Central Macular Thickness Research Articles

Systemic counterregulatory response of angiopoietin-2 after intravitreal injections with faricimab for nAMD.

Recently, a systemic counterregulatory response of angiopoietin-2 after intravitreal application of the anti vascular endothelial growth factor (anti-VEGF) drug aflibercept in neovascular age-related macular degeneration (nAMD) has been described. The aim of the study was to find out wether faricimab, a combined anti-VEGF/angiopoietin-2 drug, had an effect on systemic cytokine levels. 20 women and 11 men (mean age 79.5 ± 7.3 years) were included into this cohort study. Plama levels of VEGF-A and angiopoietin-2 were determined before and after intravitreal application of faricimab (6mg/0.05ml/eye) using ELISA-technique. These results were correlated with central macular thickness (CMT). Responders were defined as having had CMT thinning ≥ 50μm. CMT decreased from 384.8 ± 108.8μm prior to intravitreal injection (IVI) to 286.1 ± 63μm one month after IVI (p < 0.0001). Angiopoietin-2 levels increased from 526.9 ± 129 pg/ml to 597.2 ± 174.8 pg/ml (p = 0.0087) one week after IVI and dropped to 547.4 ± 165 pg/ml (ns) four weeks after IVI. Responders revealed higher angiopoietin-2 (p = 0.0035) as well as higher VEGF-A (p = 0.0248) levels throughout the study period compared to non-responders. Initial CMT revealed to be the only independent factor influencing CMT 4 weeks after IVI in linear regression models with a positive correlation between initial thickness and effect size. The trending increase in systemic angiopoietin-2 levels, may be interpreted as an escape mechanism of the concomitant anti-VEGF component of therapy. Angiopoietin-2 levels could serve as a positive predictive factor of therapy response in the future. Further research regarding this effect as well as differences between responders and non-responders is mandatory. What is known Bispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD). For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels. What is new The knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels. The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect. The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.

Evaluation of the Efficacy and Safety of Preoperative Intravitreal Triamcinolone Acetonide Combined with Internal Limiting Membrane Peeling for the Treatment of Idiopathic Macular Epiretinal Membrane.

To assess the efficacy and safety of preoperative intravitreal triamcinolone acetonide (IVTA) combined with internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (IMEM). This was a retrospective study. Thirty-six phakic eyes of 35 patients were included in this study. IVTA was administered to 18 patients (18 eyes, Group IVTA) 7 days before vitrectomy, while the other 17 patients (18 eyes, Group no-IVTA) only underwent vitrectomy and ILM peeling. Patients were followed up for at least 6 months. Data on best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), inner retinal thickness (IRT), vascular parameters (measured by optical coherence tomography angiography, OCTA), mean macular sensitivity (MMS), 63% bivariate contour ellipse area (BCEA) and P1 (measured by macular integrity assessment, MAIA) were collected. There were significant differences in BCVA and IRT between the IVTA group and the no-IVTA group at 6 months after surgery (p = .000 and p = .010). The CMT and MMS of the two groups significantly changed from the preoperative values; however, there were no differences between the 2 groups during the entire study period (p = .242 and p = .849). The changes in vascular parameters, including foveal avascular zone (FAZ) area and vessel densities of superficial and deep capillary plexus (SCP VD and DCP VD), in the two groups were not statistically significant. There were no statistically significant differences in 63% BCEA and P1 either. Macular morphology and macular integrity improved after vitrectomy combined with ILM peeling surgery. Compared with the no-IVTA group, preoperative intravitreal triamcinolone acetonide can improve best corrected visual acuity and accelerate the absorption of intraretinal fluid in terms of a significant reduction in IRT.

Subthreshold Laser Titration Database in a Population with Central Serous Chorioretinopathy and Dome-Shaped Macula

Objectives: This study aimed to describe the laser titration needed to create a safe and effective subthreshold laser (STL) for use in patients with chronic central serous chorioretinopathy (CSCR) and dome-shaped macula (DSM) and to investigate the possible factors influencing titration. Methods: This was a prospective single-center study that recruited 92 eyes of 87 patients that presented with CSCR (84.8%) and DSM (15.2%) for a 577 nm STL treatment for persistent subretinal fluid. Age, sex, and the spherical equivalent (SE) were collected. Titration was performed by applying various impacts, beginning at 800 mW and increasing in 100 mW steps. The photocoagulation threshold (PT) was assessed as the minimum power at which faint whitening was observed in fundus retinography. Results: The mean age was 53.5 ± 10.3 years and 78.3% of patients were male. The mean SE was 0.3 ± 3.0 D (range −9.5–+11.0). The overall mean power to reach PT was 1102.7 ± 183.0 mW (range 800–1600). In the multivariate analysis, age and SE were associated with PT (p = 0.022 and 0.011, respectively). On the contrary, no association was observed between PT and sex (p = 0.924), macular disease (CSCR vs. DSM, p = 0.416), or central macular thickness (CMT) (p = 0.667). Conclusions: This study highlights the broad power range required for effective subthreshold laser (STL) titration and emphasizes the need for individualized treatment parameters to optimize outcomes. No significant differences in titration power were found regarding macular disease type, CMT, or sex. However, a mild correlation between PT, SE, and age was observed.

Assessment of choroidal vascularity index in juvenile idiopathic arthritis: implications for disease monitoring.

Juvenile Idiopathic Arthritis (JIA) can affect ocular structures, but choroidal involvement is not well understood. This study investigates the Choroidal Vascularity Index (CVI) in JIA patients compared to healthy controls and explores its relationship with disease activity. In this cross-sectional study, 35 JIA patients and 40 healthy controls underwent comprehensive ophthalmic examination and swept-source optical coherence tomography (SS-OCT). CVI, central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were measured. The Juvenile Arthritis Disease Activity Score (JADAS) was calculated for JIA patients. Statistical analysis included comparison between groups and correlation analysis. JIA patients showed significantly lower CVI compared to controls (68.3 ± 2.5% vs. 72 ± 4.6%, p < 0.001). No significant difference was found in SFCT. CVI demonstrated a moderate negative correlation with JADAS (r = -0.368, p < 0.05). However, receiver operating characteristic (ROC) analysis revealed poor diagnostic performance of CVI for detecting JIA (AUC = 0.25). The study reveals reduced choroidal vascularity in JIA patients and a correlation between CVI and disease activity. While CVI shows limited diagnostic utility, it may serve as a potential marker for monitoring inflammatory burden and treatment response in JIA. Further research is needed to establish its clinical utility fully.

The effect of guanfacine treatment on ocular parameters in pediatric and adolescents patients with attention-deficit/hyperactivity disorder

BackgroundThis study aimed to evaluate the effects of guanfacine on the anterior and posterior segments of the eye.MethodsThis prospective study included 32 children and adolescents with Attention-deficit/hyperactivity disorder (ADHD). The participants underwent a detailed ophthalmologic evaluation before and 6 months after the beginning of guanfacine treatment. The following data were recorded for each participant: refraction error, intraocular pressure (IOP), anterior chamber depth (ACD), central corneal thickness (CCT), corneal aberrations using corneal topography, retinal nerve fiber layer (RNFL) analysis of seven quadrants (central, nasal, naso-superior, naso-inferior, temporal, temporo-superior, temporo-inferior), central macular thickness (CMT), and choroidal thickness (CT). Assessments were made of these parameters obtained from images using an optical coherence tomography (OCT) instrument.ResultsA significant increase in total root mean square (RMS) (p = 0.029*), RMS low-order aberration (LOA) (p = 0.014*), Coma 0° (p < 0.001*), and Coma 90° (p = 0.037*) corneal aberrations was observed at the sixth month of guanfacine treatment in comparison with the baseline examination. Other ocular parameters demonstrated no significant change from the baseline examination findings at the sixth month of guanfacine treatment. (p > 0.05, for each).ConclusionOral guanfacine in the treatment of ADHD had no effect on ocular structures such as the retina, choroid, optic nerve, refraction, or corneal thickness, although it increased corneal aberrations. The results require support through further studies with extended follow-up and a larger patient group.

Assessment of clinical outcomes and prognostic factors following membrane peeling in idiopathic epiretinal membrane using EIFL staging system: an optical coherence tomography angiography analysis

BackgroundTo evaluate the associations between anatomical changes and visual outcomes after membrane peeling in eyes with different stages of idiopathic epiretinal membrane (iERM) using optical coherence tomography angiography (OCTA).MethodsAll iERM eyes were graded into four stages based on the presence of ectopic inner foveal layers (EIFL) and underwent 23-gauge vitrectomy combined with ERM and internal limiting membrane (ILM) peeling, while their fellow eyes were treated as the control group. OCTA was used to measure retinal thickness(RT), foveal avascular zone (FAZ)-related parameters and superficial and deep capillary plexus (SCP and DCP) layers using 6 × 6 mm scans before, 1 month and 3 months after surgery. In addition, best corrected visual acuity (BCVA), metamorphopsia and macular features were assessed.ResultsForty-six subjects were included in this study. In comparison to the preoperative data, visual acuity and metamorphopsia improvement was statistically significant in four stages(P < 0.05) and the higher stage (3 and 4) achieved more pronounced improvements (P = 0.002). For higher stage, RT reduced with an increase in stage(P < 0.001), superficial and deep foveal vessel density (SFVD and DFVD) and parafoveal vessel density (PRVD) in SCP declined remarkably, FAZ area was enlarged obviously, FAZ perimeter (PERIM), foveal vessel density (FD) and PRVD in DCP increased significantly after surgery (P < 0.05). Similar to high-stage patients, those with stage 2 iERMs demonstrated a decreasing trend in central macular thickness (CMT), paraRT (parafoveal thickness), SFVD, and DFVD(P < 0.05). Nevertheless, no notable alterations were observed in other indicators. Distinct from other groups, only CMT and FD increased slightly in stage 1 iERMs (P < 0.05). Post-LogMAR BCVA and LogMAR BCVA-d (pre-LogMAR BCVA –3-month post-LogMAR BCVA) were positively correlated with preoperative stages, CMT, pre-LogMAR BCVA, SFVD, and vascular tortuosity(P < 0.05). but negatively correlated with FAZ area and DFVD (P < 0.05). Preoperative and postoperative metamorphopsia had a certain positive correlation with preoperative CMT (P < 0.05).ConclusionsAccording to OCTA analysis, different EIFL stages of iERMs showed significantly functional and anatomic differences before and after membrane peeling. Low-stage patients have better post-op visual function, while high-stage patients benefit more from surgery. It also demonstrated EIFL staging system contribute doctors to manage iERMs.

Pathogenesis of Ectopic Inner Foveal Layers (EIFL) and Its Impact on Visual Recovery after Epiretinal Membrane Peeling.

To determine the pathoanatomical alteration of ectopic inner foveal layers (EIFL) and its relationship to visual recovery after epiretinal membrane (ERM) peeling surgery. Clinical charts and tracked spectral-domain optical coherence tomography images of patients diagnosed with stage 3 and 4 ERM were reviewed and analyzed preoperatively and at 3 and 6 months postoperatively. Central macular thickness (CMT) and EIFL thickness were measured at these time points. Wilcoxon signed-rank test was used for analysis and P < 0.05 was considered statistically significant. The study cohort consisted of 54 eyes of 54 patients, 27 of whom were female. The mean age was 69.2 years. The mean Snellen VA improved from 20/50 preoperatively to 20/35 at 3 months (P<0.001) and remained 20/35 at 6 months, significantly better than preoperative levels (P=0.002). The mean preoperative EIFL thickness was 169.15 µm and decreased to 95.70 µm at 3 months (P = 0.001) and 90.95 µm at 6 months (P = 0.02). Similarly, CMT reduced from 510.00 µm preoperatively to 444.56 µm at 3 months (P < 0.001) and 415.50 µm at 6 months (P < 0.001). Reduction in EIFL thickness was significantly correlated with improvement in log-MAR VA (P =0.02) 6 months after surgery. ERM peeling results in reduced EIFL thickness, restoration of the normal foveal pit structure, and a corresponding improvement in visual acuity. Reduction in EIFL thickness is correlated with visual improvement.

Real-World Efficacy and Safety of Escalation to Weekly Adalimumab for Chronic Non-Infectious Uveitis: A Multicenter Study Involving Pediatric and Adult Patients

ABSTRACT Purpose To evaluate the efficacy and safety of weekly adalimumab (ADA) treatment in non-infectious uveitis (NIU) patients, including both pediatric and adult populations, and identify factors influencing treatment efficacy. Methods A retrospective cohort study at two hospitals in Türkiye included 51 NIU patients (29 children, 22 adults) who escalated from bi-weekly to weekly ADA due to inadequate disease control. Data on six clinical parameters (anterior chamber reaction, vitreous haze, visual acuity, central macular thickness [CMT], prednisone use, uveitis flare-up frequency), adverse effects, and treatment-related factors were collected. Statistical analyses involved non-parametric tests and regression models. Results Weekly ADA led to clinical improvement in 88.2% of patients, with uveitis control achieved in 76.4% by the 6th month. Escalation to weekly dosing significantly improved all clinical parameters compared to the 6-month period before ADA initiation (p < 0.001). Patients on combined weekly ADA and DMARD therapy experienced fewer uveitis attacks (B = - 2.272, 95% CI = [−4.289, −0.254], p = 0.028). Starting ADA as first-line treatment reduced uveitis attacks (p = 0.002) and increased the likelihood of inactive uveitis (OR = 10.349, 95% CI = [1.379, 77.687], p = 0.023). Patients resistant to multiple biologics had worse preADA visual acuity (p = 0.011). Conclusion Weekly ADA is effective and safe for controlling NIU when bi-weekly dosing is insufficient. Combining ADA with DMARDs enhances outcomes and reduce uveitis attacks. Poor preADA visual acuity may suggest resistance to biologics. Prospective studies should validate these findings, explore anti-ADA antibody development, and assess how DMARD addition affects immunological parameters and treatment efficacy.

12-month outcomes after voretigene neparvovec gene therapy in paediatric patients with RPE65-mediated inherited retinal dystrophy

AimsTo report main outcomes and complications following voretigene neparvovec (Luxturna) treatment in paediatric patients.MethodsRecords of patients under the age of 17 treated by subretinal administration of voretigene neparvovec for confirmed...

A Pilot Study Investigating the Relationship Between Choroidal Thickness and Choroidal Vascular Index and Coronary Artery Ectasia

Objective: The objective of this study was to compare changes in choroidal thickness (ChT) and choroidal vascular index (CVI) between patients with coronary artery ectasia (CAE) and healthy individuals. Methods: This study included 34 patients with CAE and 40 age-matched healthy subjects with normal coronary arteries. Measurements of ChT and CVI were taken using spectral-domain optical coherence tomography, employing the binarization method for CVI calculation. Additional parameters, including central macula thickness (CMT), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCC) thickness, were also documented. Results: The results indicated no significant differences in either subfoveal ChT or in ChT at 1500 µm both nasal and temporal to the fovea. However, significant differences were noted in ChT at the 500 µm nasal and temporal areas. The CVI was found to be significantly lower in the CAE group compared to the healthy controls. Furthermore, this study noted a significant difference in GCC thickness between the two groups, while no significant differences were observed in CMT and RNFL measurements. Conclusions: The findings suggest that patients with CAE exhibit decreased ChT and CVI in comparison to healthy controls. This highlights the potential role of ChT and CVI as important markers of disease in coronary artery ectasia, offering valuable insights into systemic cardiovascular health.

1-Year real-world outcomes of faricimab in previously treated neovascular age-related macular degeneration.

Faricimab, a bispecific antibody targeting VEGF-A and angiopoietin-2, has shown promise in treating neovascular age-related macular degeneration (nAMD). This study evaluates 1-year outcomes of faricimab in treatment-experienced nAMD patients. This single-centre retrospective cohort study included patients previously treated for nAMD who switched to faricimab between November 2022 and March 2024. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and treatment intervals were assessed at baseline, 6, and 12 months. One hundred eighty-four patients (215 eyes) were included. Patients had received a median of 18 (interquartile range [IQR] 10-28.5) anti-VEGF injections per eye over an average of 5.02 ± 11.82 years before switch. An average of 8.63 ± 2.2 faricimab injections were administered per eye over an average follow-up of 12.19 ± 2.70 months. Median BCVA decreased from 70 ETDRS letters (IQR 55-76) at baseline to 62 (IQR 47-76) at 12 months (p = 0.0038). Median CMT improved from 259.5 μm (IQR 223-299.75) at baseline to 232 μm (202.0-272.5) at 12 months (p < 0.0001). At the last follow-up, 40.2% of eyes were dry on OCT. The median dosing interval doubled from 4 weeks (IQR 4-4) to 8 weeks (IQR 6-10) with faricimab (p < 0.0001). 47.4% and 16.3% of eyes achieved treatment intervals of ≥8-12 weeks and ≥12 weeks, respectively. Three events of uveitis were noted following the loading phase. This real-world study demonstrates that faricimab maintains vision and achieves significant anatomical improvements in treatment-experienced nAMD patients. The extended treatment intervals could significantly reduce the burden on patients and healthcare resources.

The clinical effects and mechanism of action of ranibizumab in treating myopic choroidal neovascularization

PurposeMyopic choroidal neovascularization (CNV) is a common reason for visual impairment. This study investigated the clinical effects of repeated intravitreal injections of ranibizumab among patients with CNV secondary to pathologic myopia.MethodsThis study involved a single-center, non-randomized clinical prospective cohort research design including 39 patients with myopic CNV and a control group of 10 patients with cataract. Plasma and aqueous humor samples were analyzed to compare cytokine concentrations between the two groups and assess changes after intravitreal ranibizumab injections. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were also monitored.ResultsBCVA values and CMT varied significantly after intravitreal ranibizumab injections. The study group had significantly higher plasma concentrations of vascular endothelial growth factor (VEGF)-A and significantly lower epidermal growth factor (EGF) and angiopoietin-2 concentrations than the control group. Likewise, in the aqueous humor, the study group had significantly higher concentrations of fibroblast growth factor and significantly lower concentrations of EGF and VEGF-A than the control group. The average VEGF-A content decreased significantly after 1 and 2 months relative to the baseline. Mean VEGF-D and endoglin contents at two months were significantly reduced compared to the baseline and at 1 month. The average EGF contents were significantly higher at 2 months than the baseline.ConclusionRanibizumab could increase the BCVA and lower the CMT and cytokines involved in angiogenesis. This study contributes to further understanding the pathogenesis of myopic CNV and promoting new drug research and development for patients with this condition.

What is the relationship between the choroidal vascularity ındex (CVI) and myopia?

To examine the detailed vascular and morphological characteristics of the choroidal tissue in subjects with myopia. A total of 111 subjects with myopia were included in the study. The study was conducted in three groups according to spherical equivalent(SE). Group 1 comprised subjects with low myopia (SE between 0.00 diopter (D) and - 3.00 D), Group 2 included those with moderate myopia (SE between - 3.25 D and - 6.00 D), and Group 3 consisted of subjects with high myopia (SE of - 6.25 D or worse). The following parameters were measured: axial length(AL), SE, central macular thickness (CMT), choroidal thickness(CT), total choroidal area(TCA), luminal area(LA), stromal area(SA), LA/SA ratio, and choroidal vascularity index(CVI). The binarization method was employed to calculate the TCA, LA, SA, LA/SA ratio, and CVI values. A comparison was conducted between the groups with respect to all parameters. In patients with high myopia, CT values (subfoveal, nasal, and temporal) were significantly thinner than moderate and low myopic patients (< 0.001). The low myopic group exhibited significantly elevated LA, SA, and TCA values in comparison to the moderate and high myopic groups. Conversely, the LA/SA ratio and CVI values were observed to be higher in patients with high myopia than in those with low or moderate myopia. A statistically significant negative correlation was identified between CVI and LA/SA values and SE(r = - 0.270, P = 0.004; r = - 0.291, P = 0.002, respectively). A statistically significant positive correlation was identified between CVI and LA/SA values and AL (r = 0.269, P = 0.004; r = 0.281, P = 0.003, respectively). In young adults, high myopia has been linked to significant choroidal thinning in the macular region. This reduction in choroidal thickness is largely attributed to a decrease in the stromal component of the choroid, rather than the luminal (vascular) component. 08/06/2022, 2022-49.

Efficacy of different routes of triamcinolone acetonide administration on macular edema: A systematic review and network meta-analysis.

There is different administration routes of triamcinolone acetonide (TA) administration for macular edema, but the efficacy ranking remains unclear. The purpose of this study is to assess the efficacy of different administration routes of TA employed in macular edema. PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials were systematically searched for published articles comparing macular edema in patients with triamcinolone acetonide in different administration. The sparse network was evaluated using a random-effects model and consistency model within the Bayesian framework, utilizing the multinma package in R. The evidence was assessed based on the Grading of Recommendations. Assessment, Development, and Evaluation (GRADE) criteria. A total of 1138 citations were identified by our search, of which 20 RCTs enrolled 892 eyes. The network showed that intravitreal triamcinolone acetonide (IVTA) was associated with a statistically significant better best corrected visual acuity (BCVA) at the 12th week compared to placebo (MD: - 0.15, 95% CI: - 0.30 to - 0.01, P < 0.05), which was moderate-quality evidence. IVTA and suprachoroidal triamcinolone acetonide (SCTA) were both associated with a statistically significant reduction in central macular thickness (CMT) at the 12th week, which was moderate evidence. The probabilities of rankings and SUCRA demonstrated that sub-Tenon's infusion of triamcinolone acetonide (STiTA) might be the worst. SCTA and IVTA were proven to be the best administration routes for improving BCVA and reducing CMT. In addition, STiTA was less advisable than other administration routes of triamcinolone acetonide according to the rankings and SUCRA.

Innovator ranibizumab ComparEd to Biosimilar ranibizumab in combination with Expansile gas in submaculaR HemorrhaGe: the ICEBERG study

PurposeTo compare the anatomical and visual outcomes in eyes with submacular hemorrhage (SMH) treated with a combination of ranibizumab (RBZ) either innovator or biosimilar (Razumab) and intravitreal perfluoropropane gas (C3F8).MethodsTreatment naïve neovascular age related macular degeneration (n-AMD) patients with SMH were retrospectively analyzed. Patients received either innovator or biosimilar RBZ (3 loading doses followed by pro re nata regimen) and single injection of intravitreal C3F8. Optical coherence tomography (OCT) was performed at baseline, 1, 3 and 6 months. Changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed at 6 months. P value ≤ 0.05 was considered statistically significant.ResultsA total of 67 eyes (35 and 32 eyes in innovator and biosimilar group respectively) were analyzed. BCVA improved from 1.15 ± 0.19 to 0.51 ± 0.23 logarithm of minimum angle of resolution (logMAR) in innovator RBZ group (p < 0.001) and from 1.17 ± 0.15 to 0.53 ± 0.20 logMAR in biosimilar RBZ group (p < 0.001). Similarly, mean CMT showed significant reduction in both groups at 6 months (innovator RBZ: 609.5 ± 50.1 μm to 254.3 ± 20.3 μm, p < 0.001; biosimilar RBZ: 602.3 ± 58.9 μm to 251.8 ± 22.3 μm, p < 0.001). Intergroup comparisons between innovator and biosimilar RBZ showed no differences in either BCVA or CMT at all time points (all p values > 0.05). Mean number of intravitreal injections was marginally higher in innovator group compared to biosimilar RBZ (4.37 ± 0.49 vs. 4.22 ± 0.42; p = 0.18).ConclusionBiosimilar RBZ may act as a viable alternative to innovator RBZ to treat SMH with comparable anatomical and visual outcomes at 6 months.

Combination therapy of intravitreal ranibizumab and sub-tenon triamcinolone for treatment of resistant diabetic macular edema: a clinical study in Egypt

BackgroundAmong those aged 20–74 in industrialized countries, diabetic retinopathy (DR) is the main cause of visual impairment. Diabetic macular edema (DME) is the leading cause of blindness in people with DR. DME that is resistant to therapy is now being treated with a number of different management strategies. This research was to examine the efficacy of sub-tenon steroid and anti- vascular endothelial growth factor (VEGF) injections as a combination therapy for the treatment of resistant DME, owing to the synergistic effect of this combination.MethodsThis is a two-arm, randomized, prospective clinical trial that included 100 eyes of patients with refractory DME divided into 2 equal groups: group 1 received posterior subtenon triamcinolone (STTA) and anti-VEGF injections (0.5 mg ranibizumab), and group 2 received anti-VEGF injections (0.5 mg ranibizumab) only, in the same session. The 2 groups were followed up for a period of 6 months.ResultsGroup 1 showed significant improvements in best corrected visual acuity (BCVA) (from 0.20 ± 0.11 to 0.32 ± 0.12, p = 0.04) and central macular thickness (CMT) (from 393.2 ± 35.29 to 260.2 ± 11.43 µm, p = 0.001), with fewer injections required compared to Group 2. Recurrence rates were significantly higher in Group 2 (42% vs. 12%, p = 0.026). After injections, there was a noticeable rise in intraocular pressure (IOP) (16.02 ± 1.56 Vs 16.26 ± 1.24 in both groups respectively). However, this elevation is usually just transitory lasting for short periods of time and is within the safe, insignificant rise ranges.ConclusionThe use of combined therapy with anti-VEGF treatment and STTA has been found to be an effective and safe approach to managing resistant DME. The lower number of injections needed help to reduce the economic burden, especially under constrained financial circumstances.

High dose aflibercept treatment in naive neovascular age-related macular degeneration.

To evaluate the efficacy and safety of intravitreal injections of 4mg (high dose) of aflibercept in treatment-naive patients with neovascular AMD(nAMD) with treat and extend(TREX) dosing regimens, and to determine the frequency of injections. In this interventional, retrospective study a total of 15 eyes of 14 patients (eight female and 9 male) with nAMD were included. All patients were examined and OCT imaging was performed at the time of initial presentation, on the day of each injection and at subsequent follow-up visits. Each eye received intravitreal injections of 4mg/0.1mL aflibercept at the dose of every 4weeks for three months (loading phase) after that 4mg high dose of aflibercept was applied as the TREX regime. The eyes with a minimum follow-up time of 12months are included. The mean age of the patients was 74.9 ± 7.3(61-85) years and the mean follow-up time was 20.33 ± 8.7(12-34) months. Total number of injections were 9.3 ± 3.0 (5-14) during the follow-up period. A statistically significant increase was found in terms of best-corrected visual acuity and central macular thickness between mean baseline values and at 1, 3, 6, 12months, and the final examination(p < 0.05 for each comparison). No complication was observed during follow-up. High-dose Aflibercept of 4mg/0.1mL application with the TREX regimen was found to be efficient and safe. High-dose may also help to reduce the frequency of injections and visits in the follow-up period in eyes with nAMD. Prospective studies with large series are warranted.

Hardy-Rand-Rittler colour vision testing in cone and cone-rod dystrophies: correlation with structural and functional outcome measures

PurposeTo determine how Hardy-Rand-Rittler (HRR) colour vision testing correlates with visual functional and structural assessments in Cone and Cone-Rod Dystrophy.MethodsThirty-four Cone and 69 Cone-Rod Dystrophy patients diagnosed by electroretinography (ERG) at the Save Sight Institute in Sydney were included in a retrospective analysis. Each patient’s HRR colour vision test scores were compared with markers of cone and rod system function including visual acuity (VA), ERG responses, changes on Spectral Domain Optical Coherence Tomography (OCT) and Fundus Autofluorescence.ResultsThe number of plates identified on HRR testing correlated with logMAR best-corrected distance VA; r(101) = −0.49, p < 0.0001. HRR scores correlated with markers of cone and macula function including OCT Ellipsoid Zone Gap Width, Central Macular and Outer Nuclear Layer Thickness, Full Field ERG 30 Hz flicker amplitudes, light adapted 3.0 b-wave amplitudes and Pattern ERG 15- and 30-degree p50 amplitudes.ConclusionHRR colour vision testing correlates with structural and functional measures in Cone and Cone-Rod Dystrophy. HRR colour vision testing provides a simple clinic-based option to monitor disease changes in Cone and Cone-Rod Dystrophy patients, especially when ERG testing is not available.

Genetic Characteristics of 63 Patients with Non-syndromic Retinitis Pigmentosa at a Single Korean Institution

Purpose: To investigate the genetic characteristics of patients with non-syndromic retinitis pigmentosa (RP) analyzed at a single institution.Methods: We conducted a retrospective analysis of 63 patients clinically diagnosed with non-syndromic RP who underwent genetic testing. The clinical features of patients exhibiting the most common mutations, &lt;i&gt;EYS&lt;/i&gt; and &lt;i&gt;USH2A&lt;/i&gt;, were further assessed through routine ophthalmic examinations.Results: Of the 63 patients, 22 (34.9%) exhibited significant mutations. Notably, &lt;i&gt;EYS&lt;/i&gt; and &lt;i&gt;USH2A&lt;/i&gt; mutations were each found in 5 patients (7.9%); &lt;i&gt;RP1&lt;/i&gt; mutations were found in 4 patients (6.3%). The average ages at diagnosis were 38.8 years for &lt;i&gt;EYS&lt;/i&gt; mutations and 41.8 years for &lt;i&gt;USH2A&lt;/i&gt; mutations. The average best-corrected visual acuities were logMAR 0.08 for &lt;i&gt;EYS&lt;/i&gt; mutations and logMAR 0.51 for &lt;i&gt;USH2A&lt;/i&gt; mutations. Both mutation types showed a decrease in the normal macular area in fundus photographs with increasing age. In &lt;i&gt;USH2A&lt;/i&gt; mutations, optical coherence tomography revealed a more pronounced reduction in central macular thickness and central foveal ellipsoid length compared with &lt;i&gt;EYS&lt;/i&gt; mutations. Visual field tests indicated a reduction within the central 10° in 40% of &lt;i&gt;EYS&lt;/i&gt; mutations and 60% of &lt;i&gt;USH2A&lt;/i&gt; mutations. Electroretinography showed non-detectable responses in 2 individuals with &lt;i&gt;EYS&lt;/i&gt; mutations and 4 individuals with &lt;i&gt;USH2A&lt;/i&gt; mutations (40% and 80%, respectively).Conclusions: &lt;i&gt;EYS&lt;/i&gt; and &lt;i&gt;USH2A&lt;/i&gt; mutations represented 45% of the genetically identified cases; affected patients typically were diagnosed in their 40s. &lt;i&gt;EYS&lt;/i&gt; mutations tended to preserve retinal function and central foveal structure better than &lt;i&gt;USH2A&lt;/i&gt; mutations.

Efficacy & safety of brolucizumab 6.0 mg versus 3.6 mg in diabetic macular edema

BackgroundManagement of Diabetic Macular edema (DME) requires repeated injections. Therefore newer Anti-VEGFs like Brolucizumab with longer durability have been introduced. We compared two different dosages of Brolucizumab, 6.0 mg and 3.6 mg, for their safety & efficacy in treatment of DME, in treatment naïve patients over 52 weeks.MethodA prospective, pilot randomised controlled, single centre, double blinded, two arm comparative study was conducted between Dec 2022 to Apr 2024. The study recruited 82 patients of DME who were randomised into two groups of 41 patients each, one group to be treated with Brolucizumab 6.0 mg in 50 μL and the other to receive 3.6 mg in 30 μL. All patients received the first dose of Brolucizumab at 0 week and were then followed up at every 4 weeks for detailed ophthalmic and OCT macula examination. Those who met the pre-defined re-treatment criteria were re-injected with Brolucizumab, the dose being fixed for each group throughout the study. All patient receiving an injection were further followed up on Day 1, Day 7 and Day 28 to look for any adverse reactions. The efficacy parameters included change in best corrected visusal acuity (BCVA), contrast and central macular thickness (CMT) on Optical Coherence Tomography. The average number of injections recd in each group were also calculated.ResultsThe change in BCVA from baseline in 6.0 mg group was 0.54 LogMAR units and 3.6 mg group was 0.59 LogMAR units, which was not statistically significant. The reduction in CMT from baseline in 6.0 mg group was 133.2 µm (μ) and 3.6 mg group was 110.6 μ, which was not statistically significant. The improvement in contrast from baseline in 6.0 mg group was 0.74 and 3.6 mg group was 0.95, with p value of 0.0002. The re-injection interval was 14.21 weeks in 6.0 mg group and 15.56 weeks for 3.6 mg subgroup. The total number of adverse events in both groups were similar at 70 in 6.0 mg group and 47 in 3.6 mg group with only one grade 4 adverse event occurring in each group.ConclusionThe results of present study show that the safety and efficacy of both doses of Brolucizumab, i.e. 6.0 mg and 3.6 mg, for treating diabetic macular edema is similar.Trial registration Study was registered with Clinical trials registry of India (CTRI ref no. CTRI/2023/06/054105), registered on 14 Nov 2022.