One-year outcomes of fixed-dosing Aflibercept therapy for pre treated and naive polypoidal choroidal vasculopathy patient.

BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is a type of age-related macular degeneration that can cause permanent vision loss. The purpose of this paper was to report the one-year outcomes of fixed-dosing aflibercept therapy for the treatment of PCV. METHODS: This was a prospective, single-arm, interventional case series study of 25 PCV patients; 12 pre-treated and 13 treatment-naïve patients. The patients were treated and monitored for 12 months. Each patient was administered with an aflibercept (2.0 mg) injection every month for the first 3 months (the loading phase), and thereafter, once every 2 months. At every follow-up visit, best-corrected visual acuity (BCVA) test, fundus examination, and optical coherence tomography for measuring the central subfield macular thickness (CSMT) were performed. Fluorescein and indocyanine green angiography were conducted at baseline and at 4 and 12 months. RESULTS: After 12 months of aflibercept therapy, the mean BCVA of the patients significantly improved from 65.48 letters at baseline to 69.91 letters (p=0.001), and the CSMT significantly decreased from 406.92 um at baseline to 276.12 um (p< 0.001). Additionally, ten patients (40%) showed complete polyp regression. The treatment-naïve patients showed a statistically significant improvement in BCVA from 66.58 letters at baseline to 76.36 letters at 12 months, and a significant decrease in CSMT, from 462 to 243 um. In the pre-treated group, there was no change in BCVA (64.46 letters), and the decrease in CSMT from 356.08 to 303.69 um was not statistically significant. CONCLUSIONS: The fixed-dosing aflibercept regimen is effective for treating patients with PCV and is more effective in treatment-naïve patients than in pre-treated patients. TRIAL REGISTRATION: Clinical Research Information Service (CRiS), Republic of Korea. Identifer: KCT0005798, Registered: Jan 20, 2021. Retrospectively registered, URL: https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=18546.

Optical coherence tomography angiography in patients with polypoidal choroidal vasculopathy.

PURPOSE: To report the characteristics of polypoidal choroidal vasculopathy (PCV) based on optical coherence tomography angiography (OCTA) results. METHOD: A retrospective, cross-sectional case series was conducted. Patients treated for PCV were evaluated with the OCTA system. The OCTA images of these patients were compared with those from indocyanine green angiography (ICGA). All eyes of consecutive patients with PCV were included. RESULTS: The mean age of the patients (five men and two women) was 67.86 ± 14.02 years. The mean number of anti-vascular endothelial growth factor injections was 10.43 ± 10.01. OCTA demonstrated branched vascular networks, which were detected by ICGA; however, polyps were not revealed consistently by OCTA. A total of 24 polyps were detected in seven eyes from seven patients by hyper-fluorescence on ICGA. However, only 12 polyps (50 %) were hyper-reflective on OCTA. CONCLUSION: PCV polyps were not detected as consistently by OCTA as by ICGA. This suggests that the polyps were detected differently by OCTA depending on blood flow in the polyp.

Optical coherence tomography-guided selective focal laser photocoagulation: a novel laser protocol for diabetic macular edema.

BACKGROUND: To compare the anatomic and functional results between optical coherence tomography (OCT)-guided selective focal laser photocoagulation (OCT-laser) and conventional modified Early Treatment Diabetic Retinopathy Study (mETDRS) laser treatment for diabetic macular edema (DME). METHODS: We analyzed treatment outcomes in 47 consecutive eyes treated with OCT-laser compared to 31 matched eyes treated with mETDRS. In the OCT-laser group, we identified 'significant actively-leaking microaneurysms on OCT' (SALMO) which are responsible for edema in OCT B-scan images, and thoroughly ablated them with photocoagulation. Best-corrected visual acuity (BCVA) and retinal thickness by OCT were compared at baseline and 12 months after treatment between two groups. RESULTS: OCT-laser treatment resulted in significant improvements in BCVA, central subfield thickness (CST), and maximum retinal thickness (MRT) from baseline at 12 months from the time of therapy (+2.5 letter score, p = 0.04; -45.56 µm in CST, p < 0.001; -91.6 µm in MRT, p < 0.001). The mean number of treated 'SALMO' was 5.6 ± 4.0 (range 1-26), while the number of MAs in 'treatable lesions' by fluorescein angiography (FA) in the same eye was 16.3 ± 11.8 (range 2-42). There was no difference between OCT-laser and mETDRS groups in changes of these parameters from baseline at 12 months (p = 0.56, p = 0.89, p = 0.43 respectively). Fundus autofluorescence (FAF) and OCT revealed less tissue damage in OCT-laser-treated eyes, compared to eyes treated with mETDRS (p < 0.001). CONCLUSIONS: OCT-laser shows similar anatomic and functional outcomes compared to conventional laser (modified ETDRS), with significantly less retinal damages.

Effect of sulodexide in patients with non-proliferative diabetic retinopathy: diabetic retinopathy sulodexide study (DRESS).

PURPOSE: To evaluate the effectiveness of sulodexide for the treatment of hard exudates (HE) in non-proliferative diabetic retinopathy (NPDR). METHODS: This was a randomized, placebo-controlled, multicenter trial involving 130 patients (65 for each group) who had mild-to-moderate NPDR with macular HE. Participants were given a daily dose of either 50 mg sulodexide or a matching dose of placebo orally for 12 months. Main outcome measure was an improvement in HE defined as a decrease in severity by at least two grades on a 10-grade severity scale. This was evaluated by fundus photography over 12-month period. RESULTS: The sulodexide group showed significantly greater improvement in HE severity than that shown by the placebo group (39.0 % vs. 19.3 %; chi square, P = 0.005). Logistic regression analysis yielded an odds ratio of 2.790 (95 % confidence interval, 1.155-6.743; P = 0.023) for the effect of treatment once adjustments were made for demographic, prognostic and disease confounders. Intention to treat and per-protocol analysis yielded similar results. Sulodexide's safety was comparable to that of the placebo. CONCLUSIONS: Oral sulodexide therapy over 12 months improved macular HE in patients with mild-to-moderate NPDR, without leading to detectable adverse events. The study protocol was registered on clinicaltrial.gov under identifier NCT01295775.

A case of ocular toxocariasis successfully treated with albendazole and triamcinolon.

We present a case of ocular toxocariasis treated successfully with oral albendazole in combination with steroids. A 26-year-old male visited the authors' clinic with the chief complaint of flying flies in his right eye. The fundus photograph showed a whitish epiretinal scar, and the fluorescein angiography revealed a hypofluorescein lesion of the scar and late leakage at the margin. An elevated retinal surface and posterior acoustic shadowing of the scar were observed in the optical coherence tomography, and Toxocara IgG was positive. The patient was diagnosed with toxocariasis, and the condition was treated with albendazole (400 mg twice a day) for a month and oral triamcinolone (16 mg for 2 weeks, once a day, and then 8 mg for 1 week, once a day) from day 13 of the albendazole treatment. The lesions decreased after the treatment. Based on this study, oral albendazole combined with steroids can be a simple and effective regimen for treating ocular toxocariasis.

In vivo detection of acute ischemic damages in retinal arterial occlusion with optical coherence tomography: a "prominent middle limiting membrane sign".

PURPOSE: To describe characteristic findings of acute retinal ischemic damage in optical coherence tomography. METHODS: Eighteen cases of acute retinal arterial occlusion with available fundus photography, optical coherence tomography, and/or fluorescein angiography in the early phase (<1 month) with more than 2 months follow-up were reviewed. A site-to-site analysis between optical coherence tomography morphology and correlating fundus images were done on each visit. RESULTS: Retinal opacities at first presentation were vague to mild opacity in four eyes, moderate (affecting visibility of underlying choroidal vessels) in seven, severe (yellow to whitish) in five, and very severe (chalky white) in two. These changes eventually disappear within 1 month (8 of 9 eyes). Inner retinal hyperreflectivity and a "prominent middle limiting membrane" in optical coherence tomography were consistently noticed up to 1 month showing regional correlation with the retinal opaque areas and was readily identified even in areas with vague or disappeared retinal opacities. Later, inner retinal atrophic changes replace these ischemic optical coherence tomography signs. CONCLUSION: A prominent middle limiting membrane sign is a useful indicator of acute ischemic retinal damage, especially in cases showing subtle or resolved retinal opacities before the onset of atrophic changes.

Effects of Subcutaneous Methotrexate in Patients with Refractory Uveitis and Chorioretinitis.

PURPOSE: Methotrexate (MTX) is an immunosuppressive agent used to treat noninfectious inflammatory eye conditions and is generally administered orally for ocular inflammatory diseases. When used in rheumatological diseases, subcutaneous administration has been reported to show higher efficacy than oral administration. Therefore, this study aimed to evaluate the effect of subcutaneous MTX in patients with refractory uveitis or choroiditis who did not respond to other immunosuppressive agents. METHODS: A retrospective case series study was performed between January and December 2018. Patients with uveitis or chorioretinitis who showed little to no treatment response for 6 months or more with conventional immunosuppressive agents were treated with MTX, administered subcutaneously. After 6 months of treatment, patients were evaluated to determine whether complete suppression of inflammation sustained for ≥28 days was achieved in both eyes and whether improvement can be confirmed by fluorescein angiography (FAG). RESULTS: Subcutaneous MTX treatment was performed on 18 patients: 11 had intermediate uveitis and seven had posterior uveitis. In the intermediate uveitis patient group, five patients (50% of the group excluding one patient who dropped out) showed improvement in FAG and three patients (30%) showed complete suppression of inflammation. In the posterior uveitis group, two out of seven patients (excluding two patients who dropped out) showed an improvement, two patients in the group showed little change, and one patient showed aggravation of FAG findings. CONCLUSIONS: The study confirmed that in patients with uveitis or chorioretinitis who had a refractory response to treatment with other immunosuppressive agents, subcutaneous MTX showed improved treatment efficacy.

Distribution of Neurofilament in Peeled Internal Limiting Membrane.

BACKGROUND AND OBJECTIVE: The aim was to study the distribution of neurofilament in peeled internal limiting membrane (ILM). PATIENTS AND METHODS: Prospective case study. Vitrectomy and ILM peeling were performed in patients with epiretinal membrane and macular hole. ILM flap specimens were obtained as one disc area size from five locations. Immunofluorescent staining was performed with an antineurofilament heavy antibody. Using a confocal microscope, retinal cell debris density was studied using the ImageJ program. RESULTS: Percent of stained neurofilament was 1.58 ± 1.14% in total (2.45 ± 1.37% in extranasal, 1.97 ± 0.75% in extratemporal, 1.93 ± 1.26% in juxta-nasal, 0.89 ± 0.69% in fovea, and 0.63 ± 0.46% in juxtatemporal). The Kruskal-Wallis test revealed significant differences among groups (P < 0.05). Bonferroni post hoc analysis only confirmed significant difference between juxtatemporal and extranasal groups (P < 0.05). CONCLUSIONS: In peeled ILM flap, neurofilaments are rarely detected in the juxtatemporal area. However, they are frequently detected in the extranasal area. [Ophthalmic Surg Lasers Imaging Retina 2023;54:643-648.].

Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis.

PURPOSE: To evaluate the efficacy of vitrectomy including internal limiting membrane (ILM) peeling without gas tamponade for myopic foveoschisis (MF). METHOD: In this retrospective study, 15 eyes of 13 consecutive patients with MF underwent pars plana vitrectomy and ILM peeling without gas tamponade. The main outcomes were measured using best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT). RESULT: The mean refractive error was -11.0 ± 8.2 diopters and mean axial length was 30.8 ± 2.6 mm. The mean BCVA increased from 0.78 ± 0.53 to 0.61 ± 0.75 logMAR unit (p = 0.05), and the mean CMT decreased from 405 ± 143 µm to 255 ± 47 µm (p = 0.002) during a follow-up of 11.8 months. OCT showed a complete resolution of the MF, with foveal reattachment in all eyes. Full-thickness macular hole developed in two eyes during follow-up. CONCLUSION: ILM peeling without gas tamponade results in favorable anatomical and visual outcomes.

EXTEND III: efficacy and safety of ranibizumab in South Korean and Taiwanese patients with subfoveal CNV secondary to AMD.

BACKGROUND: The purpose of this study was to investigate the efficacy and safety of intravitreal ranibizumab 0.5 mg in South Korean and Taiwanese patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: This was a 12-month, open-label, single-arm, multi-center, phase III study. Ninety-five patients (Taiwanese: 51; South Korean: 44) were included in the study. Key outcome measures assessed included: mean change in best-corrected visual acuity (BCVA) from baseline to months 4 (primary endpoint) and 12 (secondary endpoint); other secondary endpoints comprising categorized mean change in BCVA from baseline at month 4 and month 12, mean change in BCVA from baseline at month 4 and month 12 per baseline characteristics; and incidence of ocular and non-ocular adverse events and serious adverse events (SAEs) at month 12. RESULTS: The mean BCVA change improved significantly (p < 0.0001) from baseline to both month 4 (+9.3 letters) and month 12 (+10.1 letters). At month 12, the proportion of patients who gained ≥5, 10, or 15 letters from baseline was 75.8%, 54.7%, and 32.6% respectively. Total and CNV lesion area significantly decreased from baseline (p < 0.0001). About 57% of patients showed complete absence of fluorescein leakage at month 12. Mean change from baseline visual acuity scores also increased significantly over time for all subgroups. At month 12, ocular SAEs occurred in 2.1% of patients (out of which one patient [1.1%] experienced endophthalmitis) and 16.8% of patients experienced non-ocular SAEs. There were no deaths reported during the study. CONCLUSIONS: Consistent with previous studies in Caucasian and Japanese populations, EXTEND III confirms that monthly intravitreal injections of ranibizumab 0.5 mg administered over 12 months is effective and well-tolerated in South Korean and Taiwanese patients with subfoveal CNV secondary to AMD.

New insights into the pathoanatomy of diabetic macular edema: angiographic patterns and optical coherence tomography.

PURPOSE: To describe the pathoanatomy of diabetic macular edema in optical coherence tomography and its correlation with fluorescein angiography patterns. METHODS: Sixty eyes of 56 patients were analyzed. Diabetic macular edema was classified into typical focal leakage (from microaneurysm), typical diffuse leakage (the capillary plexus), or combined/questionable leakage using fluorescein angiography and retinal thickness profiles. The leakage and pooling patterns in fluorescein angiography were matched to the corresponding optical coherence tomography images and analyzed. RESULTS: Focal leakage shows swelling predominantly in the outer plexiform layer (OPL). Deeply located microaneurysms directly leak into the loose fiber portion of OPL (Henle layer) through the "fluid conductivity barrier" (synaptic portion of OPL). Diffuse leakage caused swelling predominantly in the inner nuclear layer and secondarily in the OPL. The deep capillary plexus is located between the two "fluid barriers" (inner plexiform layer and OPL); thus, diffuse leakage is primarily related with swelling in the inner nuclear layer. In the combined/questionable leakage, partial sections consisting of inner nuclear layer swelling and much larger areas of OPL/outer nuclear layer swelling are noticed. CONCLUSION: Based on the concept of the fluid conductivity barrier, we revealed a correlation between the intraretinal location of the leakage source and where the fluid accumulated within the retinal layers.

Detection of ocular Toxoplasma gondii infection in chronic irregular recurrent uveitis by PCR.

Toxoplasma gondii is a zoonotic parasite resulting in human infections and one of the infectious pathogens leading to uveitis and retinochoroiditis. The present study was performed to assess T. gondii infection in 20 ocular patients with chronic irregular recurrent uveitis (20 aqueous humor and 20 peripheral blood samples) using PCR. All samples were analyzed by nested PCR targeting a specific B1 gene of T. gondii. The PCR-positive rate was 25% (5/20), including 5% (1) in blood samples, 25% (5) in aqueous humor samples, and 5% (1) in both sample types. A molecular screening test for T. gondii infection in ocular patients with common clinical findings of an unclear retinal margin and an inflammatory membrane over the retina, as seen by fundus examination, may be helpful for early diagnosis and treatment.

Clinical outcomes of combined pars plana vitrectomy and scleral fixation of the intraocular lens with a suspension bridge method in eyes with aphakia or insufficient capsular support.

PURPOSE: To describe a modified technique of scleral fixation for intraocular lens (IOL) implantation and report the clinical outcomes of combined pars plana vitrectomy and scleral IOL fixation using the suspension bridge method. METHODS: This retrospective case series included 57 eyes (56 patients) of aphakia or phakic and pseudophakic eyes with insufficient capsular support that underwent IOL implantation or dislocated IOL repositioning with scleral fixation using the 'suspension bridge' method by a single surgeon between 1 July 2010 and 1 March 2019. Preoperative status, changes in visual acuity, refractive outcomes as spherical equivalent and related complications were assessed with a minimum follow-up of 3 months. RESULTS: The mean follow-up period was 25.5 ± 25.4 months. Preoperative visual acuity (logarithm of the minimum angle of resolution) was 1.32 ± 0.68 (20/400 Snellen), and it significantly improved to 0.80 ± 0.53 (20/125), 0.59 ± 0.56 (20/80) and 0.24 ± 0.37 (20/35) at 1 week, 1 month and 3 months, respectively (p < 0.001). Postoperative complications included corneal wound dehiscence (n = 1), vitreous incarceration (n = 1), optic-iris capture (n = 6) and cystoid macular oedema (n = 1). The above-mentioned complications were successfully corrected with simple procedures. However, one case of IOL dislocation required reoperation. CONCLUSION: The modified technique of the suspension bridge method precludes the need for a scleral flap, with the advantage of easy adjustment of the IOL position. It is a simple and feasible technique with good surgical results and low complication rates.

Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole.

PURPOSE: To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole. METHODS: The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months. RESULTS: Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade. CONCLUSIONS: Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Concentration of cytokines in age-related macular degeneration after consecutive intravitreal bevacizumab injection.

BACKGROUND: To evaluate the changes in aqueous humor cytokine levels following consecutive intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) injections in eyes with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). METHOD: Aqueous humor samples were collected at the time of intravitreal injection of 1.25 mg of bevacizumab every 7.0 (+/-2.0) weeks from ten eyes with AMD for the AMD group and during cataract surgery in nine eyes for the control group. Visual acuity with Early Treatment of Diabetic Retinopathy Study (ETDRS) letters and central macular thickness (CMT) using optical coherence tomography were measured before each injection in the AMD group. Aqueous cytokine levels were determined by immunoassay using multi-analyte biochip array technology (Evidence investigator cytokine and growth factor biochip array, RANDOX laboratories Ltd., Crumlin, UK). RESULT: In the AMD group, mean +/- standard deviation(SD) aqueous VEGF levels decreased from 68.0 +/- 32.1 pg/ml at baseline to 26.3 +/- 19.0 pg/ml after the first injection (p = 0.028) and to 25.2 +/- 12.8 pg/ml after the second injection (p = 0.005). While CMT decreased from 307.7 +/- 102.0 mum to 206.8 +/- 141.5 microm (p = 0.037), ETDRS visual acuity increased from 17.6 +/- 11.7 letters to 22.0 +/- 15.6 letters after three consecutive injections (p = 0.017). CONCLUSION: Significantly decreased VEGF levels were noted after the first injection of bevacizumab. These levels were maintained after the second injection, which paralleled the change in visual acuity and CMT.

Intravitreal bevacizumab injection for central serous chorioretinopathy.

PURPOSE: The purpose of this study was to evaluate the effectiveness of intravitreal injection of bevacizumab for treatment of central serous chorioretinopathy. METHODS: In this retrospective case series, six patients (six eyes) with central serous chorioretinopathy were treated with an intravitreal injection of bevacizumab. The outcome measures included visual acuity with Early Treatment Diabetic Retinopathy Study letters, central macular thickness measurement with optical coherence tomography, changes in fluorescein angiography, and indocyanine green angiography. RESULTS: The mean age of the patients was 42.3 years and the mean follow-up period was 9.0 months (range, 5-12 months). Mean visual acuity +/- standard deviation increased from 40.8 +/- 8.3 Early Treatment Diabetic Retinopathy Study letters at baseline to 49.0 +/- 5.0 Early Treatment Diabetic Retinopathy Study letters at 1 month (P = 0.046) and to 53.3 +/- 5.2 Early Treatment Diabetic Retinopathy Study letters at 3 months (P = 0.028). Mean central macular thickness +/- standard deviation decreased from 331.5 +/- 93.4 microm to 164 +/- 34 microm at 3 months (P = 0.043). Leakage on fluorescein angiography and hyperpermeability on indocyanine green angiography decreased in conjunction with improvement in central macular thickness observed by optical coherence tomography. CONCLUSION: Intravitreal bevacizumab injections resulted in improved visual acuity and anatomical results for central serous chorioretinopathy.

Features of optical coherence tomography are predictive of visual outcomes after intravitreal bevacizumab injection for diabetic macular edema.

PURPOSE: To identify optical coherence tomography (OCT) patterns of diabetic macular edema (DME) predictive of visual outcomes after intravitreal bevacizumab (IVB; Avastin®) injection. METHODS: We retrospectively examined 56 consecutive eyes that were given IVB injections for DME alongside the preoperative macular OCT data. Using this information, we categorized the eyes into 2 groups: group 1 showing diffuse patterns; group 2 demonstrating cystoid macular edema (CME). RESULT: The mean follow-up period was 11.66 ± 3.98 months. Group 1 eyes gained 0.04 ± 9.27 ETDRS letters (p = 0.984), while group 2 eyes gained 5.79 ± 9.98 ETDRS letters (p = 0.005). Mean macular thickness decreased by 72.79 ± 145.74 µm in group 1 (p = 0.014) and by 223.71 ± 224.52 µm in group 2 (p< 0.001). CONCLUSION: Patients showing CME upon OCT achieved greater improvements in visual acuity and macular thickness after IVB injection than patients with diffuse macular edema. The type of macular edema shown by OCT may provide an objective guideline in predicting the response of DME to IVB injection.

Clinicopathologic report of uveal melanoma with persistent exudative retinal detachment after gamma knife radiosurgery.

AIMS: Our purpose was to report the clinical and pathological findings from uveal melanoma patients with persistent exudative retinal detachment (RD) after Gamma Knife radiosurgery (GKR). METHODS: A retrospective review was performed. RESULTS: GKR was performed on 19 uveal melanoma patients from 2004 to 2006, and 5 of them developed persistent exudative RD. The mean initial largest basal tumor diameter in these 5 patients was 14.4 +/- 1.9 mm, and the mean tumor height was 9.2 +/- 1.0 mm. Marginal doses of 40-50 Gy radiation were administered. RD developed or had become aggravated an average of 3 (1-10) months after GKR. Two patients underwent enucleation, while the remaining 3 underwent tumor removal by endoresection with retinal reattachment surgery by vitrectomy and silicone oil tamponade. These procedures were undertaken an average of 6.3 (1.5-14) months after radiation and 3.3 (0.5-5) months after the onset or aggravation of RD. Histologically 4 tumors showed 50-100% necrosis without any mitotic activity. Thus local tumor control after GKR appeared sufficient regardless of RD. CONCLUSION: Aggravation or development of exudative RD after GKR does not necessarily entail treatment failure. Therefore, retinal reattachment surgery in persistent exudative RD may be an option to preserve the eye.

Foveal ganglion cell layer damage in ischemic diabetic maculopathy: correlation of optical coherence tomographic and anatomic changes.

PURPOSE: To describe the morphologic features of ischemic diabetic maculopathy by high-resolution optical coherence tomography (OCT) and their correlation with the damaged foveal avascular zone (FAZ) on fluorescein angiography (FA). DESIGN: Observational case series. PARTICIPANTS: One hundred twenty-four eyes of 63 patients with diabetic retinopathy and acceptable FA and OCT images were studied. Twenty-three normal fellow eyes of 23 nondiabetic patients with unilateral acute central serous choroidopathy also were studied. METHODS: High-speed Fourier-domain OCT was used with a speckle noise-reduction technique to obtain detailed horizontal and vertical images through the center of the fovea and horizontal raster scans every 100 microm. Foveal ganglion cell layer (GCL) damage was identified on OCT as an evident difference in foveal thickness and contour compared with a normal fovea or as asymmetry within the fovea. Fluorescein angiography was performed by confocal scanning laser ophthalmoscope (HRA 2; Heidelberg Engineering, Heidelberg, Germany), and FAZ damage visible during the FA arterial phase was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) FA grading system. Correlations were sought between foveal GCL damage identified on OCT and FA capillary dropout sites. MAIN OUTCOME MEASURES: Foveal GCL damage on OCT, the size of the foveola on OCT (defined as the area of GCL thickness <10 microm), ETDRS grading of FAZ on FA, and visual acuity. RESULTS: Among the 124 eyes with diabetic retinopathy, 62 (50%) had FA evidence of either FAZ damage higher than grade 1 or FAZ capillary loss. In these eyes, damage to the FAZ seen on FA also could be detected on OCT (positive predictive value, 84.5%; negative predictive value, 72.9%), and locations of FAZ damage seen on FA corresponded well with sites of foveal GCL damage on OCT. In nondiabetic, normal eyes, the size of the foveola on OCT matched the size of the FAZ on FA. CONCLUSIONS: Evidence of foveal GCL damage on OCT is a good indicator of macular ischemic damage in eyes with diabetic retinopathy. Although in this study FA was more sensitive than OCT in detecting vascular damage, OCT provides objective results and seems to be a good noninvasive substitute for FA.

Effect of intravitreal bevacizumab injection on aqueous humor cytokine levels in clinically significant macular edema.

PURPOSE: To determine the effect of intravitreal bevacizumab (Avastin, Genentech, Inc., San Francisco, CA) injection on aqueous humor cytokine levels in clinically significant macular edema (CSME). DESIGN: Retrospective, comparative study. PARTICIPANTS: Seventeen eyes undergoing intravitreal injection for CSME and 11 eyes undergoing cataract surgery as negative controls. Nine patients with CSME were naïve to intravitreal bevacizumab injection (CSME group 1), and 8 patients previously received 1 intravitreal bevacizumab injection at a mean of 9.6+/-1.4 weeks earlier (CSME group 2). METHODS: Aqueous humor samples were collected before performing intravitreal injection in the CSME group and during cataract surgery in the control group. Aqueous cytokine levels were determined by immunoassay using multianalyte biochip array technology. MAIN OUTCOME MEASURES: The concentration of cytokines in the aqueous humor was recorded as a mean (+/- standard deviation) in CSME groups 1 and 2 and the control group. Correlations of aqueous humor cytokine levels were evaluated. RESULTS: Significantly higher levels of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein (MCP)-1 were noted in patients with CSME compared with controls. Although higher vascular endothelial growth factor (VEGF) levels were noted in CSME group 1 (P = 0.001), a lower level of VEGF was noted after intravitreal bevacizumab injection in CSME group 2 (P = 0.004) compared with the control group. VEGF levels were also lower in CSME group 2 compared with CSME group 1 (P = 0.001). In CSME group 2, a significant negative correlation was observed between VEGF and IL-6 (rho = -0.833, P = 0.01) and VEGF and MCP-1 (rho = -0.736, P = 0.037). CONCLUSIONS: Significantly higher levels of IL-6, IL-8, VEGF, and MCP-1 were noted in the aqueous humor of CSME. However, recurrence of macular edema was noted with significantly lower concentrations of VEGF after a single intravitreal injection of bevacizumab. This suggests the potential importance of IL-6 and MCP-1 in the pathogenesis of CSME. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.