.9±1.7 pg/mL (1.0-7.0 pg/mL) in those with proliferative DR (P = 0.443). Mean aqueous ET-1 level was significantly reduced in both groups (P < 0.001, respectively). CONCLUSION: The mean aqueous ET-1 level was significantly higher in the eyes with advanced DR than those with early DR and the control group. The mean aqueous ET-1 level was significantly reduced after intravitreal injections in the advanced DR group. Based on our results, future studies on the exact role of ET-1 in the pathogenesis of DR and future implication for intervention would be helpful for managing DR.

Prevalence of focal lamina cribrosa defects in eyes with pachychoroid disease spectrum.

AIM: To determine the prevalence of focal lamina cribrosa (LC) defect among patients with pachychoroid disease spectrum (PDS) in the absence of peripapillary retinoschisis. METHODS: This retrospective, cross-sectional study comprised of 180 patients with PDS, including polypoidal choroidal vasculopathy (PCV), central serous chorioretinopathy, and pachychoroidal neovasculopathy. Medical records and optic nerve head evaluations conducted using spectral-domain optical coherence tomography with enhanced depth imaging were reviewed. As a control group, 236 patients who underwent ophthalmologic evaluation for vitreous floaters, without obvious ocular disease, were also included. RESULTS: The mean age of the PDS group, which included 118 male patients (65.6%), was 57.4±11.1y. There was no significant difference between the two groups in age (P=0.710) or sex (P=0.248). Six patients (3.3%) in the PDS group and none in the control group showed focal LC defect (P=0.318). Among the six patients with focal LC defect in the PDS group, four eyes had PCV, one eye was the fellow eye of a PCV eye, and one eye had pachychoroidal neovasculopathy. CONCLUSION: Focal LC defect can be defected in patients with PDS in the absence of peripapillary retinoschisis. However, the prevalence of focal LC defect was not different significantly between PDS patients and those who did not have PDS.

Early detection of diabetic retinopathy based on deep learning and ultra-wide-field fundus images.

Visually impaired and blind people due to diabetic retinopathy were 2.6 million in 2015 and estimated to be 3.2 million in 2020 globally. Though the incidence of diabetic retinopathy is expected to decrease for high-income countries, detection and treatment of it in the early stages are crucial for low-income and middle-income countries. Due to the recent advancement of deep learning technologies, researchers showed that automated screening and grading of diabetic retinopathy are efficient in saving time and workforce. However, most automatic systems utilize conventional fundus photography, despite ultra-wide-field fundus photography provides up to 82% of the retinal surface. In this study, we present a diabetic retinopathy detection system based on ultra-wide-field fundus photography and deep learning. In experiments, we show that the use of early treatment diabetic retinopathy study 7-standard field image extracted from ultra-wide-field fundus photography outperforms that of the optic disc and macula centered image in a statistical sense.

Significant elevation of aqueous endothelin-1 in central retinal vein occlusion.

PURPOSE: To investigate aqueous humor concentrations of endothelin-1 (ET-1) in patients with central retinal vein occlusion (CRVO) compared with patients with branch retinal vein occlusion (BRVO) and a normal control group. METHODS: A total 80 subjects were included in this prospective study, including 15 patients with CRVO, 20 patients with BRVO, and 45 patients who underwent cataract surgery and had no concomitant ocular disease. Aqueous humor levels of ET-1 were obtained before intravitreal bevacizumab injection (IVB) and after 1 month. RESULTS: At baseline, the mean aqueous ET-1 level was 12.7±3.6 pg/mL in the CRVO group, 8.0±2.3 pg/mL in the BRVO group, and 2.0±0.9 pg/mL in the control group (P<0.001). After IVB, the mean aqueous level of ET-1 was 3.4±1.9 pg/mL (0.5-6.9 pg/mL) in the CRVO group and 1.8±1.0 pg/mL (0.3-3.2 pg/mL) in the BRVO group (P = 0.008). The mean aqueous ET-1 level was significantly reduced in both the patients with CRVO and those with BRVO (P<0.001). CONCLUSION: The mean aqueous humor ET-1 level was significant higher in the patients with CRVO than those with BRVO and in the control group. After IVB, the mean level was significantly reduced in both the patients with CRVO and those with BRVO.