Baseline Best-corrected Visual Acuity Research Articles

Evaluation of Medically Reversible Limbal Stem Cell Deficiency.

To evaluate the clinical characteristics and treatment strategies of limbal stem cell deficiency (LSCD) patients managed with medical therapy. The study included 29 eyes of 21 patients with LSCD who were managed medically at Ege University Faculty of Medicine, Department of Ophthalmology between May 2013 and May 2023. LSCD stages before and after medical treatment were recorded according to the LSCD staging system published by the International LSCD Working Group. The medical records of patients showing improvement in LSCD stage with medical treatment without surgical intervention were evaluated. The mean age was 35.5±23.8 years (range, 5-71 years) with a male-to-female ratio of 6:15. The primary etiology of LSCD was ocular rosacea in 12 patients (57.1%), marginal keratitis in the setting of blepharitis in 8 patients (38.1%), and topical medication toxicity in 1 patient (4.8%). The mean baseline best corrected visual acuity (BCVA) was 0.25±0.26 logarithm of the minimum angle of resolution (logMAR) (range, 0-1 logMAR). Pre-treatment LSCD stage was stage 1A in 5 eyes (17.2%), stage 1B in 12 eyes (41.4%), stage 1C in 4 eyes (13.8%), stage 2A in 4 eyes (13.8%), and stage 2B in 4 eyes (13.8%). Complete regression of LSCD was achieved in 6 eyes (20.7%) with medical treatment addressing the primary etiology. In the remaining eyes, after medical treatment, the severity of LSCD decreased below the surgical threshold, which is considered stage 2B. The mean final BCVA was 0.07±0.1 logMAR (range, 0-0.4 logMAR). This study highlights that LSCD can be completely or partially reversible with appropriate management, especially in cases with underlying limbal niche dysfunction, where inflammation plays a significant role. Although limbal stem cell transplantation is considered the main treatment approach for LSCD, localized and early-stage LSCD can be effectively managed medically without the need for surgical intervention.

Traumatic Optic Neuropathy Treatment Trial 2 (TONTT-2): evaluating the efficacy of different doses of erythropoietin – a multicentre, randomised, double-blind clinical trial

AimThe aim is to compare the efficacy and safety of three different weight-adjusted intravenous erythropoietin (EPO) doses in patients with indirect traumatic optic neuropathy (TON).MethodsThis study is a multicentre, randomised,...

The difference in clinical characteristics between patients with rhegmatogenous retinal detachment during partial and complete lock-down periods related to COVID-19 pandemics 2-year long follow-up results

BackgroundWe aimed to compare results of clinical presentation of rhegmatogenous retinal detachment (RRD), and the surgical approach during partial or complete lock-down periods (LP), and non-COVID periods in a tertiary ophthalmology clinic.MethodsThe medical data of the patients who were diagnosed with RRD in a tertiary hospital. The demographic data of patients, the duration from the beginning of the visual symptoms to hospital admission, the status of lens, the anatomical quadrant of retinal break, best-corrected visual acuity (BCVA) at presentation, the type of intraocular tamponade, and final BCVA were recorded. The exclusion criteria were RD other than rhegmatogenous (tractional or exudative), and incomplete follow-up until 2nd-year.ResultsThe study included 20 eyes of 20 RRD cases in partial LP, 20 eyes of 20 RRD cases in complete LP, and 23 eyes of 23 RRD cases in non-COVID period. The ratio of perfluoropropane (C3F8) gas to silicone oil which was applied as intraocular tamponade at the end of the surgery for RRD was 15/8 in non-COVID period, 11/9 in partial LP, and 11/9 in complete LP (p = 0.730). In final visit at postoperative 2nd-year, the BCVA was logMAR 0.613 ± 0.425 in non-COVID period, logMAR 0.668 ± 0.348 in partial LP, and logMAR 0.730 ± 0.368 in complete LP (p = 0.612). In both inferior and superior quadrant RD, there was significant difference between baseline and final BCVA after surgery. (Baseline and final BCVA in inferior RD: logMAR 1.71 ± 0.40, and logMAR 0.950 ± 0.30 (p = 0.011) and, in superior RD: logMAR 1.35 ± 0.59, and logMAR 0.505 ± 0.321 (p = 0.0001), respectively.)ConclusionsAs a result, it seems that both partial and complete LP did not modify the typology of RRD surgeries.Trial registrationRetrospectively registered. The study followed the tenets of the Declaration of Helsinki, and it was approved by the local ethical committee (2023-088).

Prognosis and factors related to anti-VEGF therapy in patients with retinal vein occlusion and concomitant carotid artery disease

To evaluate the prognosis and influencing factors of retinal vein occlusion (RVO) in patients with concomitant carotid artery disease receiving anti-vascular endothelial growth factor (VEGF) treatment. Patients diagnosed with RVO and receiving anti-VEGF treatment were included. Eye and clinical data were collected. The patients were divided into a group with concomitant carotid artery disease (Group A) and a group without concomitant carotid artery disease (Group B). The risk factors affecting the visual prognosis of RVO patients with concomitant carotid artery disease were analyzed. Among 177 eligible patients with RVO, 101 had concomitant carotid artery disease (Group A), while 76 did not (Group B). Group A had a significantly lower treatment effectiveness rate than Group B (P < 0.001). The age and platelet distribution width of Group A were significantly higher than Group B (P < 0.001). Multivariate logistic regression analysis showed that baseline best-corrected visual acuity (BCVA), disorganization of retinal inner layers (DRIL), external limiting membrane (ELM) disruption, and red blood cell distribution width (RDW) were significantly associated with the posttreatment visual prognosis of RVO patients with concomitant carotid artery disease(P < 0.05). RVO patients with concomitant carotid artery disease had a significantly lower treatment effectiveness rate than RVO patients without carotid artery disease. The poor baseline BCVA, DRIL, ELM disruption, and a greater RDW are risk factors for low anti-VEGF treatment efficacy among RVO patients with concomitant carotid artery disease.

Alteration of treatment choices and the visual prognosis for diabetic macular edema in the era of anti-VEGF drugs: Analysis of the STREAT-DME 2 study.

To assess the real-world outcome of best-corrected visual acuity (BCVA) following 2-year intervention for treatment-naïve diabetic macular edema (DME) since the approval of anti-vascular endothelial growth factor (VEGF) therapy. A total of 1,780 treatment-naïve eyes with DME for which intervention was initiated between 2015 and 2019, and which were followed for 2 years, were extracted from the longitudinal medical records of 37 retinal disease institutions in Japan. Interventions included anti-VEGF therapy, topical corticosteroid therapy, macular photocoagulation, and vitrectomy. The baseline and final BCVA, and the number and timing of interventions were recorded. Eyes were classified according to the year in which intervention was initiated. Over a 2-year period, BCVA improved annually, finally reaching 7 letters. The proportion of eyes in which good vision was maintained (BCVA >20/40) increased to 73.3% in the latest period. The administration of anti-VEGF therapy remained stable, accounting for approximately 90% of eyes. Notably, the proportion of eyes receiving anti-VEGF drugs as first-line treatment increased dramatically to approximately 80%. Anti-VEGF therapy has become the first-line treatment since the approval of anti-VEGF drugs for DME. These findings reflect the evolution of DME treatment and highlight the superiority of anti-VEGF therapy and its increased uptake over time.

Management of Terson Syndrome: Long-Term Experience in a Single Center.

Terson Syndrome (TS) is a rare entity consisting of an intraocular hemorrhage secondary to subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (IH). This study aimed to retrospectively describe the experience of the Ophthalmology Unit of Policlinico Gemelli, Rome, in the management of TS. Twenty-four eyes of 19 patients (10 males-53%; 9 females-47%; mean age of 44.73 ± 12.49 years) with TS who had pars plana vitrectomy between 2011 and 2024 were included. The primary outcome was the mean change in best-corrected visual acuity (BCVA) 1-3 months after surgery. The secondary outcome was the correlation of post-operative BCVA with the timing of vitrectomy (early vs. late, ≤100 or >100 days). The time between diagnosis and surgery ranged from 33 to 284 days (median = 102 days, interquartile range IQR = 74-161). Baseline BCVA ranged from 6 to 50 ETDRS letters with a median of 17 letters (IQR = 15-25) and significantly increased after surgery, with a median value of 80 (IQR = 70-85). The BCVA percentage improvement had a median of 325% (IQR = 300-431%). No differences in post-operative BCVA were found between patients who underwent early or late vitrectomy. One vitrectomy was complicated by an endophthalmitis. Although no clear guidelines exist on managing TS, vitrectomy significantly improves BCVA, and a delay in surgical intervention does not necessarily worsen the functional outcome. However, an early vitrectomy could improve the stimuli perception, facilitating the rehabilitation process.

Artificial Intelligence-Enhanced OCT Biomarkers Analysis in Macula-off Rhegmatogenous Retinal Detachment Patients.

To identify optical coherence tomography (OCT) biomarkers for macula-off rhegmatogenous retinal detachment (RRD) with artificial intelligence (AI) and to correlate these biomarkers with functional outcomes. Patients with macula-off RRD treated with single vitrectomy and gas tamponade were included. OCT volumes, taken at 4 to 6 weeks and 1 year postoperative, were uploaded on an AI-derived platform (Discovery OCT Biomarker Detector; RetinAI AG, Bern, Switzerland), measuring different retinal layer thicknesses, including outer nuclear layer (ONL), photoreceptor and retinal pigmented epithelium (PR + RPE), intraretinal fluid (IRF), subretinal fluid, and biomarker probability detection, including hyperreflective foci (HF). A random forest model assessed the predictive factors for final best-corrected visual acuity (BCVA). Fifty-nine patients (42 male, 17 female) were enrolled. Baseline BCVA was 0.5 logarithmic minimum angle of resolution (logMAR) ± 0.1, significantly improving to 0.3 ± 0.1 logMAR at the final visit (P < 0.001). Average thickness analysis indicated a significant increase after the last follow-up visit for ONL (from 95.16 ± 5.47µm to 100.8 ± 5.27µm, P = 0.0007) and PR + RPE thicknesses (60.9 ± 2.6µm to 66.2 ± 1.8µm, P=0.0001). Average occurrence rate of HF was 0.12 ± 0.06 at initial visit and 0.08 ± 0.05 at last follow-up visit (P=0.0093). Random forest model revealed baseline BCVA as the most critical predictor for final BCVA, followed by ONL thickness, HF, and IRF presence at the initial visit. Increased ONL and PR-RPE thickness associate with better outcomes, while HF presence indicates poorer results, with initial BCVA remaining a primary visual predictor. The study underscores the role of novel biomarkers like HF in understanding visual function in macula-off RRD.

Optimization of individualized faricimab dosing for patients with diabetic macular edema: Protocol for the SWAN open-label, single-arm clinical trial.

In patients with diabetic macular edema (DME) from YOSEMITE/RHINE, dual angiopoietin-2/vascular endothelial growth factor-A (VEGF-A) inhibition with faricimab resulted in visual/anatomic improvements with extended dosing. The SWAN trial (jRCTs031230213) will assess the efficacy, durability, and safety of faricimab during the treatment maintenance phase in patients with DME using a treat-and-extend (T&E)-based regimen adapted to clinical practice and the characteristics of patients achieving extended dosing intervals. SWAN is a 2-year, open-label, single-arm, interventional, multicenter trial enrolling adults with center-involving DME. All patients will receive three initial faricimab 6.0 mg doses every 4 weeks (Q4W). From week 12 onwards, in patients without active DME, dosing intervals will be extended in 8-week increments up to Q24W. In contrast, patients with active DME (central subfield thickness [CST] >325 μm and intraretinal fluid [IRF] or subretinal fluid [SRF] resulting in vision loss/disease aggravation) will receive a dose within a day and the dosing interval will be shortened by 4 weeks to a minimum of Q8W relative to the previous dosing interval. Recruitment commenced in August 2023 across a planned 16 sites in Japan. The primary endpoint is change in best-corrected visual acuity (BCVA) from baseline at 1 year (averaged over weeks 52, 56, and 60). Key secondary endpoints include: change from baseline in BCVA, CST, and National Eye Institute Visual Function Questionnaire scores over time; proportion of patients with BCVA (decimal visual acuity) ≥0.5, ≥0.7, ≥1.0, or ≤0.1; proportion of patients with absence of DME, and IRF and/or SRF over time. Safety endpoints include incidence/severity of ocular/nonocular adverse events. The SWAN trial is expected to provide evidence to support individualized faricimab dosing regimens, with the potential to reduce the burden of frequent treatments on patients, caregivers, and healthcare systems.

Evaluation of Intraocular Pressure, Refraction, Anterior Chamber Depth, Macular Thickness, and Specular Microscopy Post-Neodymium-Doped Yttrium-Aluminum-Garnet Laser in Patients With Posterior Capsular Opacification.

Background Cataract is the leading cause of blindness globally, particularly in India. Despite advancements in surgical techniques, postoperative complications remain common, with posterior capsular opacification (PCO) being the most frequent issue. Although neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy is recommended for managing PCO, it is associated with various side effects. This study aimed to evaluate the effects of Nd:YAG laser capsulotomy on intraocular pressure (IOP), visual acuity, anterior chamber depth (ACD), macular thickness, and corneal endothelium in Indian patients. Methodology This prospective, hospital-based study was conducted in the ophthalmology department at a tertiary care center in western Maharashtra from September 2022 to June 2024. Approval from the Institutional Scientific and Ethics Committee was obtained before commencing the research. In the study, 72 eyes from 72 patients with PCO following uncomplicated cataract surgery who were undergoing Nd:YAG laser capsulotomy were included, whereas patients with corneal pathology, retinal pathology, complicated cataract surgery, or trauma were excluded. Patients with active uveitis, non-compliant patients, and those unwilling to undergo the procedure were also excluded. Written informed consent was obtained from each patient. Data were managed in Microsoft Excel, and statistical analysis was conducted using the SPSS 26.0 software. As the continuous variables exhibited skewed distribution, the Wilcoxon test was employed to assess categorical variables such as the significance of IOP and endothelial cell differences over time. A significance level of 5% was assumed, with a p-value below 0.05 considered significant. Results The mean age of patients who underwent Nd:YAG capsulotomy was 64 years, with a female predominance of 37 (51.4%). In the study, 37 (51.4%) patients had their left eye treated, while 35 (48.6%) had their right eye treated. Overall, 45 (62.5%) patients had a baseline best-corrected visual acuity (BCVA) of 6/24-6/12. At one hour post-procedure, 46 (63.9%) patients in Group II had a BCVA of 6/24-6/12, and by one week after treatment, 53 (73.6%) patients had a BCVA of >6/12-6/6. ACD was normal in all patients before and after the procedure. Two patients developed macular edema at one hour and one week after the procedure. The mean IOP at baseline, one hour, and one week were 13.5, 13.86, and 13.69 mmHg, respectively. A significant increase in IOP was observed at one hour post-procedure, along with a significant decrease in endothelial cell count compared to baseline, which also persisted at one week. Conclusions Patients undergoing Nd:YAG capsulotomy experienced an initial rise in IOP, followed by a subsequent decline. Improved visual acuity was noted in most patients at one hour and by one week. A significant decline in endothelial cell count was observed following the procedure, and macular edema was noted in two patients. Anterior chamber reaction was observed in nearly all patients, which decreased by one week. With no change in ACD following the procedure up to one week, ocular refraction was not significantly impacted in the short term. Therefore, further large-scale intervention studies are needed to evaluate the effects of Nd:YAG laser capsulotomy size and the energy used on refractive error and post-procedure complications, as well as to explore the long-term effects on IOP.

Predictive relevance of optical coherence tomography indices in conjunction with visual acuity and surgical outcomes of idiopathic macular hole

Idiopathic macular hole (IMH) is a condition that arises from a combination of interactions among several forces on the fovea, remarkably from vitreous traction in the anteroposterior and tangential directions. Recent studies have highlighted the significance of microincision vitrectomy surgery, and IMH surgery was performed with minimal invasiveness, and visual improvement was an expected outcome. This study aimed to observe the pre-operative optical coherence tomography (OCT) indices correlated with visual acuity in the closure of IMH after surgery. Primarily, the findings were associated with clinical characteristics, including OCT indices, change in best corrected visual acuity (BCVA), clinical factors associated with IMH closure, and prognostic factors for the visual outcomes. This retrospective study included pre- and post-operative BCVA and OCT indices of 110 eyes with IMH. Each OCT variable was subjected to stepwise regression analysis regarding therapeutic factors that predict the need for IMH closure. Our results revealed that the hole form factor (HFF, r = 0.196), macular hole index (MHI, r = 0.669), and tractional hole index (THI, r = 0.085) had a positive correlation with visual acuity. However, basal hole diameter (BHD, r = −0.696) and minimum hole diameter (MHD, r = −0.407) showed a negative correlation. Out of them, HFF, MHI, BHD, and MHD were observed to be statistically significant (p < 0.05). The mean follow-up time was 149 ± 63.22 (85–300) days. The mean baseline BCVA was 0.75 ± 0.44 logMAR (Logarithm of the Minimum Angle of Resolution) units, which was improved to 0.29 ± 0.27 logMAR units at the final follow-up. The surgical success closure rate was 100 % among subjects with IMH. In conclusion, OCT indices were significant indicators of visual success rates in IMH, and OCT measurement could be employed as a single key index in predicting the IMH closure rate. Also, our findings suggested that OCT indices could be utilized as a safe and effective predictor of visual and anatomical outcomes in the case of IMH.

Significance of binocular fusion in enhancing visual acuity during amblyopia treatment.

Currently, the exploration of amblyopia treatment methods is gradually shifting to the restoration of binocular visual perceptual function. Binocular fusion function, as an important component of binocular visual function, mainly reflects the patient's ability to integrate the signals received from both eyes. In this study, we investigated the relationship between binocular fusion function and improvement in visual acuity during amblyopia treatment. A retrospective analysis was conducted on a cohort of patients with amblyopia, aged 3-14 years old, who visited an outpatient clinic in Shenzhen Eye Hospital between May 2021 and January 2023. The investigation included 105 patients (210 eyes) with isometropic or anisometropic amblyopia. All participants underwent cycloplegic refraction examination and binocular fusion function measurement. All patients underwent standard amblyopia treatment, and those with the best-corrected visual acuity (BCVA) of 0.6 or higher in the amblyopic eye of both eyes received binocular fusion training using a computer platform. A statistically significant negative correlation (-0.263, P=0.007) was observed between the absolute difference in binocular BCVA and binocular fusion function at the start of treatment (baseline). Linear regression analysis revealed that the improvement in BCVA in the amblyopic eye exhibited correlations with several factors, including the baseline binocular BCVA difference, baseline BCVA of the amblyopic eye, improvement in binocular fusion function, and the number of fusion training sessions (regression coefficients: -0.463, -0.771, 0.007, and 0.063, respectively; all P<0.05). Two patterns of binocular fusion function development during treatment were identified using group-based trajectory modeling (GBTM): the slow growth pattern and the rapid growth pattern. The results of a multivariate logistic regression model indicated a statistically significant link between fusion training and the development pattern of binocular fusion function [odds ratio (OR): 5.219, 95% confidence interval (CI): 2.045-13.323]. Enhancing binocular fusion function may result in an improvement of BCVA in the amblyopic eye of patients with amblyopia. The frequency of binocular fusion training is crucial for rapid improvement in binocular fusion function.

Clinical characteristics and long-term treatment outcomes of polypoidal choroidal vasculopathy with classic type leakage

To investigate long-term treatment outcomes of polypoidal choroidal vasculopathy (PCV) with classic type leakage and to compare the outcomes with those of PCV without classic type leakage. This retrospective study included 153 patients diagnosed with PCV and treated with anti-vascular endothelial growth factor (VEGF). Patients showing classic type leakage on fluorescein angiography were included in the classic type leakage group (N = 40, 26.1%), and those without classic type leakage were included in the occult group (N = 113, 73.9%). The best-corrected visual acuity (BCVA) at baseline and 24 months, changes in BCVA, incidence of fibrosis, and lesion reactivation after initial loading injections were compared between the two groups. There was no significant difference in the baseline BCVA between the classic type leakage group (mean logarithm of minimal angle of resolution 0.67 ± 0.53[Snellen equivalents = 20/93]) and the occult group (0.55 ± 0.49[20/70])(P = 0.639). In addition, the BCVA at 24 months (0.44 ± 0.53[20/55] vs. 0.38 ± 0.41[20/47])(P = 1.000), changes in BCVA (0.22 ± 0.42 improvement[2.2 lines] vs. 0.16 ± 0.36 improvement[1.6 lines]) (P = 0.366), and lesion reactivation (P = 0.787) did not differ between the two groups. The incidence of fibrosis was higher in the classic type leakage group (37.5%) than in the occult group (14.2%) (P = 0.002). Although the incidence of fibrosis was higher in PCVs with classic type leakage, the overall treatments were not significantly different between PCVs with and without classic type leakage. In addition, substantial visual improvement was noted at 24 months, suggesting that PCVs with classic type leakage can be effectively treated with anti-VEGF therapy.

Subretinal fibrosis occurrence according to macular neovascularisation subtypes in neovascular age-related macular degeneration.

To assess subretinal fibrosis (SF) occurrence in neovascular age-related macular degeneration (nAMD), according to macular neovascularisation (MNV) subtypes. A Retrospective national multi centre cohort study included eyes with naive nAMD. Main outcome measures were, according to MNV subtypes, cumulative incidence for SF, risk factors, and best corrected visual acuity (BCVA) for 36 months. Four hundred and twenty eyes were included. Cumulative incidence of SF was 34.3% at 1 year, 39.0% at 2 years and 50.6% at 3 years. In multivariable analysis, Type 2 and mixed type 1 and 2 MNV were associated (p < 0.001) with a more frequent and rapid development of SF (respectively 85.5% and 81.0% at 1 year, then 95.8% and 93.1% at 3 years) than Types 1 and 3 (respectively 11.3% and 3.6% at 1 year, then 22.9% and 12.7% at 3 years). In Type 2 and mixed type 1 and 2 MNV combined, at baseline a worse BCVA (p = 0.02) and a higher maximal subretinal hyperreflective material (SHRM) thickness (p = 0.005) were associated with SF development at 3 years. In Type 1 MNV, the presence at baseline of intraretinal fluid (IRF) (p = 0.007) or SHRM (p < 0.001) and a higher percentage of visits with IRF (p < 0.001) or with SHRM (p < 0.001) were associated with SF occurrence. For Type 3 MNV, only a higher percentage of visits with SHRM (p = 0.001) was associated with SF. Including all MNV subtypes, eyes with a worse BCVA at baseline were associated with SF development (p < 0.001). Conversely, presence of SF at 3 years was associated with a worse baseline BCVA (p < 0.001). Occurrence of SF differs when considering apart MNV subtypes.

Predictive Factors for Functional and Anatomical Outcomes After Anti-VEGF Treatment for Macular Edema in Patients with Branch Retinal Vein Occlusion.

This study aimed to identify predictive factors for the improvement of best-corrected visual acuity (BCVA) and reduction of central macular thickness (CMT) after treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) in a real-world setting. This retrospective study included patients with ME secondary to BRVO who were treated with intravitreal injection of bevacizumab as the first-line therapy and were followed up for 12 months. Demographic and clinical data, in addition to baseline spectral domain optical coherence tomography (SD-OCT) features, were considered as possible biomarkers of final BCVA and CMT. We also collected the data concerning the need for additional treatment including sectorial laser photocoagulation, change to another anti-VEGF agent, or intravitreal corticosteroid injection. A total of 161 eyes were analyzed. BCVA significantly improved from baseline to 12-month follow-up (0.6 and 0.4 logMAR, respectively; P 0.01). CMT decreased significantly during the follow-up period (from 498.0 to 325.0 m; P 0.01). Final BCVA correlated positively with baseline BCVA (P 0.01, r = 0.57). Older age at diagnosis and baseline SD-OCT findings including CMT, disruption of the retinal inner layers, retinal pigment epithelium (RPE) damage, and impairment of the ellipsoid zone and external limiting membrane negatively affected final BCVA (P 0.01). Multiple regression analysis identified age and BCVA at baseline as the only independent predictors of final BCVA (P = 0.001 and P 0.01, respectively). No association was found between clinical data, SD-OCT parameters, and final CMT. Various clinical and SD-OCT parameters are prognostically relevant for visual improvement in ME secondary to BRVO. Age at diagnosis and baseline BCVA were found to be independent predictors of visual outcome.

Aflibercept Biosimilar MYL-1701P vs Reference Aflibercept in Diabetic Macular Edema

Biosimilars may be lower-cost alternatives to originator biologic products, potentially offering expanded access or reduced economic burden, but have not been evaluated with aflibercept in diabetic macular edema (DME). To compare efficacy and safety of MYL-1701P, an aflibercept biosimilar, with reference aflibercept (Eylea [Regeneron]) in DME. This was a double-masked, randomized clinical trial that included participants at 77 centers across the US, Europe, Japan, and India. Included in the analysis were individuals 18 years and older with type 1 or type 2 diabetes with central DME and best-corrected visual acuity (BCVA) letter score of 73 to 38 in the study eye using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Study data were analyzed from October to December 2021. Formulations of MYL-1701P (0.5-mg vial) or reference aflibercept every 4 weeks for 5 consecutive intravitreal injections, followed by every 8 weeks through week 52. The primary outcome was the adjusted difference in least squares mean (SE) change from baseline BCVA letter score at week 8 with an equivalence margin of -3 to +3 letters. Secondary outcomes included change in central subfield thickness (CST), BCVA, number of injections over 52 weeks, incidence of adverse events (AEs), and antidrug antibodies (ADAs). A total of 355 participants (mean [SD] age, 62.2 [9.2] years; 216 male [60.8%]) were randomized to MYL-1701P (179 participants [50.4%]) and aflibercept (176 participants [49.6%]). At week 8, mean (SE) change in BCVA was 6.60 (0.55) letters vs 6.56 (0.55) letters in the MYL-1701P vs aflibercept groups. The adjusted mean difference of 0.04 letters (90% CI, -1.16 to 1.24 letters) met the primary outcome. At week 8, mean (SE) change in CST was -112 (7) μm vs -124 (7) μm in the MYL-1701P vs aflibercept groups (adjusted mean difference, 12 μm; 90% CI, -3 to 26 μm). The incidence of treatment-emergent AEs in the MYL-1701P and aflibercept arms were ocular (30.9% [55 of 178] vs 29.5% [52 of 176]), serious ocular (0.6% [1 of 178] vs 1.1% [2 of 176]), nonocular (65.2% [116 of 178] vs 65.3% [115 of 176]), and serious nonocular (16.9% [30 of 178] vs 11.9% [21 of 176]). The mean (SD) total number of injections was 8.4 (2.1) vs 8.7 (1.8) in the MYL-1701P vs aflibercept groups. The incidence of treatment-induced or treatment-boosted ADAs was 2.8% (5 of 177) vs 5.7% (10 of 176) in the MYL-1701P vs aflibercept arms. MYL-1701P demonstrated clinical equivalence in regard to efficacy, with comparable safety and immunogenicity, to reference aflibercept. These findings support use of MLY-1701P as an alternative to reference aflibercept. ClinicalTrials.gov Identifier: NCT03610646.

Unified Approach to Treating Exogenous Endophthalmitis With Immediate Vitrectomy.

Purpose: To analyze the outcomes and complications of immediate (within 24 hours) small-gauge (23-gauge, 25-gauge) pars plana vitrectomy (PPV) for all causes of exogenous endophthalmitis. Methods: A retrospective case series was evaluated. Results: The study included 107 patients who had immediate PPV for exogenous endophthalmitis between 2016 and 2022. The primary outcome measures were the change from baseline best-corrected visual acuity (BCVA) to the final follow-up and the complications after PPV. Causes of exogenous endophthalmitis included intravitreal injections (62.6%), PPV (18.7%), cataract surgery (11.2%), glaucoma surgery (5.6%), and trauma (1.9%). The most common complications were retinal detachment (17.8%) and secondary glaucoma (9.3%). The mean logMAR BCVA improved significantly from the initial diagnosis to the final follow-up (2.26 vs 1.21) (P < .0001). Conclusions: In most cases, immediate small-gauge vitrectomy for exogenous endophthalmitis leads to an improvement in VA, regardless of the VA at presentation. Patients should be counseled about the potential risks associated with PPV surgery.

Clinical characteristics and outcomes of band keratopathy: a 10-year retrospective analysis

Background: Band keratopathy is a chronic, degenerative corneal disease resulting from gradual calcium deposition in the superficial cornea. Herein, we report the spectrum of causes, treatment outcomes, and recurrence rates of band keratopathy at a tertiary referral center throughout one decade. Methods: This retrospective study included patients with clinical diagnoses of band keratopathy who were treated with combined ethylenediaminetetraacetic acid (EDTA) and superficial keratectomy with or without amniotic membrane transplantation (AMT). Patient medical records were reviewed, and detailed demographic and ophthalmological data, such as baseline and last follow-up best-corrected distance visual acuity (BCDVA), ocular or medical comorbidities, type of intervention, postoperative follow-up duration, relevant complications, and recurrence were recorded. Results: A total of 32 eyes of 29 patients with 3 (10.3%) bilateral and 26 (89.7%) unilateral cases of treatment-requiring bank keratopathy were included. The mean (standard deviation [SD]) (range) age was 39.4 (22.4) (2–74) years, and most patients were female. The most common secondary cause was previous vitreoretinal surgery with silicone oil tamponade (15.6%); however, idiopathic cases were the most common (18.8%). Systemic comorbidities were present in 27.6% of patients, consisting of hypertension, diabetes mellitus, epilepsy, coronary artery disease, Behcet’s disease, and juvenile idiopathic arthritis; however, none of the patients had systemic diseases associated with hypercalcemia. Two of the 3 patients with bilateral involvement had chronic uveitis secondary to systemic rheumatological disease. The mean (SD) follow-up duration was 5.6 (4.0) years, and no serious postoperative complications occurred. The mean (SD) baseline and final BCDVA in logarithm of the minimum angle of resolution (logMAR) were 1.98 (1.0) and 1.7 (1.0), respectively (P &gt; 0.05). Combined EDTA chelation and superficial keratectomy with and without AMT were performed in 12.5% and 87.5% of eyes, respectively. Recurrence was observed in 37.5% of eyes within the mean (SD) (range) follow-up of 9.4 (9.1) (1–32) months. Seven of the 12 eyes with recurrence underwent re-EDTA chelation combined with superficial keratectomy and AMT; however, 5 patients managed conservatively. Conclusions: In this study, band keratopathy requiring intervention more commonly affected female individuals and was unilateral. Most cases were idiopathic. Systemic comorbidities were present in approximately one-third of cases. Managing band keratopathy using a combination of EDTA chelation and superficial keratectomy with or without AMT could be a potential treatment modality. Further large-scale studies are required to provide robust conclusions regarding the efficacy and safety of this management approach.

Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease.

To describe the multimodal imaging features, treatment, and outcomes of patients diagnosed with adult-onset Coats disease. This retrospective study included patients first diagnosed with Coats disease at ≥18 years of age between September 2017 and September 2021. Some patients received anti-vascular endothelial growth factor (VEGF) therapy (conbercept, 0.5 mg) as the initial treatment, which was combined with laser photocoagulation as needed. All the patients underwent best corrected visual acuity (BCVA) and intraocular pressure examinations, fundus color photography, spontaneous fluorescence tests, fundus fluorescein angiography, optical coherence tomography (OCT), OCT angiography, and other examinations. BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed. The study included 15 patients who were aged 24-72 (57.33±12.61)y at presentation. Systemic hypertension was the most common associated systemic condition, occurring in 13 (86.7%) patients. Baseline BCVA ranged from 2.0 to 5.0 (4.0±1.1), which showed improvement following treatment (4.2±1.0). Multimodal imaging revealed retinal telangiectasis in 13 patients (86.7%), patchy hemorrhage in 5 patients (33.3%), and stage 2B disease (Shield's staging criteria) in 11 patients (73.3%). OCT revealed that the baseline central macular thickness (CMT) ranged from 129 to 964 µm (473.0±230.1 µm), with 13 patients (86.7%) exhibiting a baseline CMT exceeding 250 µm. Furthermore, 8 patients (53.3%) presented with an epiretinal membrane at baseline or during follow-up. Hyper-reflective scars were observed on OCT in five patients (33.3%) with poor visual prognosis. Vision deteriorated in one patient who did not receive treatment. Final vision was stable in three patients who received laser treatment, whereas improvement was observed in one of two patients who received anti-VEGF therapy alone. In addition, 8 of 9 patients (88.9%) who received laser treatment and conbercept exhibited stable or improved BCVA. Multimodal imaging can help diagnose adult-onset Coats disease. Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema. The final visual outcome depends on macular involvement and the disease stage.

Comparison of surgical outcomes of macular telangiectasia type 2 associated macular hole with idiopathic macular hole: A tertiary center review.

To assess the longitudinal surgical outcomes of macular telangiectasia type 2 macular hole (MacTel-MH) and compare them with those of idiopathic MH. This retrospective, single-tertiary center study included patients who underwent MH surgery between January 2015 and September 2023. Patients with characteristic optical coherence tomography (OCT) findings of MacTel in both eyes or those who underwent fluorescence angiography were classified as having MacTel MH. Baseline and postoperative best-corrected visual acuity and OCT parameters were reviewed. Totally, 27 and 243 eyes with MacTel and idiopathic MH, respectively, were included. MH closure rate was better achieved in idiopathic than in MacTel MH group at 2 years postoperatively. Temporal recovery of ellipsoid zone and external limiting membrane was more prominent in MacTel than in idiopathic MH group. Statistically significant visual acuity improvement was seen between 3 months and 2 years postoperatively in MacTel MH group. To the best of our knowledge, this is the first study to analyze the surgical outcomes of MacTel MH in both anatomical and functional aspects and compare them with patients with idiopathic MH. Postoperative microglia change would have affected the restoration of outer retinal layer of patients; however, further studies are needed for clarification.

Comparison of One-Year Outcome of Intravitreal Aflibercept with or without Photodynamic Therapy for Polypoidal Choroidal Vasculopathy.

Background and Objectives: Our study compared the visual and anatomical outcomes of polypoidal choroidal vasculopathy (PCV) patients receiving intravitreal aflibercept (IVA) with or without photodynamic therapy (PDT) over 12 months. Materials and Methods: This retrospective study was performed for 60 eyes from 60 patients with treatment-naïve PCV. Thirty eyes were treated using IVA monotherapy (IVA group), and thirty eyes were treated using a combination of IVA with PDT (IVA/PDT group). The baseline characteristics, treatment outcomes, and retreatment rates were compared between the two groups over a one-year follow-up period. Results: The best-corrected visual acuity (BCVA) was found to have improved significantly in the IVA/PDT group at every 3-month visit. However, no significant BCVA improvement was observed in the IVA group. A significantly lower retreatment rate and higher dry macula rate were found in the IVA/PDT group than that in the IVA group. In the entire population of the study, a better baseline vision and younger age were associated with better final visual outcomes. Retreatment was associated with poor baseline BCVA and IVA monotherapy. Conclusions: The combination of IVA and PDT may offer superior visual improvement and a higher dry macula rate compared to IVA monotherapy in the treatment of PCV patients while requiring fewer retreatments over 12 months.