Selective internal limiting membrane peeling for prevention of secondary epiretinal membrane after vitrectomy for rhegmatogenous retinal detachment.

PURPOSE: We introduce selective internal limiting membrane (ILM) peeling, a guideline procedure to determine whether to remove the ILM during vitrectomy for rhegmatogenous retinal detachment (RRD). STUDY DESIGN: Retrospective case series METHODS: Patients who underwent pars plana vitrectomy for RRD and were followed up for 12 months or longer were included. When vitreous cortex remnants (VCRs) were detected with triamcinolone acetonide, the ILM was removed; otherwise, the ILM was preserved ("selective ILM peeling"). The factors associated with the presence of VCRs and incidence of secondary epiretinal membrane (ERM) were analyzed. RESULTS: VCRs were detected in 87 of 133 eyes (65.4%) in which the ILM was removed. Younger age, better preoperative visual acuity, and vitreous hemorrhage were negatively correlated with the presence of VCRs. No ERM occurred in the eyes after ILM peeling. Among the eyes with ILM preservation, subclinical ERM was noticed in 4 eyes (8.7%), and 1 eye (2.1%) required additional surgery owing to ERM. ERM occurred more commonly in eyes with the ILM preserved (P = .004). However, no differences in the rate of additional surgeries were found between the 2 groups. CONCLUSION: Selective ILM peeling offers an alternative option to reduce the burden of ILM peeling or additional surgery.

Efficacy of inverted inner limiting membrane flap technique for macular holes of ≤400 µm: A systematic review and meta-analysis.

PURPOSE: To evaluate the efficacy of inverted internal limiting membrane (ILM) flap technique in full-thickness macular holes (MHs) with a size of ≤400 µm compared to the ILM peeling technique. METHODS: Related literatures that compared inverted ILM flap and ILM peeling in MHs ≤ 400 µm were reviewed by searching electronic databases including Pubmed, EMbase, ClinicalTrials.gov, and Cochrane Library up to April 2023. The primary outcome measure was hole closure rate, and the secondary outcome measures were the mean postoperative best-corrected visual acuity (BCVA), retinal sensitivity, and outer status of the retinal layers, including the external limiting membrane and ellipsoid zone. The quality of the articles was assessed according to the revised version of the Cochrane risk-of-bias tool for randomized trials or the Newcastle-Ottawa scale. In the case of heterogeneity, a sensitivity analysis was conducted, and publication bias was visually evaluated using a funnel plot. RESULTS: This review included six studies with 610 eyes for the primary outcome and 385 eyes for the secondary outcomes, which were two randomized control trials and four retrospective studies. Pooled data revealed that the overall MH closure rate was 99.4% in the inverted ILM flap group and 96.2% in the ILM peeling group, without significant difference between the two groups (odds ratio = 3.91; 95% confidence interval, 0.82~18.69; P = 0.09). The inverted ILM flap technique did not have a favorable effect on the BCVA, retinal sensitivity, or recovery of the outer retinal layers. These results were consistent with those of the subgroup analysis of the different follow-up periods. No significant publication bias was observed. CONCLUSION: In eyes with MHs of ≤400 µm, both techniques demonstrated excellent surgical outcomes without significant differences. Therefore, surgical techniques can be selected according to surgeon preferences.

Effect of topical bromfenac on intraretinal cystoid lesion in simultaneous cataract and idiopathic epiretinal membrane surgery.

PURPOSE: To investigate the effect of topical nonsteroidal anti-inflammatory drugs (NSAIDs,) bromfenac on the intraretinal cystic lesions (IRC) when performing simultaneous cataract and idiopathic epiretinal membrane (iERM) surgery. METHODS: This study included patients with iERM who had been followed up for 6 months after vitrectomy, membrane removal, and concurrent cataract surgery. Eyes were treated with topical bromfenac or not. The baseline fluorescein angiography (FA) was obtained to assess the microvascular leakage (ML). Structural changes of macula, including IRC and central macular thickness (CMT) were assessed using optical coherence tomography (OCT). The main outcome measures were changes in IRCs and best-corrected visual acuity (BCVA) regarding FA findings. RESULTS: One hundred eighteen eyes were included. IRC and ML were observed in 51 eyes (43.2%) and 63 eyes (53.4%), respectively. The IRC did not show any association with the ML. Of total, 29 eyes (24.6%) were treated with topical bromfenac (Group A). Compared to Group B, topical bromfenac did not show beneficial effects in aspect of preventions for the newly developed IRC and treatment for pre-existed IRC. Whether the ML existed or not, topical bromfenac did not show any different effect on the changes in BCVA and IRC. CONCLUSION: When performing simultaneous cataract and ERM surgery, topical NSAIDs, bromfenac did not show beneficial effects on the preventions and treatment of IRC in both eyes with and without the ML.

Accuracy of generative deep learning model for macular anatomy prediction from optical coherence tomography images in macular hole surgery.

This study aims to propose a generative deep learning model (GDLM) based on a variational autoencoder that predicts macular optical coherence tomography (OCT) images following full-thickness macular hole (FTMH) surgery and evaluate its clinical accuracy. Preoperative and 6-month postoperative swept-source OCT data were collected from 150 patients with successfully closed FTMH using 6 × 6 mm2 macular volume scan datasets. Randomly selected and augmented 120,000 training and 5000 validation pairs of OCT images were used to train the GDLM. We assessed the accuracy and F1 score of concordance for neurosensory retinal areas, performed Bland-Altman analysis of foveolar height (FH) and mean foveal thickness (MFT), and predicted postoperative external limiting membrane (ELM) and ellipsoid zone (EZ) restoration accuracy between artificial intelligence (AI)-OCT and ground truth (GT)-OCT images. Accuracy and F1 scores were 94.7% and 0.891, respectively. Average FH (228.2 vs. 233.4 µm, P = 0.587) and MFT (271.4 vs. 273.3 µm, P = 0.819) were similar between AI- and GT-OCT images, within 30.0% differences of 95% limits of agreement. ELM and EZ recovery prediction accuracy was 88.0% and 92.0%, respectively. The proposed GDLM accurately predicted macular OCT images following FTMH surgery, aiding patient and surgeon understanding of postoperative macular features.

Impact of slab selection on the relationship between choriocapillaris flow deficits and enlargement rate of geographic atrophy.

OBJECTIVE: To evaluate the effect of changing slab position on the correlation between choriocapillaris (CC) flow deficits (FD) in eyes with geographic atrophy (GA) and yearly enlargement rate (yER) of GA. METHODS: OCT and OCTA images obtained on Cirrus HD-OCT device were collected from patients with GA. Each patient underwent OCTA scan at baseline and two OCT scans, one at baseline and one after at least 12 months. GA was delineated on en-face fundus image to calculate yER. OCTA images were generated from three 10 µm thick slabs 11, 21 and 31 µm posterior to RPE-fit line. 100 µm-wide concentric rings were generated around GA to calculate FD% in each ring which was correlated with yER. RESULTS: For the 11-21 µm slab, FD% was not significantly correlated with yER for any of the rings (p > 0.05). For the 21-31 and 31-41 µm slab, FD% of rings located in the 600 µm region around GA was significantly correlated with yER (p < 0.05). However, in all slab locations, there was no significant correlation between yER and CC FD% of rings located beyond the 600 µm region (p > 0.05). CONCLUSIONS: Slab selection for quantification of CC FD% may have a significant impact on quantitative results in eyes with GA.

Clinical features of retinopathy after cardiopulmonary resuscitation.

PURPOSE: To evaluate the clinical patterns of retinopathy in patients who received cardiopulmonary resuscitation (CPR) using wide-field fundus photography and slit-lamp fundus examination. METHODS: The medical records of patients aged ≥ 18 years who survived after receiving CPR and underwent wide-field fundus photography and slit-lamp fundus examination within 3 months were retrospectively analyzed. Fundus findings, including retinal hemorrhage and cotton wool spots, were investigated. The subjects were categorized into the retinopathy and non-retinopathy groups based on the presence of fundus findings. Systemic and CPR-related factors were analyzed to compare the two groups. RESULTS: Twenty eyes (10 patients) and 28 eyes (14 patients) were included in the retinopathy and non-retinopathy groups, respectively. The retinopathy group had longer CPR time than the non-retinopathy group (15 ± 11 min vs. 6 ± 5 min, p = 0.027). In the retinopathy group, retinal nerve fiber layer hemorrhage was observed in all eyes, and intraretinal hemorrhage was observed in 55% of the eyes. 80% of hemorrhages were located in the peripapillary or posterior pole. There were no interval changes in visual acuity, intraocular pressure, and central retinal thickness for 6 months. The average remission periods of retinal hemorrhage and cotton wool spots were 6.8 ± 2.6 month and 5.6 ± 2.1 months, respectively. No retinopathy progression was observed. CONCLUSION: The signs of retinopathy, such as retinal hemorrhages and cotton wool spots, which are found after CPR, mainly occur in patients who receive longer time of CPR and improve over time.

Incidence and Risk Factors of Recurrent Anterior Uveitis in Initial Acute-Onset Vogt-Koyanagi-Harada Disease.

PURPOSE: We report the estimated incidence of, and risk factors for, recurrent anterior uveitis in patients with initial acute-onset Vogt-Koyanagi-Harada (VKH) disease using survival analyses. METHODS: Patients who were diagnosed with initial acute-onset VKH disease during 2003-2022 at two university hospitals were included. Recurrent anterior uveitis was defined as the first occurrence of the granulomatous anterior uveitis with anterior chamber cells and flare of 2+ or more by the Standardization of Uveitis Nomenclature (SUN) Working Group grading scheme, after the disappearance of conspicuous uveitis and serous retinal detachment for at least 3 months, regardless of systemic or local treatment. The univariate log-rank test and multivariate Cox regression analyses were performed, including patients' demographic characteristics, underlying diseases, presence of prodromal symptoms, duration of visual symptoms, visual acuity, slit-lamp and fundus findings, and height of serous retinal detachment. The treatment method and response to treatment were also included. RESULTS: The estimated incidence was 39.3% at 10 years. Fifteen of 55 patients (27.3%) had recurrent anterior uveitis during the mean follow-up of 4.5 years. The presence of focal posterior synechiae at the diagnosis increased the risk of recurrent anterior uveitis 6.97-fold compared to the absence of synechiae (95% confidence interval [CI], 2.20-22.11; p < 0.001). Use of systemic high-dose steroid therapy more than 7 days after the development of visual symptoms resulted in a hazard ratio of 4.55 (95% CI, 1.27-16.40; p = 0.020). CONCLUSIONS: This study reports the estimated incidence and risk factors of recurrent anterior uveitis in VKH disease from survival analyses. However, because of the retrospective nature of this study, it is hard to confirm the consistency of the medical records regarding risk factors, thus, the presence of focal posterior synechiae can be inconclusive as a risk factor. Further studies are warranted.

A Case of Lyme Disease Presenting as Bilateral Panuveitis.

Here, we describe a case of Lyme disease presenting as bilateral panuveitis. A 25-year-old woman presented to our clinic with decreased visual acuity of 20/320 and 20/160 in the right and left eye, respectively. An ophthalmic examination revealed the presence of anterior chamber cells 3+, vitreous cells 1+, vitreous haziness 2+/1+, and retinal infiltration in both eyes. She also had fever, headache, and difficulty in breathing. An initial blood analysis did not detect infection; however, high levels of erythrocyte sedimentation rate and C-reactive protein were noted. Pleural and pericardial effusions, and multiple reactive arthritis lesions were observed on chest computed tomography and bone scans, respectively. Oral steroids (30 mg/day) and steroid eye drops were initiated. Ten days later, she was diagnosed with Lyme disease, based on an indirect immunofluorescence antibody test. Ceftriaxone (2 g) was intravenously administered for 2 weeks followed by administration of oral trimethoprim-sulfamethoxazole (400 mg/80 mg/day) for 1 week. Thereafter, she received a 4-week course of doxycycline (100 mg) twice daily. Her symptoms and ocular findings improved; however, a gradually increasing dose of oral steroid was needed to control retinal lesions for some time, since multiple retinitis lesions developed in the peripheral retina after tapering the oral steroid dose to 5 mg/day. In conclusion, panuveitis can occur in patients with Lyme disease and can be treated with systemic antibiotics and steroids.

TOPOGRAPHIC ASSESSMENT OF INTRARETINAL CYSTOID SPACE AND ITS PROGNOSTIC VALUES IN IDIOPATHIC EPIRETINAL MEMBRANE.

PURPOSE: To assess the topographical distribution of intraretinal cystoid space (IRC) and its prognostic value in idiopathic epiretinal membrane (iERM). METHODS: One hundred twenty-two eyes of iERM that had been followed up for 6 months after membrane removal were included. Based on the baseline IRC distribution, the eyes were divided into Groups A, B, and C (absence, IRC within 3 mm, and 6 mm from the fovea, respectively). The best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), ectopic inner foveal layer, and microvascular leakage (ML) were assessed. RESULTS: Fifty-six eyes (45.9%) had IRC, of which 35 (28.7%) were in Group B and 21 (17.2%) in Group C at baseline. Compared with group B, group C showed worse BCVA, thicker CSMT, and a greater association with ML (OR = 5.415; P = 0.005) at baseline; and also presented with worse BCVA, thicker CSMT, and wider distribution of IRC postoperatively. A wide distribution of IRC was an unfavorable baseline factor in achieving good visual acuity (OR = 2.989; P = 0.031). CONCLUSION: Widely distributed IRCs were associated with advanced disease phenotype as poor BCVA, thick macula, and baseline ML in iERM and also showed a poor visual outcome after membrane removal.

Endogenous Endophthalmitis From a Klebsiella pneumoniae Liver Abscess: The Incidence, Risk Factors, and Utility of Imaging.

PURPOSE: We investigated the rate of ophthalmologic examinations to detect endogenous endophthalmitis in patients with pyogenic liver abscesses (PLAs) and the incidence and risk factors of endophthalmitis from a PLA caused by Klebsiella pneumoniae (PLA-K). DESIGN: Retrospective case series. METHODS: A total of 536 patients admitted to a university hospital in Korea to treat PLAs during 2012-2022 were included. The proportion of patients who were referred for ophthalmologic examinations was investigated and the incidence of endophthalmitis in 248 patients with PLA-K was calculated. Univariate and multivariate logistic regression analyses were performed to define risk factors including demographic characteristics, underlying diseases, radiologic findings, and systemic conditions. RESULTS: A comprehensive ophthalmologic examination was performed in 73.7% of all patients with PLAs, and the incidence of endophthalmitis from a PLA-K was 7.3%. A liver abscess >5 cm increased the incidence of endogenous endophthalmitis 4-fold compared with smaller abscesses (odds ratio [OR] = 4.01 [95% confidence interval {CI}, 1.02-15.78], P = .047) and portal or hepatic vein thrombophlebitis increased the incidence approximately 4-fold (OR = 4.04 [95% CI, 1.10-14.83], P = .036). Acute cholangitis was approximately 8-fold (OR = 8.33 [95% CI, 1.25-55.71], P = .029), and disseminated intravascular coagulation was approximately 6-fold (OR = 5.76 [95% CI, 1.22-27.21], P = .027) more related to prevalence of endophthalmitis. Other extrahepatic infections increased the incidence approximately 43-fold (OR = 43.06 [95% CI, 10.14-182.90], P < .001). CONCLUSIONS: Clinicians should consider the risk of endogenous endophthalmitis when PLA-K patients have large liver abscesses (>5 cm), acute cholangitis, portal or hepatic vein thrombophlebitis, disseminated intravascular coagulation, or other extrahepatic infections.

Characteristics of Computed Tomography for Identifying Patients at High Risk of Endogenous Endophthalmitis Due to Klebsiella pneumoniae-Related Pyogenic Liver Abscess.

Endogenous endophthalmitis (EE) associated with Klebsiella pneumoniae (K. pneumoniae)-related pyogenic liver abscess (PLA) is one of the fatal complications of PLA and leads to loss of vision. Early diagnosis and treatment are important to save the patient's vision. We investigated the characteristics of computed tomography (CT) in EE associated with K. pneumoniae-related PLA for the identification of the predictors of EE, in order to facilitate early diagnosis. A total of 274 patients diagnosed with K. pneumoniae-related PLA, including 15 patients with EE, were identified between January 2005 and December 2019. The clinical (age, gender, and underlying disease) and radiologic (the location, size, and number of abscesses) features were reviewed. In addition, the involvement of the adjacent vessels, such as the hepatic vein and portal vein, was carefully reviewed. A comparative analysis was performed between the EE and non-EE groups. Uni- and multivariate logistic regression analyses were used to identify the predictors of EE. Diabetes mellitus (DM), the involvement of the left or both hepatic lobes, and the adjacent vessels on the CT were significantly more frequent than those in the non-EE group (p < 0.05 in all), and they were the significant predictors of EE in the logistic regression analyses. In patients with K. pneumoniae-related PLA, the CT findings, such as the locations of the abscess (i.e., left or both lobes) and the involvement of the adjacent vessels, should be considered in addition to the ocular symptoms for an early diagnosis of EE.

A real-world study assessing the impact of retinal fluid on visual acuity outcomes in patients with neovascular age-related macular degeneration in Korea.

To evaluate the real-world treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) in Korea, focusing on retinal fluid resolution. This multi-institutional retrospective chart review study, analyzed medical records of patients with nAMD (age ≥ 50 years) who received their first anti-vascular endothelial growth factor (VEGF) treatment in ophthalmology clinics across South Korea between January 2017 and March 2019. The primary endpoint was the proportion of patients with retinal fluid after 12 months of anti-VEGF treatment. The association between fluid-free period and VA gains was also evaluated. A total of 600 patients were enrolled. At baseline, 97.16% of patients had retinal fluid; after 12 months of anti-VEGF treatment, 58.10% of patients had persistent retinal fluid. VA improvements were relatively better in patients with absence of retinal fluid compared with presence of retinal fluid (+ 12.29 letters vs. + 6.45 letters at month 12; P < .0001). Longer duration of absence of retinal fluid over first 12 months correlated with better VA gains at month 12 (P < .01). More than half of the study patients with nAMD had retinal fluid even after 12 months of treatment with their current anti-VEGF. Presence of retinal fluid was associated with relatively worse VA outcomes.

Impact of signal strength on quantitative retinal and choriocapillaris flow measurement from optical coherence tomography angiography.

We evaluated the impact of signal strength (SS) on quantitative measurements from optical coherence tomography (OCTA). Twenty healthy-volunteers were included. A neutral density filter (NDF) was attached to spectral-domain OCTA (SD-OCTA) and swept-source OCTA (SS-OCTA). All subjects were imaged with both devices three times using three different conditions: no filter, NDF0.3, and NDF0.6. For SD-OCTA, SS decreased from 10.0 to 8.2 and 4.0 with the NDF0.3 and 0.6, respectively. The vessel density (VD) and vessel length density (VLD) of the superficial capillary plexus (SCP) decreased when SS decreased from 10 to 8.2, but no further decrease when SS changed from 8.2 to 4.0. The flow metrics of the deep capillary plexus (DCP) did not change. For SS-OCTA, SS decreased from 10 to 9.5 and 7.2. The VD and VLD of the SCP and DCP decreased when SS decreased, except for the VD of the DCP when SS changed from 10 to 9.5. The choriocapillaris flow deficits significantly increased along with the decrease in SS. Quantitative flow parameters were significantly affected by a small change in SS and were most conspicuous in the SCP and choriocapillaris. These finding highlight the importance of high and consistent SS in quantitative OCTA studies.

Retro mode illumination for detecting and quantifying the area of geographic atrophy in non-neovascular age-related macular degeneration.

PURPOSE: To evaluate the ability of retro mode illumination imaging for quantifying atrophy compared to confocal color fundus photography (c-CFP), green light fundus autofluorescence (G-FAF), blue light fundus autofluorescence (B-FAF) using the scanning laser ophthalmoscope (SLO) Mirante device by Nidek (Nidek Co., Ltd, Gamogori, Japan). METHODS: Eyes with clinical evidence of geographic atrophy (GA) associated with non-neovascular age-related macular degeneration, evaluated at the Doheny Eye Centers-UCLA and Hospital Sacco Milan, were included in this prospective, cross-sectional study. All eyes were imaged with multiple retinal imaging modalities using the SLO Nidek Mirante device: c-CFP, G-FAF, B-FAF, retro mode illumination deviated-right (RMDR), and deviated-left (RMDL). Masked graders measured the GA lesion on each modality and inter-modality and inter-grader repeatability were assessed. RESULTS: The mean (SD) area of GA measured 9.76 (3.82) mm2, 9.75 (3.91) mm2, 9.76 (3.92) mm2, 9.82 (3.87) mm2, and 9.81 (3.86) mm2 using c-CFP, G-FAF, B-FAF, RMDR, and RMDL, respectively (p = 0.2). Inter-modality correlation was high (Pearson's r > 0.9 and p < 0.0001). Agreement between graders was excellent for all modalities. CONCLUSIONS: Retro mode imaging demonstrated good agreement for measuring GA compared to other imaging modalities, with a high level of repeatability. Given that retro mode imaging uses infrared light and is comfortable, it may prove to be a useful tool for the assessment of GA in the clinic.

Establishment of a prediction tool for ocular trauma patients with machine learning algorithm.

AIM: To predict final visual acuity and analyze significant factors influencing open globe injury prognosis. METHODS: Prediction models were built using a supervised classification algorithm from Microsoft Azure Machine Learning Studio. The best algorithm was selected to analyze the predicted final visual acuity. We retrospectively reviewed the data of 171 patients with open globe injury who visited the Pusan National University Hospital between January 2010 and July 2020. We then applied cross-validation, the permutation feature importance method, and the synthetic minority over-sampling technique to enhance tool performance. RESULTS: The two-class boosted decision tree model showed the best predictive performance. The accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve were 0.925, 0.962, 0.833, 0.893, and 0.971, respectively. To increase the efficiency and efficacy of the prognostic tool, the top 14 features were finally selected using the permutation feature importance method: (listed in the order of importance) retinal detachment, location of laceration, initial visual acuity, iris damage, surgeon, past history, size of the scleral laceration, vitreous hemorrhage, trauma characteristics, age, corneal injury, primary diagnosis, wound location, and lid laceration. CONCLUSION: Here we devise a highly accurate model to predict the final visual acuity of patients with open globe injury. This tool is useful and easily accessible to doctors and patients, reducing the socioeconomic burden. With further multicenter verification using larger datasets and external validation, we expect this model to become useful worldwide.

MICROVASCULAR LEAKAGE IS A POOR PROGNOSTIC FACTOR FOR IDIOPATHIC EPIRETINAL MEMBRANE: A Fluorescein Angiography Study.

PURPOSE: To investigate the angiographic findings assessed using fluorescein angiography and their prognostic values of idiopathic epiretinal membrane. METHODS: Seventy-three eyes of idiopathic epiretinal membrane that had been followed up for 6 months after surgical treatment were included. Midphase fluorescein angiography images were obtained at baseline. Structural changes, including central subfield macular thickness, intraretinal cystic lesion, and ectopic inner retinal layer on the fovea, were assessed using optical coherence tomography. The main outcome measures were microvascular leakage (ML) and its association with optical coherence tomography findings and best-corrected visual acuity (BCVA). RESULTS: Of a total of 73 eyes, 37 showed ML and had worse BCVA (P = 0.040), greater central subfield macular thickness (P = 0.028), and more ectopic inner retinal layer (P < 0.001) than those without ML at baseline. Also, ML was associated with worse postoperative BCVA (P < 0.001) and ectopic inner retinal layers (P < 0.001; P = 0.034) at baseline and 6 months. The baseline factors associated with postoperative BCVA of ≥20/25 were better BCVA (P = 0.027) and the absence of ML (P < 0.001). CONCLUSION: Half of the idiopathic epiretinal membrane eyes showed that ML was associated with inner retinal deformity and poor visual recovery. Fluorescein angiography helped to predict visual prognosis after idiopathic epiretinal membrane surgery.

Efficacy of intravitreal povidone-iodine administration for the treatment of Candida albicans endophthalmitis in rabbits.

This study aimed to investigate the efficacy of intravitreal povidone-iodine (PI) administration for the treatment of Candida albicans endophthalmitis. Forty New Zealand white rabbits were divided into four groups (n = 10 per group). After the induction of endophthalmitis using Candida albicans, groups A, B, and C received single intravitreal injections of 0.035 mg voriconazole, 0.3 mg PI, and their combination, respectively. Rabbits that were administered sham injections were in group D as controls. Fundus photography, vitreous culture, electroretinography (ERG), and histologic examinations of the retina were conducted on day 7. The anterior chamber flare (grade 0 to 4), severity of iritis (grade 0 to 4), and vitreous opacity (grade 0 to 3) were scored. Candida albicans was cultured in the vitreous sample. On day 7, the vitreous opacities were found in all groups. Compared to that in group D, groups A, B, and C showed a lower score for flare (p < 0.001) and iritis (p < 0.001) and less fungal growth in the vitreous culture (n = 2, 1, 1, and 10 in groups A, B, C, and D, respectively; p < 0.001). Furthermore, ERG and histologic findings demonstrated less affected a- and b-waves and damaged retinal tissues in groups A, B, and C. However, these findings were not different among groups A, B, and C. PI significantly improved Candida albicans endophthalmitis, and the effect was comparable that of the voriconazole, although some vitreous opacities remained. No synergistic effect of the combination of PI and voriconazole was observed. Intravitreal PI may be useful to treat Candida albicans endophthalmitis.

Intravitreal injection of povidone-iodine for the treatment of vancomycin-resistant Enterococcus faecalis endophthalmitis in rabbit eyes.

The aim of this study was to investigate the efficacy of intravitreal povidone-iodine (PI) in the treatment of vancomycin-resistant Enterococcus faecalis (VRE) endophthalmitis. Fifty New Zealand white rabbits were divided into 5 groups (n = 10 in each group). After the induction of endophthalmitis using VRE (minimum inhibitory concentration [MIC] ≥ 40 µg/mL) in the right eye, Group A, B, C, and D received intravitreal injections of 0.1% PI, 0.3% PI, 0.05% vancomycin, and 0.5% vancomycin, respectively. Eyes in Group E were used as controls. Fundus photography, vitreous culture, electroretinography (ERG), and histologic examinations of the retina were conducted on day 14. A marked improvement in endophthalmitis was observed in Group A, B, C and D, compared to Group E. Fundus photographs showed mild vitreous opacities in Group A and B, and moderate vitreous opacity in Group C. All eyes in Group D had a clear vitreous. In vitreous culture, bacterial growth was found in 6 eyes (100, 200, 200, 400, 500, and 500 colony-forming units) in Group C, but not in Groups A, B, or D. ERG and histological examination also indicated intraocular damage in Group C. Our results show that intravitreal injection of PI, even at low concentrations, was effective for treatment of VRE endophthalmitis, although some vitreous opacity remained. Intravitreal vancomycin injection was also useful to treat resistant strains, if used at a higher concentration within the safety threshold.

TOPOGRAPHIC ASSESSMENT OF CHORIOCAPILLARIS FLOW DEFICITS IN THE INTERMEDIATE AGE-RELATED MACULAR DEGENERATION EYES WITH HYPOREFLECTIVE CORES INSIDE DRUSEN.

PURPOSE: To evaluate the choriocapillaris (CC) flow deficit (FD) in eyes with hyporeflective cores (HCs) inside drusen in eyes with intermediate age-related macular degeneration. METHODS: Intermediate age-related macular degeneration subjects underwent optical coherence tomography and optical coherence tomography angiography using a Cirrus HD-optical coherence tomography (Carl Zeiss Meditec, Dublin, CA). All B-scans were inspected for the presence of drusen with an HC that was defined as dark, condense materials inside drusen. Drusen regions delineated in the manufactures advanced retinal pigment epithelium elevation map were superimposed to the compensated CC optical coherence tomography angiography images. Quantitative analysis of CC FD% was performed under drusen with and without HCs, 150-µm-wide ring region around drusen with and without HCs, drusen-free region, and whole macula. RESULTS: Fifty eyes were included in this cross-sectional study. Twenty eyes had drusen with HCs. Thirty eyes without HCs were matched for age and sex. The CC FD% of whole macula was significantly greater in eyes with an HC than those without it (46.3% vs. 42.9%; P = 0.001). In eyes with HCs, regional CC FD% was the greater under drusen (59.8%) and in a 150-µm-wide ring surrounding drusen with HCs (53.0%) than corresponding regions for drusen without HCs (52.5% and 47.3%, respectively) (P < 0.005 in all, Bonferroni correction). The CC FD% in macular regions remote from drusen was 43.2%. CONCLUSION: Intermediate age-related macular degeneration eyes with HCs demonstrated more impaired CC flow, compared with those without this featured. The CC was also more severely impaired directly below these drusen with HCs. These findings highlight that the appearance of HCs may be an indicator of a more advanced disease phenotype.

Impact of Scan Tilt on Quantitative Assessments Using Optical Coherence Tomography Angiography.

Purpose: To investigate the impact of scan tilt on quantitative assessments using swept-source optical coherence tomography angiography (SS-OCTA) in healthy participants. Methods: Healthy participants were imaged with a SS-OCTA system (PLEX Elite 9000; Carl Zeiss Meditec, Inc, Dublin, CA). After a standard scan was obtained, tilted scans were obtained by moving the optical coherence tomography beam entrance position horizontally. The tilting angle was measured from the B-scan image, and the flattest (horizontal) and the most tilted images were selected for comparative analysis. Foveal avascular zone (FAZ) area, vessel density (VD), and vessel length density (VLD) from the superficial and deep retinal capillary plexus (SCP, DCP), and choriocapillaris flow deficits (CC FDs) were computed and compared between horizontal and tilted images. Results: Thirteen eyes were excluded due to poor image quality or small angle difference (<8°) between the horizontal and tilted images. A final cohort of 27 normal eyes of 17 participants with a mean age of 39.3 ± 5.9 years was eligible for analysis. The FAZ area, VD, and VLD of both SCP and DCP were not significantly different between horizontal and tilted images. The CC FD, however, was significantly higher in horizontal images compared with tilted images (21.65% ± 2.41% vs. 21.06% ± 2.19%, P = 0.005). Conclusions: CC FD measurements may be significantly affected by the position of the scanning beam and resultant scan tilting. These findings highlight the importance of capturing on-axis (pupil-centered) scans for quantitative OCTA analyses. Translational Relevance: By assessing what impact a titled scan can have on OCTA measurements, this study will aid clinicians in understanding how to interpret their results in this situation.