Impact of molecular symmetry on crystallization pathways in highly supersaturated KH2PO4 solutions.

Solute structure and its evolution in supersaturated aqueous solutions are key clues to understand Ostwald's step rule. Here, we measure the structural evolution of solute molecules in highly supersaturated solutions of KH2PO4 (KDP) and NH4H2PO4 (ADP) using a combination of electrostatic levitation and synchrotron X-ray scattering. The measurement reveals the existence of a solution-solution transition in KDP solution, caused by changing molecular symmetries and structural evolution of the solution with supersaturation. Moreover, we find that the molecular symmetry of H2PO4- impacts on phase selection. These findings manifest that molecular symmetry and its structural evolution can govern the crystallization pathways in aqueous solutions, explaining the microscopic origin of Ostwald's step rule.

Association between the response of intravitreal antivascular endothelial growth factor injection and systemic factors of diabetic macular edema.

BACKGROUND: This study investigated the effects of systemic factors in response to intravitreal injections in patients with macular edema due to non-proliferative diabetic retinopathy (NPDR). METHODS: We retrospectively reviewed the medical records of patients treated with intravitreal injections for macular edema secondary to NPDR between January 2018 and January 2021. The patients were divided into three groups according to the injection response. When patients with diabetic macular edema showed 20µ or more reduction in central retinal thickness compared to baseline, they were classified as responsive group, and if not, they were classified as refractory group. The responsive group was further divided into the complete and incomplete response groups. Patients with complete disappearance of edema at seven months were classified as the complete response group, whereas those in which edema did not disappear were classified as the incomplete response group. The clinical characteristics of each group, including medical history, ophthalmic examination results, and laboratory examination results at the time of diagnosis, were analyzed. RESULTS: Of the 112 eyes (91 patients) that satisfied the inclusion criteria, 89 (77 patients) in the responsive group and 23 (14 patients) in the refractory group were included in the analysis. The responsive group was further divided into the complete (51 eyes) and incomplete (38 eyes) response groups. The refractory group had significantly higher glycated hemoglobin levels and significantly lower estimated glomerular filtration rates than the responsive group (p = 0.026 and p = 0.012, respectively). In the multivariate logistic regression analysis, both factors were found to be significant in predicting the degree of response (all p < 0.05). No factor showed a significant difference between the incomplete and complete response groups(all p > 0.05). CONCLUSIONS: In macular edema caused by NPDR, low glomerular filtration rates and high glycated hemoglobin levels may be used as predictors of poor response to intravitreal injection therapy. In addition to blood glucose control, education should be provided regarding the need for the continuous monitoring of renal function.

Simultaneous measurements of volume, pressure, optical images, and crystal structure with a dynamic diamond anvil cell: A real-time event monitoring system.

The dynamic diamond anvil cell (dDAC) technique has attracted great interest because it possibly provides a bridge between static and dynamic compression studies with fast, repeatable, and controllable compression rates. The dDAC can be a particularly useful tool to study the pathways and kinetics of phase transitions under dynamic pressurization if simultaneous measurements of physical quantities are possible as a function of time. We here report the development of a real-time event monitoring (RTEM) system with dDAC, which can simultaneously record the volume, pressure, optical image, and structure of materials during dynamic compression runs. In particular, the volume measurement using both Fabry-Pérot interferogram and optical images facilitates the construction of an equation of state (EoS) using the dDAC in a home-laboratory. We also developed an in-line ruby pressure measurement (IRPM) system to be deployed at a synchrotron x-ray facility. This system provides simultaneous measurements of pressure and x-ray diffraction in low and narrow pressure ranges. The EoSs of ice VI obtained from the RTEM and the x-ray diffraction data with the IRPM are consistent with each other. The complementarity of both RTEM and IRPM systems will provide a great opportunity to scrutinize the detailed kinetic pathways of phase transitions using dDAC.

Relationship between ocular surface temperature and 0.1% cyclosporine a in dry eye syndrome with meibomian gland dysfunction.

To determine the relationship between ocular surface temperature (OST) and 0.1% cyclosporine A in patients with dry eye syndrome and meibomian gland dysfunction (MGD). This study retrospectively analyzed 35 eyes from 18 patients with dry eye disease (DED) and MGD, who were divided into two groups. Group 1 was treated with artificial tears, and eyelid margin scrubs without anti-inflammatory eye drops, while group 2 received the same treatment as group 1 along with 0.1% cyclosporine A. The ocular surface disease index (OSDI), tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), lipid layer thickness (LLT), meibum quality score (MQS), and OST were measured at baseline and 1 month later. Nineteen and 16 eyes were included in groups 1 and 2, respectively. Both groups showed a significant decrease in OSDI and OST; however, the decrease was more significant in group 2. No other significant differences in TMH, NIBUT, and LLT were observed; however, MQS significantly differed in group 2. This study found that 0.1% CsA administration can relieve symptoms in patients with DED and MGD although there were no definite keratitis clues, such as epithelial erosion. In addition, the conjunctival temperature showed a correlation with symptom improvement.

Factors related to changes in visual symptoms after successful photodynamic therapy in central serous chorioretinopathy.

To investigate biomarkers related to visual symptom and best corrected visual acuity (BCVA) improvement after photodynamic therapy (PDT) for central serous chorioretinopathy. This retrospective cross-sectional study involved 42 consecutive eyes, from 42 patients who underwent successful PDT, divided into two groups according to improvement in subjective visual complaints: complete (20 eyes) and incomplete recovery (22 eyes). The clinical characteristics of each group, including central foveal thickness (CFT), foveal avascular zone (FAZ) area, and degree of change in signal voiding of the choriocapillaris on optical coherence tomography angiography, were compared. Correlations between best-corrected visual acuity (BCVA) and baseline clinical features were investigated. At baseline, CFT and FAZ areas showed significant differences between the two groups (all p < 0.05). Multiple binary logistic regression analysis revealed that greater CFT predicted complete recovery from visual complaints (p = 0.002). Reduction or disappearance of signal voiding in the choriocapillaris 6 months post-PDT occurred more frequently in the complete recovery group (p < 0.05). FAZ area before PDT correlated with BCVA before and 6 months after PDT and BCVA improvement during the study period (all p < 0.05). CFT and FAZ area before PDT correlated with completeness of visual symptom recovery after PDT. Smaller FAZ area before PDT correlated with better BCVA before and after treatment.

Association of advanced chronic kidney disease with diabetic retinopathy severity in older patients with diabetes: a retrospective cross-sectional study.

BACKGROUND: Despite the recent increasing trend in the prevalence of type 2 diabetes among older individuals, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) in these patients remains unclear. This study investigated the severity of renal dysfunction according to the degree of DR in older patients with type 2 diabetes. METHODS: A total of 116 patients with diabetes and CKD stage ≥3 who visited both the nephrology and ophthalmology outpatient departments between July 2021 and January 2022 were screened. There were 53 patients in the no DR group, 20 in the nonproliferative DR (NPDR) group, and 43 in the proliferative DR (PDR) group. RESULTS: DR severity was related to the deterioration of renal function. The proportion of patients with advanced CKD significantly increased with DR severity (p for trend <0.001). In the multivariate regression model adjusted for age of ≥80 years, male sex, poorly controlled diabetes, macroalbuminuria, insulin use, diabetes duration of ≥10 years, cerebrovascular accident, hypertension, hyperlipidemia, and cardiovascular disease history, the odds ratio compared with the no DR group was approximately 4.6 for the NPDR group and approximately 11.8 for the PDR group, which were both statistically significant (p=0.025 and p<0.001, respectively). CONCLUSION: DR severity in older patients with diabetes may be associated with deterioration of renal function and high prevalence of advanced CKD. Therefore, periodic examination for DR in older patients with diabetes is important for predicting renal function deterioration and CKD progression.

Comparison of Extracorporeal Shock Wave Therapy and Ultrasound-Guided Shoulder Injection Therapy in Patients with Supraspinatus Tendinitis.

Background: The present study compared the clinical effect of extracorporeal shock wave therapy (ESWT) with that of ultrasound (US)-guided shoulder steroid injection therapy in patients with supraspinatus tendinitis. We hypothesized that the two treatments would show comparable results. Methods: The inclusion criteria were age over 20 years and diagnosis of supraspinatus tendinitis using US. Ultimately, 26 patients were assigned using blocked randomization: 13 in the US-guided shoulder injection group and 13 in the ESWT group. Treatment outcomes were evaluated using the pain visual analog scale (pVAS), the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 1 and 3 months after the procedure. Results: At 1 month after the intervention, pVAS, ASES, and constant score were significantly higher in the US-guided shoulder injection group than in the ESWT group, but not at 3 months after the intervention. Both groups showed clinically significant treatment effects at 3 months after the intervention compared to baseline. No significance was shown using equivalence testing. Conclusions: US-guided shoulder injection therapy was not superior to ESWT therapy. Considering the complications and rebound phenomenon of steroid injections, interventions using ESWT may be a good alternative to treat patients with supraspinatus tendinitis.

PARAFOVEAL INNER RETINAL THINNING AS THE BIOMARKER PREDICTING LESS RECURRENCE OF MACULAR EDEMA IN CENTRAL RETINAL VEIN OCCLUSION AFTER DISCONTINUING ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR.

PURPOSE: To identify the predictive factors for the recurrence of macular edema after the cessation of antivascular endothelial growth factor treatment in eyes with central retinal vein occlusion (CRVO). METHODS: This retrospective study included participants who had discontinued intravitreal bevacizumab injections for complete resolution of macular edema related to CRVO at 3 months after the last injection. Fifty-two eyes were enrolled in this study and classified into two groups based on the recurrence of macular edema within 1 year after the stopping point, when the decision to discontinue injections was made. Clinical characteristics and optical coherence tomographic parameters at baseline and at the stopping point were investigated. RESULTS: Multivariate logistic regression analysis demonstrated that, at baseline, old age was associated with a significantly higher risk of macular edema recurrence (odds ratio, 1.092; P = 0.022). At the stopping point, parafoveal inner retinal thickness (odds ratio: 1.043, P = 0.014) and the presence of ellipsoid zone disruption (odds ratio: 5.922, P = 0.032) were predictive factors for recurrence. The receiver operating characteristic curve showed that parafoveal inner retinal thinning of >7 µm compared with that in the fellow eye was significantly associated with decreased recurrence of macular edema. CONCLUSION: Parafoveal inner retinal thinning and intact ellipsoid zone after resolution of macular edema by antivascular endothelial growth factor treatment were predictive of a lower risk of recurrence of macular edema in CRVO. These intuitive biomarkers may help predict future disease courses and design optimal treatment strategies.

Silent progressive bilateral papillitis after COVID-19 vaccination: A case report.

RATIONALE: We report the case of a patient who developed asymptomatic bilateral papillitis after coronavirus disease 2019 (COVID-19) vaccination. PATIENT CONCERNS: A 61-year-old man presented to our tertiary clinic with bilateral optic disc edema, which was incidentally detected during his visit to a primary ophthalmology clinic. He had received an adenovirus-vectored COVID-19 vaccine 2 weeks before the optic disc edema was detected and had experienced no ocular discomfort, except for a floater in his right eye. Although his visual acuity was normal and he had no color vision deficiencies or marked visual field defects, the optic disc edema worsened over several days. Orbital magnetic resonance imaging showed no optic tract enhancement, and lumbar puncture revealed normal cerebrospinal fluid pressure. The patient tested negative for aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies and Leber hereditary optic neuropathy-associated gene mutations. DIAGNOSIS: The patient was diagnosed with bilateral papillitis, possibly induced by the COVID-19 vaccination. INTERVENTIONS: The patient received steroid pulse therapy with methylprednisolone (500 mg/day) for 3 days followed by an oral prednisolone taper for 3 weeks. OUTCOMES: The patient's papillitis started to subside 3 weeks after he received systemic steroid therapy and completely resolved without any sequelae 2 months later. A year after the diagnosis, the fundus remained stable without disease recurrence or optic disc atrophy. LESSONS: Healthy individuals receiving COVID-19 vaccines may present with various manifestations of optic neuritis. In the present case, the patient presented with asymptomatic progressive bilateral optic disc edema and had a favorable long-term course after receiving steroid therapy.

Quantitative Magnetic Resonance Imaging measurement of muscle atrophy and fatty degeneration after arthroscopic rotator cuff repair.

BACKGROUND: It is unclear whether muscle atrophy (MA) and fatty degeneration (FD) have improved after arthroscopic rotator cuff repair (ARCR). Therefore, the objective of this study was to perform quantitative magnetic resonance imaging (MRI) measurement to evaluate MA and FD before and after surgery. Correlations of clinical outcome with changes in MA and FD were also analyzed. MATERIALS AND METHODS: From March 2013 to March 2017, 40 patients who had no re-tear up to 1 year after ARCR were enrolled. MA and FD of supraspinatus muscle before surgery, at 3 days after surgery, and at 1 year after surgery were measured quantitatively in conventional Y-view and supraspinatus origin-view (SOV). Measurement items were muscle area (mm2), occupation ratio (%), fatty infiltration (FI, %), and fatty degenerative area (mm2). Postoperative clinical outcomes were measured at 1 year after ARCR. Correlation between measure values and outcome scores were analyzed. RESULTS: Inter-measurement reliability was high (ICC = 0.933, Cronbach-α = 0.963). There was no significant change in MA in conventional Y-view at 1 year after surgery (Occupation ratio, p = 0.2770; MA, p = 0.3049) or in SOV (MA, p = 0.5953). FI and fat area measured with the conventional method on Y-view and showed significant differences (p = 0.0001). However, FI and fat area measured with the modified method on Y-view and SOV showed no significant difference (all p > 0.05). Postoperative clinical outcomes showed significant improvement compared to preoperative ones (p = 0.0001). However, there was no significant correlation between FD and FA (p = 0.653). CONCLUSION: Quantitative MRI measurement was shown to be a reliable and valid method. MA and FD do not improve after ARCR considering postoperative anatomical changes of supraspinatus at 1-year follow-up. FD of the supraspinatus in conventional Y-view, but not in SOV, showed a significant change at 1 year postoperatively. MA showed no significant improvement. There was no correlation between improvement in clinical scores and changes in FD and MA.

Clinical and Anatomical Outcomes of Arthroscopic Repair of Large Rotator Cuff Tears with Allograft Patch Augmentation: A Prospective, Single-Blinded, Randomized Controlled Trial with a Long-term Follow-up.

Background: Arthroscopic rotator cuff repair using human dermal matrix allograft augmentation has been widely used. We assessed the effect of acellular human dermal matrix augmentation after arthroscopic repair of large rotator cuff tears through a prospective, single-blinded, randomized controlled trial with a long-term follow-up. Methods: Sixty patients with large-sized rotator cuff tears were randomly assigned to two groups. Patients in the control group underwent arthroscopic rotator cuff repair. Allograft patch augmentation was additionally performed in the allograft group. All patients were subdivided into a complete coverage (CC) group or an incomplete coverage (IC) group according to footprint coverage after cuff repair. Constant and American Shoulder and Elbow Surgeons (ASES) scores were assessed preoperatively and at final follow-up. Magnetic resonance imaging was also performed at the same time to evaluate the anatomical results. Results: Forty-three patients were followed up for an average of 5.7 years. Clinical scores (Constant and ASES) increased significantly at the last follow-up in both groups. The increase in ASES score in the allograft group was statistically significantly greater than that in the control group. The degree of Constant score improvement did not differ significantly between the two groups. The retear rate was 9.1% in the allograft group, which was significantly lower than that in the control group (38.1%). In the control group, the CC subgroup had a statistically significantly lower retear rate (16.7%) than did the IC subgroup. There were no retear cases in the CC subgroup of the allograft group. Conclusions: Long-term follow-up of arthroscopic repair of large rotator cuff tears with allograft patch augmentation showed better clinical and anatomical results. Footprint coverage after rotator cuff repair was an important factor affecting the retear rate. If the footprint was not completely covered after rotator cuff repair, allograft patch augmentation may reduce the retear rate.

Assessment of Scleral Contour Changes in High Myopia by Optical Coherence Tomography.

PURPOSE: This study aimed to establish and validate optical coherence tomography (OCT) based diagnostic criteria of high myopia. METHODS: This was a cross-sectional study including 100 eyes of high myopia with axial length larger than 26.5 mm and 100 control eyes, which were examined by spectral-domain OCT. Vertical and horizontal OCT of 9 mm scanning across fovea were analyzed. OCT characteristics including mirror artifact, scleral sink due to steep inclination of posterior sclera, scleral visibility, abnormality of outer retinal layer, foveoschisis, and dome-shaped macula were assessed in each group. RESULTS: The mean axial length was 28.65 ± 2.07 mm (range, 26.51-34.59 mm) in high myopia group and 23.79 ± 0.99 mm (range, 21.26-25.94 mm) in control group. Among the OCT characteristics noted at high frequency in the eyes with high myopia, three criteria achieving high sensitivity and specificity were determined: scleral sink over 500 µm, scleral visibility over 100 µm, and dome-shaped macula. Under conditions of presence of any of three criteria in either horizontal or vertical OCT scanning, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value for high myopia were found to be 95.0%, 98.0%, 98.0%, and 95.1%, respectively. In a new set of OCT images from 50 eyes with high myopia and 50 eyes of nonhigh myopia cases, the OCT-based criteria also proved similar level of diagnostic validity. CONCLUSIONS: The OCT-based criteria, which directly addressed posterior scleral contour changes, may lead to an intuitive and accurate diagnosis of high myopia. Also, the criteria may contribute to early detection and monitoring of eyes that cannot be defined as high myopia but can progress. OCT may be useful for monitoring high myopia patients as OCT can detect myopia-associated retinal pathologies as well as scleral contour changes.

Histamine binding activity of surface-modified yeast by histamine binding protein (HBP).

Histamine is an immune mediator that is mainly secreted when an immediate, rapid response is needed in the body, and an excessive secretion of histamine or lack of enzymes that degrade histamine can result in various side effects. Histamine binding protein (HBP) is secreted by a mite species to prevent the host's histamine-induced immune responses by binding the histamine molecule in the blood. Cloning was performed to express HBP on the yeast surface (MBTL-GWL-1), and immunofluorescence (IF) and western blot was performed to confirm the expression of the recombinant protein. The histamine inhibitory ability of GWL-1 cells was tested according to the cell concentration. The highest inhibitory ability of 1.30 × 107 CFU/ml of GWL-1 cells was of about 60 %. The GWL-1 cell concentration and the degree of histamine inhibition were confirmed to be dose-dependent, and dead cell debris was shown to have a histamine inhibitory effect, although not as much as that of whole cells. Phagocytosis assays were performed to determine whether histamine affected the RAW 264.7 cell's phagocytosis, and to indirectly confirm the GWL-1 cell's histamine inhibition. By confirming that, we found that GWL-1 captures histamine. Therefore, it can be expected to become a competitive material in the anti-allergy market.

ASSOCIATIONS WITH RECURRENCE OF MACULAR EDEMA IN BRANCH RETINAL VEIN OCCLUSION AFTER THE DISCONTINUATION OF ANTI VASCULAR ENDOTHELIAL GROWTH FACTOR.

PURPOSE: To identify factors predicting the recurrence of macular edema after the discontinuation of intravitreal antivascular endothelial growth factor injection in patients with branch retinal vein occlusion. METHODS: This retrospective study included only subjects who had discontinued injections at 3 months after the final bevacizumab injection due to fully resolved macular edema. Fifty-two eyes meeting the criteria were included in the study and divided into two groups (recurrence and no recurrence). Clinical features and measurements of retinal thickness at the time of the diagnosis and when the decision to stop injections was made (stopping point) were analyzed. RESULTS: At the stopping point, the no recurrence group showed a thinner parafoveal inner retina, better best-corrected visual acuity, and lower incidence of ellipsoid zone disruption in multivariate logistic regression analysis (all P < 0.05). Similarly, parafoveal inner retinal thinning of more than 30 µm, when compared with the corresponding region of the fellow eye or the unaffected region of the affected eye, was significantly related to less recurrence of macular edema. CONCLUSION: Thinning of the parafoveal inner retina as well as better vision and intact outer retinal layers are associated with a lack of recurrence of macular edema. These findings suggest that inner retinal atrophy after branch retinal vein occlusion may result in a reduction in oxygen demand in the affected retinal tissue and less production of vascular endothelial growth factor.

Risk Factors for Extended-Spectrum-ß-Lactamase-Producing Escherichia coli in Community-Onset Bloodstream Infection: Impact on Long-Term Care Hospitals in Korea.

BACKGROUND: The prevalence of extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) in the community has increased worldwide due to multifactorial reasons. ESBL-EC bloodstream infection (BSI) complicates the decision for proper antimicrobial administration. In this multicenter study, we investigated the prevalence, risk factors, and molecular background of community-onset (CO) ESBL-EC BSI. METHODS: We included data for all episodes of ESBL-EC BSI of community origin from May 2016 to April 2017 obtained from the Korean national antimicrobial resistance surveillance system, which comprises six sentinel hospitals. Data, including previous history of admission and use of antimicrobials and medical devices before BSI, were collected, along with microbiological analysis results. RESULTS: Among 1,189 patients with CO BSI caused by E. coli, 316 (27%) were identified as ESBL producers. History of admission, especially to a long-term care hospital (LTCH), and previous use of ß-lactams/ß-lactamase inhibitors, carbapenem, lincosamide, aminoglycoside, and extended-spectrum cephalosporin were independent risk factors for CO ESBL-EC BSI; admission to an LTCH showed the highest odds ratio (3.8, 95% confidence interval 2.3-6.1). The most common genotype was CTX-M-15 (N=131, 41%), followed by CTX-M-14 (N=86, 27%). ST131 was the most common sequence type among ESBL-EC groups (57%). CONCLUSIONS: In Korea, 27% of CO E. coli BSI were caused by ESBL producers. From perspectives of empirical treatment and infection control, history of admission to an LTCH and antimicrobial use should be noted.

Changes of antibiotic prescribing pattern and its resistance to E. Coli in South Korea: a 12-year retrospective observational study.

In the present study, we investigated the pattern of changes in antibiotic prescription and antimicrobial resistance (AMR) in Escherichia coli in South Korea between 2007 and 2018. We collected data related to antibiotic prescription and AMR in E. coli from the national surveillance system. We used the Mann-Kendall test and Spearman's correlation to identify the trends of antibiotic prescription and AMR in E. coli and to examine the relationship between them, respectively. Although we noted a significant decreasing trend of ampicillin and gentamicin prescriptions in all medical institutions, we identified a higher level of AMR in long-term care facilities than in other medical institutions. We did not identify a significant positive correlation between ampicillin and gentamicin prescriptions and their resistance in E. coli. However, we found a significant positive correlation between cefotaxime prescription and its resistance in E. coli in hospitals, long-term care facilities, and clinics. Our results strongly suggest that long-term care facilities in South Korea have the potential to sustain AMR epidemics and that more efforts are needed to curb AMR in E. coli. Further epidemiological studies using enhanced AMR surveillance are warranted.

The implications of subretinal fluid in pachychoroid neovasculopathy.

This study aimed to identify the clinical characteristics and longitudinal changes in exudative pachychoroid neovasculopathy (PNV) and non-exudative PNV. This retrospective cohort study involved 81 eyes of PNV diagnosed by multimodal imaging including optical coherence tomography angiography. At baseline, they were divided into exudative PNV group and non-exudative PNV group depending on the presence of subretinal fluid. The clinical features of both groups and the longitudinal changes were investigated and compared. There were 55 eyes with non-exudative PNV and 26 eyes with exudative PNV. Individuals with non-exudative PNV were older, more frequently asymptomatic and had a higher prevalence of polypoidal choroidal vasculopathy in the opposite eye (all P's < 0.05). Whereas individuals with exudative PNV showed thicker choroid and more frequent history of central serous chorioretinopathy (all P's < 0.001). During about 12 months of longitudinal observation, the transformation into polypoidal choroidal vasculopathy was noted in 4 eyes of non-exudative PNV group, whereas in none of the exudative PNV group. Exudative PNV and non-exudative PNV seem to be separate entities with different epidemiological parameters. Non-exudative PNV, which is frequently found without symptoms at an older age, is suspected to be the significant precursor lesion of polypoidal choroidal vasculopathy. In contrast, exudative PNV may share the same pathophysiology as central serous chorioretinopathy.

Characteristics of secondary epiretinal membrane due to peripheral break.

This study aimed to investigate morphological differences between idiopathic epiretinal membrane (ERM) and secondary ERM due to peripheral break (SEPB) and to identify clinical characteristics in eyes with SEPB to facilitate peripheral retinal examination. The retrospective cross-sectional study involved 93 consecutive eyes in 91 patients who underwent ERM removal surgery. Eyes were divided into two groups: the macular pucker group and the idiopathic ERM group. En-face Optical Coherence Tomography (OCT) images, fundus photographs, severity of metamorphopsia (M-score) and clinical characteristics of each group were compared. ERM extent and eccentricity (ratio of the shortest and longest distances from the foveal center to the boundary) were obtained through en-face OCT imaging. Fundus photographs were used to judge whether the membrane was turbid or not. Patients with SEPB were younger than patients with idiopathic ERM (61.3 ± 7.5 vs. 66.6 ± 8.3 years; p < 0.05). Preoperative M-score and myopic refractive error, axial length were also significantly higher in the macular pucker group than in the idiopathic ERM group (all p < 0.05). There was no difference in ERM extent between the two groups. The incidence of ERM eccentricity was 23 of the 34 eyes (67.6%) in the SEPB group and 26 of the 59 eyes (44.1%) in the idiopathic ERM group (p < 0.05). The incidence of turbid ERM was 18 of the 34 eyes (52.9%) in the SEPB group and 10 of the 59 eyes (16.9%) in the idiopathic ERM group (p < 0.01). The SEPB group, compared with the idiopathic ERM group, tended to have eccentric, turbid ERM at a younger age and with more severe metamorphopsia and myopic refractive error.

Structural profile of dome-shaped macula in degenerative myopia and its association with macular disorders.

BACKGROUND: To evaluate the detailed structural profile of dome-shaped macula and its association with myopic macular complications. METHODS: This retrospective study included 147 eyes of 93 patients who were diagnosed with degenerative myopia. The height of the scleral dome and diameter of the dome base were measured via enhanced depth imaging optical coherence tomography images with 1:1 µm setting. Spherical equivalent and best-corrected visual acuity were compared in eyes with and without dome-shaped macula. In eyes with dome-shaped macula, the height and diameter of the dome were compared in eyes with and without myopic macular complications including choroidal neovascularization, myopic foveoschisis, and macular hole. RESULTS: Dome-shaped macula was noted in 60 eyes (40.8%) of 42 patients. The mean height of the dome in the eyes with dome-shaped macula was 126.5 ± 69.4 µm (53 to 345 µm) and the mean diameter of the dome base was 2862.1 ± 794.9 µm (1567 µm to 4886 µm). In comparing eyes with and without dome-shaped macula, eyes with dome-shaped macula had higher myopia (- 13.7 diopters vs - 12.1 diopters, P = 0.022). There was no difference in visual acuity in eyes with or without dome-shaped macula (P = 0.132). The height and diameter of the dome in eyes with and without myopic foveoschisis were 78.6 ± 20.6 µm and 134.9 ± 71.6 µm, 2499.2 ± 303.1 µm and 2969.3 ± 645.7 µm, respectively (P = 0.009 and P = 0.017). However, the height and diameter of the dome were not related to the incidence of a macular hole (P = 0.324 and P = 0.605) and choroidal neovascularization (P = 0.835 and P = 0.905). CONCLUSIONS: The prevalence of dome-shaped macula was about 40% in the eyes with degenerative myopia. Although dome-shaped macula was associated with higher degrees of myopia, a prominent dome seemed to be protective against myopic foveoschisis.

Macular Abnormalities Associated With 5α-Reductase Inhibitor.

Importance: The neuroprotective action of sex hormones has been described. Data on the association between 5α-reductase inhibitor (5-ARI), a male sex hormone antagonist, and macular abnormalities are lacking to date. Objective: To assess the association between the use of 5-ARI for treatment of benign prostate hypertrophy and/or androgenic alopecia in men and macular abnormalities on optical coherence tomography imaging. Design, Setting, and Participants: This retrospective case-control, cross-sectional study included electronic health record data from 31 male patients who showed foveal cavitation on spectral-domain optical coherence tomography imaging from January 1, 2016, to June 30, 2019. Exposures: Receipt of 5-ARI for at least 2 years as treatment of benign prostate hypertrophy and/or androgenic alopecia. Main Outcomes and Measures: Clinical data and multimodal imaging findings and the proportion of 5-ARI users. Results: Among 31 male patients with foveal cavitation, 5-ARI was used for 10 of 14 patients (71.4%) with macular abnormalities of unknown origin and for 2 of 17 patients (11.8%) with macular abnormalities of well-known specific origin (P = .001). The mean age of these 14 patients was 74.7 years (range, 60.1-88.0 years). In the 15 eyes of 10 patients who had received 5-ARI for macular abnormalities of unknown origin, mean (SD) age was 72.8 (7.5) years, mean (SD) length of time receiving 5-ARI was 72.3 (39.2) months, and mean (SD) logMAR visual acuity was 0.08 (0.10) (Snellen equivalents, 20/24 [20/25]). Optical coherence tomography imaging showed a disease spectrum ranging from tiny foveal cavitation to an impending macular hole. Of the total male patients, 80.0% (8 of 10) had no symptoms. Conclusions and Relevance: The findings suggest that macular abnormalities associated with 5-ARI are characterized by cystoid abnormalities and foveal cavitation in male patients, which may progress to outer foveal defect and macular hole. These macular abnormalities associated with a male sex hormone antagonist suggested by this investigation warrant further corroboration.