Switching to brolucizumab from aflibercept in age-related macular degeneration with type 1 macular neovascularization and polypoidal choroidal vasculopathy: an 18-month follow-up study.

PURPOSE: To assess the effect of switching to brolucizumab from aflibercept on eyes with type 1 macular neovascularization (MNV) and polypoidal choroidal vasculopathy (PCV) at 18 months. METHODS: This study was a retrospective, observational case series that included 19 eyes of 19 patients with type 1MNV and 23 eyes of 22 patients with PCV. We compared the injection intervals, visual acuity, total lesion size, and the number of polypoidal lesions between baseline and 18 months. The correlations between the data including treatment interval, total lesion size, and the number of polyps were also assessed. RESULTS: Treatment intervals were significantly extended; from 7.4 ± 1.4 weeks to 11.6 ± 2.6 weeks for type 1 MNV, p < 0.001; from 6.9 ± 1.3 to 11.7 ± 3.1 weeks for PCV, p < 0.001. In type 1 MNV eyes, strong correlation was found between total lesion size and brolucizumab injection intervals (r = - 0.81; p = 0.0002) and moderate correlation was found between treatment frequency with aflibercept and that with brolucizumab (r = 0.76; p = 0.040). In PCV eyes, we found strong correlation between the number of polyps and brolucizumab treatment frequency (r = - 0.81; p = 0.0016) and moderate correlation between total lesion size and brolucizumab treatment interval (r = - 0.48; p = 0.034). Intraocular inflammation occurred in 2 of 19 eyes (10.3%) with type 1 MNV and 5 of 23 eyes (21.7%) with PCV. CONCLUSION: The properties to extend brolucizumab injection intervals might be the smaller lesion size and lower aflibercept frequency for type 1 MNV and the smaller number of polyps and the smaller size of lesion for PCV.

Using optical coherence tomography angiography to guide myopic choroidal neovascularization treatment: a 3-year follow-up study.

PURPOSE: To report the long-term changes of the size of myopic choroidal neovascularization (mCNV) using optical coherence tomography angiography (OCTA). METHODS: This was a retrospective, observational case study of eleven eyes in eleven patients with mCNV followed with OCTA for a minimum of 3 years. The flow area of mCNV on OCTA, the size of chorioretinal atrophy (CRA) and central choroidal thickness were analyzed. The relationship between the changes of mCNV size and recurrences treated with anti-vascular endothelial growth factor (VEGF) agents was also assessed. RESULTS: Three eyes out of eleven eyes showed enlargement of the mCNV over 3 years. In two of the three eyes, the mCNV recurrences had not been treated immediately (the examination intervals were 4 months and 5 months, respectively), and we found obvious enlargement of the mCNV. In three eyes, the mCNV size decreased in 1 year and was stable thereafter without recurrences. In five eyes, mCNV size did not show remarkable changes for 3 years. In three of the five eyes, no recurrences were detected and two of the five eyes underwent prompt treatments against recurrences. CONCLUSION: Regular examination and prompt treatments against recurrences are critical to prevent enlargement of mCNV.

Factors influencing the reduction in corneal endothelial cells after Ex-Press® surgery.

PURPOSE: We investigated the factors that influence the reduction in corneal endothelial cells after Ex-Press® surgery. METHODS: This was a retrospective study. We included patients who had undergone Ex-Press surgery and were followed up for > 2. We analyzed the corneal endothelial cell density (ECD) before and after Ex-Press surgery. We investigated the insertion position (Ex-Press device was inserted into cornea or trabecular meshwork (TM)), Ex-Press-iris touch, cornea-iris touch, peripheral anterior synechiae, history of trabeculotomy, history of selective laser trabeculoplasty, type of glaucoma, and simultaneous cataract surgery as influencing factors. We used multivariate analysis to determine the factors influencing the reduction rate of ECD. RESULTS: We included 129 eyes. The mean of ECD had decreased 7.0% at 2 years. Ex-Press surgeries significantly decreased the ECD after 2 years (p = 0.0118). As a result of the multivariate analysis, the factor that led to a significantly faster reduction in ECD was the insertion position of the Ex-Press (p < 0.0001). The reduction rate of ECD after 2 years in cases of insertion into the cornea (27 eyes) was 15.1 ± 3.6%, and in cases of insertion into a TM (102 eyes), it was 5.2 ± 1.4%. CONCLUSIONS: Insertion into the cornea was a risk factor for rapid ECD loss. The Ex-Press should be inserted into a TM for long-term protection of the corneal endothelial cells.

Spontaneous atrial fibrillation initiated by tyramine in canine atria with increased sympathetic nerve sprouting.

BACKGROUND: Chronic left ventricular myocardial infarction (LVMI) promotes atrial and pulmonary veins (PV) sympathetic nerve sprouting. OBJECTIVES: To test the hypothesis that sympathetic stimulation with tyramine initiates atrial fibrillation (AF) by early after depolarization (EAD)-mediated triggered activity at the left atrial PV (LAPV) junction. METHODS: LVMI was created in 6 dogs and 6 dogs served as controls. Six to 8 weeks later the activation pattern of the isolated LAPV was optically mapped using dual voltage and intracellular Ca(+2) (Ca(i) (2+) )-sensitive epifluorescent dyes before and after tyramine (5 µM) perfusion. RESULTS: Tyramine initiated spontaneous AF in 5 of 6 atria but none in the control group (P < 0.01). The AF was initiated by late phase 3 EAD-mediated triggered activity that arose from the LAPV junction causing functional conduction block in LA, reentry, and AF. The AF was subsequently maintained by mixed reentrant and focal mechanisms. The EADs arose during the late phase 3, when the Ca(i) (2+) level was 64 ± 12% of the peak systolic Ca(i) (2+) transient amplitude, a property caused by tyramine's simultaneous shortening of the action potential duration and lengthening of the Ca(i) (2+) transient duration in the LVMI group but not in the control. Tyrosine hydroxylase and growth associated protein 43 positive nerve sprouts were significantly increased in the sinus node, LAA, and the LSPV in the LVMI group compared to control (P < 0.01). CONCLUSIONS: Increased atrial sympathetic nerve sprouts after LVMI makes the LAPV junction susceptible to late phase 3 EAD-mediated triggered and AF during sympathetic stimulation with tyramine.

Corneal topographic changes after blepharoptosis surgery in patients with deepening of the upper eyelid sulcus.

PURPOSE: We analyzed the corneal topography before and after blepharoptosis surgery and examined whether there was a difference in the corneal topographic changes with and without deepening of the upper eyelid sulcus (DUES). STUDY DESIGN: Retrospective study. METHODS: A total of 23 eyes of 23 patients (6 men and 17 women) were enrolled in this study. The patients were divided into two groups according to the presence or absence of DUES, and their clinical characteristics were compared. RESULTS: There were no significant differences between the DUES (n = 9) and non-DUES (n = 14) groups in any of the parameters examined before blepharoptosis surgery, including age, best-corrected visual acuity (BCVA), margin reflex distance-1 (MRD-1), spherical equivalent, average keratometry (AveK), cylindrical power (CYL), corneal higher order aberrations (HOAs) and central corneal thickness (CCT). In the non-DUES group, BCVA, spherical equivalent, AveK, CYL, and CCT were not significantly different between before and after surgery. On the other hand, in the DUES group, BCVA, spherical equivalent, and CCT were not significantly different before or after surgery, however, AveK, CYL and HOAs showed significant decreases after surgery. In addition, related to the post-surgical changes in CYL, the DUES group had a higher rate of reduced CYL. CONCLUSION: It is expected that in eyes with DUES blepharoptosis surgery can reduce AveK, CYL and HOAs in association with postoperative corneal flattening, and that will contribute to improvements in visual function.

Hydroxychloroquine's Early Impact on Cone Density.

PURPOSE: To evaluate early effects of hydroxychloroquine (HCQ) on the retina using adaptive optics (AO). METHODS: This was a prospective observational single-center study of 29 eyes of 29 patients who had been treated with HCQ for the first time and followed with AO for a minimum of two years. Cone counting was performed in 4 quadrants, nasal, temporal, superior, and inferior, at 0.75 mm from the foveal center. The changes of cone density on AO, visual acuity, and foveal thickness within two years of use were analyzed. The changes of mean cone density of patients whose cumulative dose was over 200 g in 2 years were also assessed. We evaluated the correlation between cone density and cumulative dose of HCQ. RESULTS: There was no significant decrease in cone density in the first 2 years of HCQ use. VA and foveal thickness did not show obvious change, either. Among 9 patients whose cumulative dose was over 200 g in 2 years, the mean cone density showed no significant change at 6, 12, 18, and 24 months compared with baseline (P=0.381, P=0.380, P=0.281, and P=0.534, respectively). There was no correlation between cone density and cumulative dose of HCQ at two years (Spearman's correlation coefficient, r = -0.0553, P=0.780; n = 29). CONCLUSION: AO showed no change in cone density in the first two years of HCQ use.

Detecting latitudinal and altitudinal expansion of invasive bamboo Phyllostachys edulis and Phyllostachys bambusoides (Poaceae) in Japan to project potential habitats under 1.5°C-4.0°C global warming.

Rapid expansion of exotic bamboos has lowered species diversity in Japan's ecosystems by hampering native plant growth. The invasive potential of bamboo, facilitated by global warming, may also affect other countries with developing bamboo industries. We examined past (1975-1980) and recent (2012) distributions of major exotic bamboos (Phyllostachys edulis and P. bambusoides) in areas adjacent to 145 weather stations in central and northern Japan. Bamboo stands have been established at 17 sites along the latitudinal and altitudinal distributional limit during the last three decades. Ecological niche modeling indicated that temperature had a strong influence on bamboo distribution. Using mean annual temperature and sun radiation data, we reproduced bamboo distribution (accuracy = 0.93 and AUC (area under the receiver operating characteristic curve) = 0.92). These results infer that exotic bamboo distribution has shifted northward and upslope, in association with recent climate warming. Then, we simulated future climate data and projected the climate change impact on the potential habitat distribution of invasive bamboos under different temperature increases (i.e., 1.5°C, 2.0°C, 3.0°C, and 4.0°C) relative to the preindustrial period. Potential habitats in central and northern Japan were estimated to increase from 35% under the current climate (1980-2000) to 46%-48%, 51%-54%, 61%-67%, and 77%-83% under 1.5°C, 2.0°C, 3.0°C, and 4.0°C warming levels, respectively. These infer that the risk areas can increase by 1.3 times even under a 1.5°C scenario and expand by 2.3 times under a 4.0°C scenario. For sustainable ecosystem management, both mitigation and adaptation are necessary: bamboo planting must be carefully monitored in predicted potential habitats, which covers most of Japan.