RISK OF EXUDATION IN EYES WITH NONEXUDATIVE POLYPOIDAL CHOROIDAL VASCULOPATHY.

PURPOSE: To investigate the characteristics and natural history of treatment-naive nonexudative polypoidal choroidal vasculopathy (PCV) and to determine biomarkers predicting exudative conversion. METHODS: Patients diagnosed with nonexudative PCV based on indocyanine green angiography and optical coherence tomography were included. Incidence of exudative conversion in nonexudative PCV patients and cumulative estimates for overall risk were assessed. Indocyanine green angiography and optical coherence tomography imaging-based features were analyzed to identify risk factors for exudative conversion. RESULTS: The study included 42 eyes of 40 patients with nonexudative PCV. The mean follow-up duration was 54.3 ± 35.5 months. Of the 42 eyes with nonexudative PCV, exudative conversion developed in 23 eyes (54.8%) after 42.2 ± 28.3 months (range, 8-103 months). Kaplan-Meier analysis showed that the exudation-free survival at 5 years after baseline was estimated to be 53.6%. Multivariate regression analysis showed that sequentially increased protrusion of retinal pigment epithelium in the polyp area was a significant risk factor for exudation in nonexudative PCV (odds ratio = 10.16; 95% CI 1.78-57.81; P = 0.01). CONCLUSION: Exudative conversion has been noted in nearly half of the nonexudative PCV cases in 5 years. The progressive protrusion of polypoidal lesions on optical coherence tomography examination may be a significant biomarker for predicting the near-term onset of exudation.

PERIPHERAL EXUDATIVE HEMORRHAGIC CHORIORETINOPATHY IN ASIAN POPULATIONS.

PURPOSE: Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare degenerative disease that affects the peripheral retina. Reports of PEHCR in Asian patients are rare. Thus, the aim of this study was to investigate the clinical characteristics and outcomes of PEHCR in Asian patients. METHODS: A retrospective chart review of 33 eyes of 29 Asian patients with PEHCR. RESULTS: The mean age of the patients was 70 years, and 75.9% of them were women. Vitreous hemorrhage occurred in 51.5% of eyes during a mean follow-up of 43.1 months. The occurrence of vitreous hemorrhage was associated with a thicker baseline subfoveal choroid ( P = 0.001) and the male sex ( P = 0.005). Final visual acuity was less than 20/200 in 29.2% of eyes. The predictive factors for a final visual acuity worse than 20/200 included poor initial visual acuity ( P = 0.002), initial lesion involvement of more than 180° of the peripheral retina ( P = 0.03), an extension of subretinal hemorrhage to the macula ( P = 0.040), and absence of complete tumor regression ( P = 0.02). CONCLUSION: Asian PEHCR patients seem to be more frequently associated with vitreous hemorrhages, especially in male patients with thicker choroids. Although PEHCR was largely self-limiting, approximately one-third of the eyes ended up with a visual acuity of less than 20/200 with extensive lesion involvement.

Incidence and Progression of Chorioretinal Folds During Long-Duration Spaceflight.

Importance: The primary contributing factor for development of chorioretinal folds during spaceflight is unknown. Characterizing fold types that develop and tracking their progression may provide insight into the pathophysiology of spaceflight-associated neuro-ocular syndrome and elucidate the risk of fold progression for future exploration-class missions exceeding 12 months in duration. Objective: To determine the incidence and presentation of chorioretinal folds in long-duration International Space Station crew members and objectively quantify the progression of choroidal folds during spaceflight. Design, Setting, and Participants: In this retrospective cohort study, optical coherence tomography scans of the optic nerve head and macula of crew members completing long-duration spaceflight missions were obtained on Earth prior to spaceflight and during flight. A panel of experts examined the scans for the qualitative presence of chorioretinal folds. Peripapillary total retinal thickness was calculated to identify eyes with optic disc edema, and choroidal folds were quantified based on surface roughness within macular and peripapillary regions of interest. Interventions or Exposures: Spaceflight missions ranging 6 to 12 months. Main Outcomes and Measures: Incidence of peripapillary wrinkles, retinal folds, and choroidal folds; peripapillary total retinal thickness; and Bruch membrane surface roughness. Results: A total of 36 crew members were analyzed (mean [SD] age, 46 [6] years; 7 [19%] female). Chorioretinal folds were observed in 12 of 72 eyes (17%; 6 crew members). In eyes with early signs of disc edema, 10 of 42 (24%) had choroidal folds, 4 of 42 (10%) had inner retinal folds, and 2 of 42 (5%) had peripapillary wrinkles. Choroidal folds were observed in all eyes with retinal folds and peripapillary wrinkles. Macular choroidal folds developed in 7 of 12 eyes (4 of 6 crew members) with folds and progressed with mission duration; these folds extended into the fovea in 6 eyes. Circumpapillary choroidal folds developed predominantly superior, nasal, and inferior to the optic nerve head and increased in prevalence and severity with mission duration. Conclusions and Relevance: Choroidal folds were the most common fold type to develop during spaceflight; this differs from reports in idiopathic intracranial hypertension, suggesting differences in the mechanisms underlying fold formation. Quantitative measures demonstrate the development and progression of choroidal folds during weightlessness, and these metrics may help to assess the efficacy of spaceflight-associated neuro-ocular syndrome countermeasures.

SMOKING, RURAL RESIDENCE AND DIABETES AS RISK FACTORS FOR PRESUMED OCULAR HISTOPLASMOSIS SYNDROME.

PURPOSE: To investigate the relationship of smoking, urbanicity, and diabetes to presumed ocular histoplasmosis syndrome (POHS) and associated choroidal neovascularization (CNV). METHODS: Medical records of 751 adult patients with POHS were reviewed, including 603 patients without CNV and 148 patients with CNV. Age-matched and gender-matched controls were randomly selected from the same practice for comparison. Statistical comparisons of smoking history, urbanicity, and diabetic history were performed using chi-square and conditional logistic regression analyses. RESULTS: Increased rates of current or former smoking, rural residence, and diabetes were found in patients with POHS compared with controls. POHS patients with CNV had increased rates of current or former smoking and rural residence as compared with controls. CONCLUSION: A history of current or past smoking is associated with an increased risk of developing both POHS alone and POHS with CNV. We did not find a significant additional risk of smoking on the development of CNV in patients with POHS. Patients living in rural locations are more likely than those in urban locations to develop both POHS and POHS with CNV. Diabetics may be more likely to develop POHS than nondiabetics.

Oftalmopatías: situación epidemiológica de egresos hospitalarios en el Hospital Regional Guillermo Grant Benavente entre los años 2018 y 2021 / Ophthalmopathy: epidemiological situation of hospital discharges at the Guillermo Grant Benavente Regional Hospital between 2018 and 2021

Introducción: La salud visual es de vital importancia para el individuo, habiendo una mayor incidencia de oftalmopatías sobre los 50 años. Pese a su impacto sanitario, Chile carece de estudios epidemiológicos suficientes. La gran variabilidad de sus presentaciones hace importante conocer cuales ameritan el tratamiento intrahospitalario. Objetivo: Describir las principales causas de egresos hospitalarios por enfermedades del ojo y sus anexos en el Hospital Regional Guillermo Grant Benavente entre los años 2018 y 2021. Materiales y métodos: Estudio ecológico que analizó 1764 egresos hospitalarios por enfermedades del ojo y sus anexos del Hospital Guillermo Grant Benavente entre los años 2018 y 2021. Los datos corresponden al Departamento de Estadísticas e Información en Salud (DEIS). Resultados: Las patologías más prevalentes fueron: Trastornos De La Coroides Y De La Retina (33%) (TCR) Trastornos Del Cristalino (14,7%), Trastornos De La Esclerótica, Córnea, Iris Y Cuerpo Ciliar (10,2). Trastornos Del Párpado, Aparato Lagrimal Y Órbita (12,7%) (TPAO) Esta última con diferencias estadísticamente significativas para el sexo. Conclusión: Se ve una disminución de la atención hospitalaria desde el año 2020 debido a la pandemia del virus SARS-COV-2. No hay diferencias por sexo, excepto para la TPAO, similar a lo visto en la literatura. La acumulación de oftalmopatías en el rango de población adulta y adulta mayor, refleja un envejecimiento poblacional. Se reconoce además a los TCR como la patología con mayor incidencia. El estudio contribuye a la epidemiologia local, aportando a la falta de conocimientos actualizados, describiendo los diagnósticos más frecuentes de la especialidad.

Introduction: Eye care is vital for the individual, with a higher incidence of ophthalmopathy over 50 years. Despite its health impact, Chile lacks sufficient epidemiological studies. The great variability of their presentations makes it important to know which ones merit in-hospital treatment. Objective: To describe the main causes of hospital discharges for eye diseases and its adnexa at the Guillermo Grant Benavente Regional Hospital between 2018 and 2021. Material and methods: An ecological descriptive study that analyzed 1,764 hospital discharges for eye diseases and its adnexa from the Hospital Guillermo Grant Benavente between the years 2018 and 2021. The data corresponds to the Department of Statistics and Health Information (DEIS). Results: The most prevalent pathologies were: Disorders of the Choroid and Retina (33%) (TCR), Disorders of the Lens (14.7%), Disorders of the Sclera, Cornea, Iris, and Ciliary Body (10.2). Disorders of the Eyelid, Lacrimal Apparatus and Orbit (12.7%) (TPAO) The latter with statistically significant differences for sex. Conclusion: A decrease in hospital care is seen since 2020 due to the SARS-COV-2 virus pandemic. There are no differences by sex, except for PPAO, similar to what has been seen in the literature. The accumulation of ophthalmopathy in the range of the adult population and older adults, reflects an aging population. TCR is also recognized as the pathology with the highest incidence. The study contributes to the local epidemiology and the lack of updated knowledge, describing the most frequent diagnoses of the specialty.

CHARACTERISTICS OF PERIPAPILLARY INTRACHOROIDAL CAVITATION IN HIGHLY MYOPIC EYES: The Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study.

PURPOSE: To characterize peripapillary intrachoroidal cavitation (PICC) in highly myopic participants and its associated risk factors. METHODS: This observational, cross-sectional study recruited 890 Chinese participants with bilateral high myopia, defined as ≤-6.00 diopters spherical power. Fundus photography and spectral-domain optical coherence tomography were used to determine the presence of PICC, defined as a yellow-orange lesion adjacent to the disc border with a corresponding intrachoroidal hyporeflective space. RESULTS: Among 890 participants, 884 right eyes were included for analysis. The rate of PICC was 3.6% (32 eyes). Peripapillary intrachoroidal cavitation was observed in two eyes without myopic retinal lesions, nine eyes with tessellated fundus only, 16 eyes with diffuse chorioretinal atrophy, and five eyes with patchy chorioretinal atrophy. The most commonly affected area was inferior disc border (87.5%), followed by multiple (9.4%) and superior (3.1%) disc borders. The multiple linear logistic regression model showed that older age, more myopic spherical equivalent, and longer axial length were associated with the presence of PICC. CONCLUSION: Peripapillary intrachoroidal cavitation was present in 3.6% of highly myopic eyes. It was more common in eyes with a higher myopic maculopathy category. Older age, more myopic spherical equivalent, and longer axial length were risk factors for the presence of PICC.

Traumatic choroidal injuries - classification, incidence, diagnosis and prognosis twenty-year results of Eye Injury Vitrectomy Study.

PURPOSE: To characterize the classification, incidence, diagnosis and prognosis of traumatic choroidal injuries. METHODS: Subjects were selected from the database of the Eye Injury Vitrectomy Study (EIVS) and were examined for occurrences of different categories of choroidal injuries. Standard photographs were collected. Anatomical and visual outcomes were assessed in patients with greater than 1 year of follow-up. Eyes that had no light perception (NLP) and/or phthisis bulbi were defined as having had unfavourable outcomes. The percentage of eyes with an unfavourable outcome was analysed for different types of choroidal injuries. RESULTS: Nine categories of choroidal injuries with distinctive features were identified in the EIVS database. The incidence and the percentage of eyes with an unfavourable outcome in each injury category were as follows: suprachoroidal effusion, 21.2% (7.2%); suprachoroidal haemorrhage, 12.8% (11.2%); massive suprachoroidal haemorrhage, 4.0% (64.9%); choroidal avulsion, 4.2% (92.2%); traumatic chorioretinal rupture, 1.8% (13.3%); choroidal rupture, 4.8% (6.8%); choroidal loss, 1.6% (79.3%); choroidal hole, 1.1% (5.3%); and choroidal damage at the wound site, 39.2% (17.7%). CONCLUSIONS: Ocular trauma can cause a variety of choroidal injuries that have distinctive features, some of which are associated with a high frequency of unfavourable prognoses.

Rate of misdiagnosis and clinical usefulness of the correct diagnosis in exudative neovascular maculopathy secondary to AMD versus pachychoroid disease.

The aim of this study was to explore the relative prevalence and clinical differences between age-related macular degeneration (AMD) and pachychoroid disease in patients older than 50 years with newly diagnosed exudative neovascular maculopathy, and also assess the rate of misdiagnosis between these two disorders. In this retrospective observational study, we reviewed data from patients 50 years of age and older with newly diagnosed treatment-naïve exudative macular neovascularization (MNV) secondary to AMD or pachychoroid disease. Of the 139 patients (139 eyes) who fulfilled the inclusion criteria, 35 patients were graded as being affected by pachychoroid disease complicated by exudative MNV and 104 subjects had neovascular AMD. Therefore, prevalence of pachychoroid disease complicated by exudative MNV was 25.2% (confidence interval-CI 18.2-33.2%). Mean ± SD age was 67.0 ± 8.8 years in the pachychoroid disease group and 80.6 ± 6.6 years in the neovascular AMD group (P < 0.0001). At baseline, BCVA was better in patients with pachychoroid disease complicated by exudative MNV (0.4 ± 0.3 LogMAR vs. 0.7 ± 0.5 LogMAR, P = 0.003). At the 1-year follow-up visit, BCVA was still better in patients with pachychoroid-associated MNV (0.34 ± 0.32 LogMAR vs. 0.59 ± 0.52 LogMAR; P = 0.005). In our study cohort, 19 patients were graded to be affected by pachychoroid disease complicated by exudative MNV even though a diagnosis of neovascular AMD was erroneously reported in their medical records at baseline. In conclusion, pachychoroid disease is a frequent cause of exudative MNV in aged patients with a high rate of misdiagnosis. A correct diagnosis may be important as these two disorders differ in terms of clinical characteristics and prognosis.

Comparison of Peripapillary Choroidal Microvasculature Dropout in Primary Open-angle, Primary Angle-closure, and Pseudoexfoliation Glaucoma.

PRECIS: The prevalence of choroidal microvascular dropout (CMvD) was significantly higher in primary open-angle glaucoma (POAG) than primary angle-closure glaucoma (PACG) or pseudoexfoliation glaucoma (PXG) in the early stage. However, in the advanced stage, it did not differ among the 3 groups. PURPOSE: The purpose of this study was to compare the prevalence of peripapillary CMvD in POAG, PACG, and PXG. MATERIALS AND METHODS: The presence of peripapillary CMvD was identified using optical coherence tomography angiography (AngioVue/RTVue-XR) imaging of the choroid in 186 eyes from 186 subjects [age and visual field (VF) mean deviation (MD) matched; 62 POAG, 62 PACG, and 62 PXG eyes]. Prevalence of CMvD was compared among glaucoma types in early and moderate to advanced disease, as divided by VF MD (-6 dB). The association between glaucoma type and presence of CMvD was evaluated using logistic regression analysis. RESULTS: Prevalence of CMvD was significantly different between glaucoma types in early-stage disease (PACG 7.5%, PXG 25%, and POAG 46.3%, P<0.001), but it did not differ between glaucoma types in eyes with moderate to advanced disease (PACG 59.1%, PXG 68.2%, and POAG 81%; P=0.331). After adjusting for age, sex, the ß-zone peripapillary atrophy/disc ratio, and glaucoma severity (VF MD), the CMvD odds ratio was 7.50 times greater in POAG than in PACG (P=0.001). CONCLUSIONS: CMvD was more common in POAG relative to both PACG and PXG, especially in early-stage disease. This finding suggested a role for ischemic injury in the pathogenesis of POAG.

Vision-Related Quality of Life, Anxiety and Depression in Congolese Patients with Polypoidal Choroidal Vasculopathy.

OBJECTIVE: To assess the impact of polypoidal choroidal vasculopathy (PCV) on quality of life (QoL) and mental health in a cohort of Congolese patients. METHODS: Fifteen PCV patients and 26 age-matched controls completed the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Outcome measures were QoL and HADS scores, frequency of anxiety and depression, correlations between best-corrected distance visual acuity (BCDVA) and QoL and HADS scores. Risk factors for anxiety and depression were also determined. RESULTS: The QoL composite score was (54.9 ± 24.2) in patients and (94.5 ± 4.5) in controls, p <.001. Patients scored higher on HADS-A (9.5 ± 3.4) and HADS-D (6.7 ± 4.7) than controls (3.0 ± 2.7 and 1.5 ± 2.6), all p <.001. Anxiety and depression were present in 73.3% and 46.7% of patients, respectively, versus 1% each of controls (p <.001). Every unit improvement in best eye's BCDVA increased QoL composite score by 24.3, but decreased HADS-D by 5.9. Macular lesions decreased QoL by 34.5 while increasing HADS-A and HADS-D scores by 4.2 and 4.4, respectively. A history of stroke also increased the HADS-A score by 5.9. CONCLUSIONS: PCV impairs the QoL and induces both anxiety and depression in Congolese PCV patients. Screening for QoL, anxiety and depression in PCV patients at first presentation will help detect those in need of psychological support.

Latest Developments in Polypoidal Choroidal Vasculopathy: Epidemiology, Etiology, Diagnosis, and Treatment.

Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelial detachments, and neurosensory retinal detachments due to abnormal aneurysmal neovascular lesions. It is generally considered as a variant of neovascular age-related macular degeneration, but there are some differences between the clinical presentation, natural history, and treatment response between patients with PCV and typical neovascular age-related macular degeneration patients. Over the past decade, new research and technological advancements have greatly improved our understanding of the PCV disease process and the management of PCV. This review aims to summarize the recent research findings to highlight the epidemiology, pathogenesis, genetics, the application of various diagnostic tools for PCV, and the available treatment options for PCV.

Illustration of tessellation in Down syndrome.

Background: Tessellated fundus refers to a specific change in the appearance of the internal layers of the eye in which the choroidal large vessels became visible through polygonal hypopigmented areas. Such hypopigmented areas alternate with hyperpigmented zones in a tigroid pattern. Fundus tessellation is often associated with myopia and choroidal thinning.Materials and Methods: We analyzed fundus images from 50 children with Down syndrome and 52 controls.Results: Tessellation was present in 64% of children with Down syndrome, compared with only 13.5% of controls (p < .0001). In most cases, tessellation was located peripapillary, and no difference was observed in tessellation localization between children with Down syndrome and controls (p = .60). Although more prevalent in myopic children with and without Down syndrome, tessellation was present in almost half (48%) of children with Down syndrome with hyperopia versus only 5% of controls with the same refractive status.Conclusions: Mechanical stretching of the choroid could explain the high rate of tessellation in myopes. Other factors must contribute to the higher prevalence of tessellated fundus in children with Down syndrome without myopia. We discuss potentially relevant factors and propose vascular involvement as a contributor to tessellation in our population with Down syndrome. Further studies assessing choroidal vasculature in individuals with Down syndrome are needed to confirm this theory.

Real-World Treatment Outcomes of Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy in Asians.

PURPOSE: To describe the 12-month outcomes of treatment-naïve eyes with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) after initiation of intravitreal anti-vascular endothelial growth factor (VEGF) monotherapy or combination therapy with verteporfin photodynamic therapy (PDT). DESIGN: A 12-month single-center, retrospective, comparative, nonrandomized cohort study. PARTICIPANTS: Patients with AMD or PCV who initiated intravitreal anti-VEGF therapy during 2015. METHODS: Demographics, visual outcomes, OCT, and treatment data were collected at baseline and months 1, 3, 6, and 12 after treatment initiation. Multivariate analysis was performed to identify baseline features predictive of visual maintenance and improvement after 12 months of treatment. MAIN OUTCOME MEASURES: Primary end point was visual acuity (VA) change from baseline to month 12. Secondary end points were treatment exposure and change in central subfield thickness on OCT. RESULTS: A total of 364 patients (165 AMD and 199 PCV) were included. Baseline vision was 41 and 43 logarithm of the minimum angle of resolution (logMAR) letters for AMD and PCV patients, respectively. Patients with AMD and PCV received 5.5 and 5.3 injections (5.0 monotherapy vs. 5.6 combination therapy; mean, 1.2 PDT sessions), respectively. Patients with AMD gained 4.7 logMAR letters after 12 months (P = 0.002), whereas PCV patients gained 6.6 logMAR letters (P = 0.001) and 10.8 logMAR letters (P < 0.001) for monotherapy and combination therapy, respectively. Only patients with presenting VA of fewer than 35 letters (Snellen equivalent, 6/60) achieved significant visual improvement (10.4 letters for AMD, 17.1 letters for PCV with monotherapy, and 35.5 letters for PCV with combination therapy). Predictors of VA gain included number of intravitreal injections (AMD and PCV adjusted odds ratio, 12.1 [P = 0.001] and 12.5 [P = 0.004] for ≥7 injections, respectively) and baseline VA of 20 logMAR letters or fewer (adjusted odds ratio, 3.8 and 10.6 for AMD and PCV, respectively). Age, gender, race, use of PDT or focal laser therapy, and central subfield thickness were not predictive of significant visual gain at 12 months. CONCLUSIONS: In Asian patients, treatment of AMD with anti-VEGF therapy yielded 12-month visual outcomes comparable with those of other real-world studies from Western populations but poorer than those of controlled trials. In contrast, for PCV eyes, anti-VEGF monotherapy and combination therapy with PDT yielded comparable outcomes as those of controlled clinical trials.

Prevalence and Associations of Fundus Tessellation Among Junior Students From Greater Beijing.

Purpose: To determine the prevalence of fundus tessellation and associations with ocular and systemic parameters among junior students from Greater Beijing. Methods: The school-based study included 1443 individuals with a mean age of 12.4 ± 0.5 years (range: 9-16 years). All participants underwent a comprehensive ophthalmic examination and an interview. Fundus tessellation, defined as variation in the visibility of large choroidal vessels, was differentiated into three grades. Results: The prevalence and degree of fundus tessellation were 688/1430 (48.1%; 95% confidence intervals [CI]: 45.5%, 50.7%) and 0.54 ± 0.61 (median, 0.00; range, 0-3), respectively. In multivariable regression analysis, a higher degree of fundus tessellation was associated with reduced subfoveal choroidal thickness (P < 0.001; beta, -0.02; odds ratio [OR], 0.98; 95% CI: 0.98, 0.99) and longer axial length (P < 0.001; beta, 0.23; OR, 1.25; 95% CI: 1.10, 1.43). Subfoveal choroidal thickness decreased from 299 ± 61 µm (95% CI: 293, 304) in eyes without fundus tessellation to 246 ± 57 µm (95% CI: 241, 251), 197 ± 43 µm (95% CI: 187, 207), and 131 ± 30 µm (95% CI: 93, 168) in eyes with grade 1, 2, and 3 fundus tessellation, respectively. A higher degree of peripapillary fundus tessellation was associated with reduced subfoveal choroidal thickness (P < 0.001; beta, -0.02; OR, 0.98; 95% CI: 0.98, 0.99) and younger age at myopia onset (P = 0.008; beta, 0.41; OR, 1.51; 95% CI: 1.11, 2.04). Conclusions: The prevalence of fundus tessellation is relatively high in Chinese teenagers. As in adults, the degree of fundus tessellation is a surrogate for choroidal thickness in teenagers. Marked fundus tessellation indicates a leptochoroid and is associated with earlier myopia onset.

Choroidal Microvascular Dropout in Pseudoexfoliation Glaucoma.

Purpose: To compare the prevalence of choroidal microvasculature dropout (CMvD) in pseudoexfoliation glaucoma (PXG) and disease severity-matched primary open-angle glaucoma (POAG) eyes. Methods: In a cross-sectional study, 39 eyes with PXG (33 patients) and 39 glaucoma severity-matched POAG eyes (34 patients) underwent visual fields, optical coherence tomography and optical coherence tomography angiography examination. Peripapillary vessel density (VD) was evaluated from the radial peripapillary capillary slab, parafoveal VD was measured on the superficial vascular plexus slab of the macula, and CMvD was evaluated on the choroidal slabs of the optic disc scan. Results: The PXG and POAG groups were similar with respect to average mean deviation on visual fields (-12.1 vs. -12.0 decibel, P = 0.96) and average peripapillary retinal nerve fiber layer thickness on optical coherence tomography (71 vs. 74 µ, P = 0.29). Average peripapillary superficial VD (49.7% vs. 51.3%, P = 0.35) and parafoveal VD (44.8% vs. 45.8%, P = 0.33) were similar between the PXG and POAG groups. CMvD was seen in 18 PXG and 31 POAG eyes (46.2% vs. 79.5%, P = 0.002). On multivariate analysis that accounted for the severity of glaucoma, the odds of CMvD was significantly lower in the PXG group when compared with the POAG group (odds ratio: 0.18-0.21, P < 0.01). Conclusions: The prevalence of CMvD was significantly lower in the PXG eyes when compared with the POAG eyes.

Ocular manifestations in tuberculosis cases with HIV in Nepal.

INTRODUCTION: TB has seen resurgence associated with HIV. Tuberculosis can affect any ocular tissue. The association of HIV with TB is supposed to increase the incidence and plethora of ocular manifestations in tuberculosis. OBJECTIVES: To study the various ocular manifestations seen in tuberculosis patients with associated HIV infection. MATERIAL AND METHODS: This hospital based, cross sectional descriptive study was conducted in Tribhuvan University, Teaching Hospital, Maharajgunj, Nepal and Geta Eye Hospital, Kailali from 2010 to 2015. Diagnosed cases of pulmonary and extra pulmonary tuberculosis with HIV co infection were evaluated for ocular manifestations after excluding other opportunistic infections. RESULTS: Of 70 cases eligible for the study, extra pulmonary tuberculosis was seen in60% of the cases. 5 patients (7.1 %) had ocular manifestations. CD4 counts were <50/mm3 in 3 cases. Ocular involvement was seen in the form of choroidal granulomas, papillitis, cranial nerve palsy, retinal vasculitis and central serous chorioretinopathy. CONCLUSION: This study demonstrated that ocular involvement is a frequent finding in cases with tuberculosis and HIV. Ocular findings are more common in cases with lesser CD4 counts. As ocular tuberculosis can be visually devastating, we recommend regular ocular evaluation of all patients with HIV and systemic tuberculosis.

Case series of coexistence of polypoidal choroidal vasculopathy with other rare fundus diseases.

PURPOSE: To record the coexistence of polypoidal choroidal vasculopathy (PCV) with other rare fundus diseases in a Chinese population. METHOD: In this retrospective hospital-based study, a chart review of 861 patients with newly diagnosed PCV was performed. The clinical features of rare fundus comorbidities of PCV were recorded. RESULTS: Five eyes of 5 patients aged 63.4 ± 11.22 years (0.58%) had PCV coexisting with other fundus diseases in the same eye. Of the 5 PCV patients, 2 (0.23%) had myelinated nerve fiber, 2 (0.23%) had branch retinal vein occlusion, and 1 (0.12%) had retinal angiomatous proliferation. CONCLUSION: We reported rare fundus comorbidities of PCV in a large Chinese cohort. These comorbidities included myelinated nerve fiber, branch retinal vein occlusion and retinal angiomatous proliferation. The combination might constitute an accidental occurrence.

Plasma markers of chronic low-grade inflammation in polypoidal choroidal vasculopathy and neovascular age-related macular degeneration.

PURPOSE: Ageing is the strongest predictor of neovascular age-related macular degeneration (AMD), where neuroinflammation is known to play a major role. Less is known about polypoidal choroidal vasculopathy (PCV), which is an important differential diagnosis to neovascular AMD. Here, we report plasma markers of inflammation with age (inflammaging) in patients with PCV, patients with neovascular AMD and a healthy age-matched control group. METHODS: We isolated plasma from fresh venous blood obtained from participants (n = 90) with either PCV, neovascular AMD, or healthy maculae. Interleukin(IL)-1ß, IL-6, IL-8, IL-10 and tumour necrosis factor receptor 2 (TNF-R2) were measured using U-PLEX Human Assays. Routine plasma C-reactive protein (CRP) was measured using Dimension Vista 1500. RESULTS: Patients with PCV had plasma levels of IL-1ß, IL-6, IL-8, IL-10 and TNF-R2 similar to that in healthy controls. Patients with neovascular AMD had significantly higher plasma IL-1ß, IL-6 and IL-10 than healthy controls, whereas no significant differences were observed for plasma IL-8 and TNF-R2. Differences between plasma IL-1ß, IL-6 and IL-10 possessed a positive but weak ability in discriminating neovascular AMD from PCV. Both patients with PCV and patients with neovascular AMD had significantly higher levels of routine plasma CRP. CONCLUSION: Patients with PCV differ from patients with neovascular AMD in terms of plasma inflammaging profile. Apart from increased CRP, no signs of inflammaging were observed in patients with PCV. In patients with neovascular AMD, we find a specific angiogenesis-twisted inflammaging profile.

Prevalence and Risk Factors for Polypoidal Choroidal Vasculopathy in a General Japanese Population: The Hisayama Study.

PURPOSE: To estimate the prevalence and risk factors for polypoidal choroidal vasculopathy (PCV) in a general Japanese population. METHODS: This population-based, cross-sectional study was conducted in 2007 with subjects from the Hisayama Study. Of the 3,648 residents in Hisayama, Japan, 2,663 who were ≥ 50 years old were enrolled in this study. The characteristics of PCV were determined by fundus examination or based on indocyanine green and fluorescein angiographic findings. We evaluated the contributions of the risk factors for PCV. RESULTS: Among the 207 participants with age-related macular degeneration (AMD), 174 (6.5%) had early AMD, and 33 (1.2%) had late AMD, including 10 participants with PCV (0.4%). Male and smoking habit were significant risk factors for the development of PCV. CONCLUSIONS: The prevalence of PCV is higher among Japanese subjects than Caucasians in Western countries. Male gender and smoking habit were significant risk factors for PCV in a general Japanese population.