Displacement of submacular hemorrhage using subretinal cocktail injection versus pneumatic displacement: a real-world comparative study.

INTRODUCTION: To compare the outcome of submacular hemorrhage (SMH) displacement using pneumatic displacement with intravitreal expansile gas versus pars plana vitrectomy (PPV) with subretinal injection of tissue plasminogen activator (tPA), anti-vascular endothelial growth factor (VEGF) agent and air as primary surgery. METHODS: Retrospective interventional case series of 63 patients who underwent surgical displacement of SMH secondary to neovascular age-related macular degeneration (nAMD) or polypoidal choroidal vasculopathy (PCV) from May 1, 2015 to October 31, 2022. Medical records were reviewed for diagnosis, logMAR visual acuity (VA), central subfield thickness (CST) and post-operative displacement rates and complications up to 12 months after operation. RESULTS: The diagnosis was nAMD in 24 (38.1%) and PCV in 39 (61.9%) eyes. There were 40 (63.5%) eyes in the pneumatic displacement group (38 received C3F8, 2 received SF6) and 23 (36.5%) eyes in the subretinal cocktail injection. Mean baseline VA was 1.46 and 1.62, respectively (p=0.404). The subretinal injection group had more extensive SMH (p=0.005), thicker CST (1006.6m vs 780.2m, p=0.012) and longer interval between symptom and operation (10.65 vs 5.53 days, p<0.001). The mean post-operative VA at 6 months was 0.67 and 0.91 (p=0.180) for pneumatic displacement and subretinal injection group, respectively, though VA was significantly better in the pneumatic group at 12-month visit (0.64 vs 1.03, p=0.040). At least 10 Mean change in VA were >10 letters gain in both groups up to 12 months. Post-operative CST reduction was greater (625.1m vs 326.5m, p=0.008) and complete foveal displacement (87.0% vs 37.5%), p<0.001, odds ratio (OR) = 11.1) and displacement to arcade or beyond (52.5% vs 17.5%, p=0.009, OR = 5.15) were more frequent in the subretinal injection group. Two patients with failed pneumatic displacement were successfully treated with subretinal cocktail injection as a second operation. CONCLUSION: Surgical displacement of SMH lead to clinically meaningful improvement in VA. PPV with subretinal cocktail injection is more effective than pneumatic displacement in displacing SMH with similar safety profile despite longer interval before operation, higher CST and more extensive SMH at baseline. Retinal surgeons could consider this novel technique in cases with thick and extensive SMH or as a rescue secondary operation in selected cases.

OCT-based biomarkers for predicting treatment response in eyes with centre-involved diabetic macular oedema treated with anti-VEGF injections: a real-life retina clinic-based study.

BACKGROUND/AIMS: To determine whether a combination of baseline and change in spectral domain-optical coherence tomography (SD-OCT)-based biomarkers can predict visual outcomes in eyes with diabetic macular oedema (DMO) treated with antivascular endothelial growth factors (VEGF) injections. METHODS: This is a retrospective cohort study conducted in Hong Kong, China. 196 eyes with centre-involving DMO, who received anti-VEGF injections between 1 January 2011 and 30 June 2018 were recruited. Medical records of the participants were retrieved retrospectively, visual acuity (VA) at baseline, 6, 12 and 24 months and SD-OCT before initiation and after completion of anti-VEGF treatment were obtained. The SD-OCT images were evaluated for the morphology of DMO, vitreomacular status, presence of disorganisation of retinal inner layers (DRIL), sizes of intraretinal cysts, visibility of external limiting membrane (ELM), ellipsoid zone (EZ) and cone outer segment tip (COST) and the presence of hyper-reflective foci in retina or the choroid. RESULTS: The presence of baseline DRIL, hyper-reflective foci in retina and disruption of ELM/EZ and COST were associated with worse baseline and subsequent VA up to 24 months after treatment. Improvement in DRIL (p=0.048), ELM/EZ (p=0.001) and COST (p=0.002) disruption after treatment was associated with greater improvement in VA at 12 months. Eyes with cystoid macular oedema (p=0.003, OR=8.18) and serous retinal detachment (p=0.011, OR=4.84) morphology were more likely to achieve at least 20% reduction in central subfield thickness. CONCLUSION AND RELEVANCE: Baseline SD-OCT biomarkers and their subsequent change predict VA and improvement in vision in eyes with DMO treated with anti-VEGF injections. We proposed an SD-OCT-based system that can be readily used in real-life eye clinics to improve decision making in the management of DMO.

Optical Coherence Tomography Classification Systems for Diabetic Macular Edema and Their Associations With Visual Outcome and Treatment Responses - An Updated Review.

ABSTRACT: Optical coherence tomography (OCT) is an invaluable imaging tool in detecting and assessing diabetic macular edema (DME). Over the past decade, there have been different proposed OCT-based classification systems for DME. In this review, we present an update of spectral-domain OCT (SDOCT)-based DME classifications over the past 5 years. In addition, we attempt to summarize the proposed OCT qualitative and quantitative parameters from different classification systems in relation to disease severity, risk of progression, and treatment outcome. Although some OCT-based measurements were found to have prognostic value on visual outcome, there has been a lack of consensus or guidelines on which parameters can be reliably used to predict treatment outcomes. We also summarize recent literatures on the prognostic value of these parameters including quantitative measures such as macular thickness or volume, central subfield thickness or foveal thickness, and qualitative features such as the morphology of the vitreoretinal interface, disorganization of retinal inner layers, ellipsoid zone disruption integrity, and hyperreflec-tive foci. In addition, we discuss that a framework to assess the validity of biomarkers for treatment outcome is essentially important in assessing the prognosis before deciding on treatment in DME. Finally, we echo with other experts on the demand for updating the current diabetic retinal disease classification.

Characterization of macular choroid in normal-tension glaucoma: a swept-source optical coherence tomography study.

PURPOSE: To investigate the features of the small-to-medium (choriocapillaris and Sattler's layer) and large (Haller's layer) sized vessel layers of the macular choroid in normal-tension glaucoma (NTG) patients using swept-source optical coherence tomography (SS-OCT). METHODS: We conducted an observational cross-sectional study in 234 NTG eyes from 134 patients, and 203 normal eyes from 109 non-glaucomatous control subjects. We used Image J to segment the choroidal layer and then a Python script to measure the average macular choroidal thickness (MCT) and choroidal vascular index (CVI) of two vessel layers at five different locations. Quantitative optical coherence tomography angiography (OCTA) metrics for the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at macular region were also measured by a customized MATLAB program. Generalized estimating equations (GEE) models were performed to determine ocular and demographic factors associated with the choroidal metrics, adjusting for inter-eye correlation. RESULTS: Significant average MCT thinning was found in NTG eyes at all five locations of the two layers, in comparison with controls (all p ≤ 0.05). In addition, compared with control eyes, significant decrease in CVI was found in NTG eyes at all five sections of the large sized vessel layer: 500 µm nasal and temporal to macula (p = 0.002), 1500 µm nasal (p < 0.001), 2500 µm nasal (p = 0.001), 1500 µm temporal (p < 0.001) and 2500 µm temporal (p = 0.004). In contrast, no significant CVI difference was detected in the small-to-medium sized vessel layer. In the comparison of OCTA metrics of SCP and DCP at macular region between NTG and normal eyes, there were no significant difference of parafoveal vessel density (VD), foveal avascular zone (FAZ) area, FAZ circularity and fractal dimension (FD) in both layers. CONCLUSION: We found significant alterations in macular choroidal vascularity (reduced CVI and thinner layer) in NTG patients. Such alterations are more pronounced in the Haller's layer, rather than the choriocapillaris & Sattler's layer, in NTG. Choroidal layer may be more related to vasculature changes at macular region in NTG.

Ketamine effects on the urogenital system--changes in the urinary bladder and sperm motility.

Different doses of ketamine (10 mg/kg, 20 mg/kg, 30 mg/kg, 40 mg/kg, 50 mg/kg, and 60 mg/kg) were injected i.p. (I.P.), respectively, to male ICR mice to determine the optimal dosage for chronic administration. At and above 40 mg/kg I.P. injection, mice had almost no hindlimb movement during swimming test. Subsequently, 30 mg/kg was used as the dose for the study in the toxicity of long-term ketamine administration on urinary bladder and sperm motility. The treatment group were subdivided into two (n = 10 each group); one received daily ketamine treatment i.p. for 3 months and another group for 6 months. Corresponding number of mice in control groups (n = 5 each group) received saline injection instead of ketamine. Terminal dUTP nick and labeling (TUNEL) study and Sirius red staining were carried out on the sectioned slides of the urinary bladders to study the degree of apoptosis in both epithelium and muscular layers of the urinary bladder and the relative thickness of the muscular layers in this organ was also computed. Apoptosis in the bladder epithelium was observed initially in the 3-month ketamine treated mice and the number of apoptotic cells was significantly different (P < 0.05) between the 3-month and 6-month ketamine treated mice and the control. The relative thickness of muscular layers in the bladder wall also decreased significantly (P < 0.05) when the 6-month treated mice and the control were compared. Sirius red staining revealed increase of collagen in the urinary bladder of the treated mice, most evidently 6 months after ketamine treatment. In addition, the sperm motility was studied and there was a statistically significant difference between the control and ketamine treated groups in the percentages of sperms which were motile (P < 0.05). This suggested that the chronic administration of ketamine affected the genital system as well.