Central Macular Thickness Research Articles

Comparing the Outcomes of Anti-VEGF Treatment for Choroidal Neovascular Membrane

This quasi-experimental study was conducted in the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, and Bangladesh Eye Hospital, Dhaka, Bangladesh, from March 2020 to August 2021, to compare the efficacy of Bevacizumab and Ranibizumab on patients with choroidal neovascular membrane (CNVM) due to age-related macular degeneration (AMD). A total of 34 eyes of 34 participants with CNVM in AMD divided into Group A, received monthly intravitreal ranibizumab (0.5 mg in 0.05 ml) and Group B, bevacizumab (1.25 mg in 0.05 ml) for 3 consecutive months. Before treatment, mean BCVA was found 37.9412±16.68259 in group A and 35.2941±12.68249 in group B. After treatment, the mean best-corrected visual acuity (BCVA) was found 53.5294±14.97547 in group A and 48.8235±13.75334 in group B. The differences were not statistically significant (p>0.05) between two groups. The improvement in BCVA was highly significant (p<0.0001) in both groups before and after giving intravitreal bevacizumab and ranibizumab. Before treatment, mean central macular thickness (OCT) was found in 344.8824±82.51582 μm in group A and 360.1765±82.22016 μm in group B. After treatment, OCT was found 255.18±71.852 μm in group A and 241.76±42.405 μm in group B. The differences were not statistically significant (p>0.05) between two groups. However, the improvement by decreasing macular thickness was highly significant (p<0.0001) in both groups before and after giving intravitreal bevacizumab and ranibizumab. Treatment with intravitreal bevacizumab or ranibizumab was associated with a similar improvement in mean visual acuity and decreasing central macular thickness by 4 months. CBMJ 2024 July: vol. 13 no. 02 P: 265-273

Association of serum lipid profile and other systemic risk factors with retinal hard exudates in diabetic retinopathy

PurposeDiabetic macular edema is one of the leading causes of vision loss across the world. Hard exudates at the macula can lead to structural abnormalities in the retina leading to irreversible vision loss. Systemic dyslipidemia and other modifiable risk factors when identified and treated early may help prevent substantial vision loss. The purpose of this study was to study the association between serum lipid levels and other systemic risk factors like hemoglobin, HbA1c, and serum creatinine with hard exudates and macular edema in patients with diabetic retinopathy.MethodsIt is a prospective cross-sectional study conducted in a tertiary health care center in South India. 96 patients having diabetic retinopathy with hard exudates were included. Modified Airlie house classification was used to grade the hard exudates. Blood investigations including serum lipid profile, hemoglobin, HbA1c, and serum creatinine were carried out. Central subfield macular thickness was measured using optical coherence tomography.Results96 patients of type II DM with diabetic retinopathy were divided into three groups of hard exudates. A statistically significant correlation was observed between the severity of hard exudates and total cholesterol (p = 0.00), triglycerides (p = 0.00), LDL (p = 0.00), and VLDL (p = 0.00). HbA1c levels showed a statistically significant correlation with the severity of hard exudates (p = 0.09), no significant correlation was noted between hard exudates and hemoglobin levels (p = 0.27) and with serum creatinine (p = 0.612). A statistically significant association between CSMT and hard exudates (p = 0.00) was noted.ConclusionIn our study, we concluded that the severity of hard exudates is significantly associated with increasing levels of serum total cholesterol, triglycerides, LDL, VLDL, and HbA1c levels in type II DM patients presenting with diabetic retinopathy. The increasing duration of diabetes is significantly associated with increasing severity of hard exudates. Central subfield macular thickness increases with increasing severity of hard exudates in diabetic retinopathy.

Artificial intelligence-based extraction of quantitative ultra-widefield fluorescein angiography parameters in retinal vein occlusion

ObjectiveTo examine the association between quantitative vascular parameters extracted from intravenous fluorescein angiography (IVFA) and baseline clinical characteristics of patients with retinal vein occlusion (RVO). MethodsOur prospective single-centre study in Toronto, Canada, recruited patients with a diagnosis of macular edema secondary to RVO presenting with a central macular thickness (CMT) ≥310 μm from 2017 to 2023. IVFA images were captured using an ultra-widefield scanning laser ophthalmoscope and processed using the artificial intelligence-based RETICAD system to extract quantitative measurements of blood flow, perfusion, and blood–retinal barrier (BRB) permeability. Univariable and multivariable regression models were used to investigate associations between quantitative IVFA parameters and baseline best-corrected visual acuity (BCVA), CMT, and macular volume. ResultsThe study included 41 eyes from 41 RVO patients. In the multivariable analysis, BRB permeability was significantly associated with both CMT (p < 0.001) and macular volume (p = 0.005). Subgroup analyses revealed that in central RVO patients, central BRB permeability remained significantly associated with CMT (p = 0.022) and macular volume (p = 0.010); however, there was no association with BCVA (p = 0.921). In branch RVO patients, central BRB permeability was significantly associated with BCVA (p = 0.006) and CMT (p = 0.009), but not with macular volume (p = 0.723). Additionally, both central and peripheral BRB permeability were significantly higher in patients with RVO compared to healthy controls (p < 0.001). ConclusionsOur investigation reveals novel associations between baseline clinical characteristics and quantitative IVFA parameters in RVO patients, which may serve as clinically relevant biomarkers. Future studies should explore these associations in diverse RVO patient populations with extended follow-up.

The Effect of Pan-Retinal Photocoagulation on Central Macular Thickness in a Sample of Iraqi Patients With Proliferative Diabetic Retinopathy.

To evaluate the effect of pan-retinal photocoagulation (PRP) on central macular thickness (CMT) in a sample of Iraqi patients with proliferative diabetic retinopathy (PDR). This prospective study was conducted at Ghazi Al-Hariri for Surgical Specialties Hospital, Baghdad, from March 2024 to May 2024. A total of 24 eyes from 18 treatment-naive PDR patients with no previous diabetic macular edema (DME) were enrolled. Each eye received PRP in two sessions, one week apart, using the Nidek GYC 500 laser system. CMT was measured at baseline and four weeks after the second PRP session using the Topcon DRI Triton Plus optical coherence tomography (OCT). Statistical analyses, including paired t-tests and Shapiro-Wilk tests for normality, were performed to evaluate changes in CMT. The mean CMT increased from 258.4 ± 30.7 microns at baseline to 269.9 ± 36.8 microns post PRP, with a mean increase of 11.5 ± 26.3 microns. This increase was statistically significant (p = 0.042). The Shapiro-Wilk test confirmed that the data were approximately normally distributed both before (W = 0.960, p = 0.445) and after (W = 0.931, p = 0.103) PRP treatment. PRP significantly increases CMT in PDR patients, although no additional treatment for macular edema was necessary. These findings align with previous studies, suggesting that PRP-induced macular thickening is a common outcome. Further research is recommended to explore long-term effects and potential mitigation strategies.

Correlation of glycosylated hemoglobin (HbA1c) with retinal nerve fiber layer (RNFL) thickness and central macular thickness (CMT) in the diabetic population in North India.

The current study was aimed to find correlation of glycosylated hemoglobin with retinal nerve fiber layer thickness (RNFLT) and central macular thickness (CMT) in the diabetic population in North India. This was a cross-sectional observational study of 300 diabetic patients divided equally in two groups with and without retinopathy, and 150 people were included as control. The study was conducted from October 2020 to August 2022. All patients underwent slitlamp fundoscopy with a +78 D lens, and spectral-domain (SD) optical coherence tomography was performed to measure the RNFLT and CMT, and the staging of retinopathy was done as per the ETDRS classification. Along with that, blood investigations were ordered, including fasting (FBS) and post-prandial (PPBS) blood sugar and glycosylated hemoglobin (HbA1c). Quantitative variables were compared using one-way analysis of variance, or Kruskal-Wallis test was applied for inter-group comparison, followed by a Student Newman Keuls Test. The mean age of the patients in the diabetic group with retinopathy was 52.62 ± 9.38 years. The overall male: female ratio was 3:2. The mean FBS in the diabetic group with retinopathy was 146.54 ± 45.40mg/dl; the PPBS and HbA1c in the same were 210.39 ± 63.71mg/dl and 7.85 ± 1.33%, respectively. RNFL thinning was found in all four quadrants in diabetics irrespective of the status of retinopathy (P-value = 0.000) with a significant weak negative (r<0.4) correlation of glycosylated hemoglobin values with RNFLT in the inferior (r value = -0.300, P-value = 0.000) and superior (r value = -0.236, P-value = 0.004) quadrants of right eyes and in inferior (r value = -0.176, p- value = 0.031), superior (r value = -0.222, P value = 0.006), and nasal quadrants (r value = -0.166, p- value = 0.043) of left eyes in diabetics with retinopathy. However, in diabetics without retinopathy, no correlation was found. On correlating HbA1c with CMT, a weak positive (r<0.3) association existed in both eyes in the diabetic group without retinopathy (r = 0.020 and 0.048 for OD and OS, respectively) and diabetics with retinopathy (r = 0.152 and 0.127 for OD and OS, respectively). However, the association was not found to be significant in either of the groups (P-value > 0.05). The study concluded that neurodegeneration occurs in diabetic retinopathy as evident with nerve fiber layer thinning, and it is negatively correlated with glycosylated hemoglobin (HbA1c).

Long-Term Impact of Diabetic Retinopathy on Response to Anti-VEGF Treatment in Neovascular AMD.

To explore the long-term effect of diabetic retinopathy on response to anti-vascular endothelial growth factor (VEGF) treatment in age-related macular degeneration-associated type 1 macular neovascularization (MNV) using optical coherence tomography angiography (OCTA). A total of 45 eyes with exudative neovascular age-related macular degeneration (nAMD) with type 1 MNV were included in the analysis. Among them, 24 eyes of 24 patients had no history of diabetes mellitus (DM) in their anamnesis and were assigned to the Not Diabetic group; 21 eyes of 21 patients had mild diabetic retinopathy and were included in the Diabetic group. We considered the following outcome measures: (1) best-corrected visual acuity changes; (2) central macular thickness; (3) MNV lesion area; and (4) MNV flow area. The OCTA acquisitions were performed at the following time points: (1) baseline visit, which corresponded to the day before the first injection; (2) post-loading phase (LP), which was scheduled at 1month after the last LP injection; and (3) 12-month follow-up visit. All morphofunctional parameters showed a significant improvement after the LP and at the 12-month follow-up visit. Specifically, both the Diabetic group and the Not Diabetic group displayed a significant reduction of MNV lesion areas at both the post-LP assessment (P = 0.026 and P = 0.016, respectively) and the 12-month follow-up (P = 0.039 and P = 0.025, respectively). Similarly, the MNV flow area was significantly decreased in both the Diabetic group and the Not Diabetic group at the post-LP assessment (P < 0.001 and P = 0.012, respectively) and at the 12-month follow-up (P = 0.01 and P = 0.035, respectively) compared to baseline. A smaller reduction in the MNV lesion area was observed in the Diabetic group at both the post-LP evaluation (P = 0.015) and the 12-month follow-up (P = 0.032). No other significant differences were found between the groups for the other parameters (P > 0.05). Our results indicated that the Diabetic group exhibited a smaller reduction in MNV lesion area after 12months of anti-VEGF treatment. This highlights the importance of considering diabetic retinopathy as a potential modifier of treatment outcomes in nAMD management, with DM serving as a crucial risk factor during anti-angiogenic treatment.

Ocular dominance and its association with retinal thickness profile - A cross-sectional study.

The retinal thickness profile is essential for detecting ocular diseases like glaucoma and other optic neuropathies. The retinal nerve fiber layer (RNFL) thickness is affected by age, ethnicity, axial length, optic disc area, and inter-eye differences. Ocular dominance has a strong functional correlation with cerebral cortical activity. However, its relationship with RNFL thickness profile is yet to be fully established. A cross-sectional study was conducted in 136 healthy adults to study the association between ocular dominance and RNFL parameters measured by Spectral domain optical coherence tomography (SD-OCT) and to study the association of ocular dominance with other parameters such as handedness, intraocular pressure, average axial length, average keratometry, and refractive error. Sighting ocular dominance was detected using the Miles test, and sensory ocular dominance was detected using the fogging test. Visual acuity and refraction assessment were done, and the patients underwent ocular biometry using the Lenstar 900 machine to measure the axial length and keratometry. The RNFL thickness was measured using the Cirrus HD optical coherence tomographer. One hundred and thirty-two (97.06%) individuals were right-handed, four (2.94%) were left-handed, 108 (79.41%) participants were right eye dominant, and 28 (20.59%) were left eye dominant. There was 100% agreement between sighting and sensory ocular dominance. The average RNFL thickness and other measured ocular parameters were comparable in the dominant and nondominant eyes. Regardless of dominance, the left eyes in the study cohort had a greater statistically significant difference in superior RNFL thickness (P < 0.05), which correlated with increased central macular thickness. Ocular dominance occurred mostly in the right eye. The RNFL thickness profile is not associated with ocular dominance in emmetropic and mild myopic individuals with normal best corrected visual acuity.

Clinical Outcomes of a New Monofocal Intraocular Lens in Patients Undergoing Phacovitrectomy for Idiopathic Epiretinal Membrane

Introduction: The purpose of this study was to evaluate the clinical outcomes and quality of life of newly generated monofocal intraocular lens (IOL) in patients diagnosed with idiopathic epiretinal membrane (IEM) following phacovitrectomy. Methods: In this prospective study, 42 patients with IEM and cataract underwent pars plana vitrectomy. They were divided into the ICB00 group (21 patients) and the ZCB00 group (21 patients). Data collected before and after the surgery were compared between the two groups, including uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), vision-related quality of life (VRQOL), intraocular pressure, contrast sensitivity (CS), and central macular thickness (CMT). Results: The preoperative characteristics of the two groups showed no significant differences. However, at the 6-month follow-up after surgery, there were significant improvements in UDVA (p < 0.001), UIVA (p < 0.001), VRQOL (p < 0.001), CS (p < 0.001), and CMT (p < 0.001) compared to baseline. Notably, the Eyhance ICB00 group showed a significantly higher UCIVA value at 6 months post-surgery when compared to the Tecnis ZCB00 group (p = 0.001), while other parameters did not show significant differences between the groups. Conclusion: The Eyhance IOL significantly improved both intermediate and distance visual acuity, with no notable difference in quality of life or CS compared to the Tecnis ZCB00 IOL after IEM removal. It appears to be a favorable choice for combined cataract and vitreoretinal surgery, offering enhanced vision for daily tasks and a promising alternative to traditional monofocal IOLs.

Three-month outcomes of treatment with faricimab or aflibercept for neovascular age-related macular degeneration: a propensity score matching study in a Japanese population.

This study aimed to compare the treatment outcomes of patients with neovascular age-related macular degeneration (nAMD) who initially received faricimab or aflibercept treatment using propensity score matching (PSM) to align patient backgrounds. Patients with treatment-naïve nAMD who received either faricimab or aflibercept for three consecutive monthly injections as the loading phase were enrolled in this study. In the 1:1 PSM, sex, age, best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), and AMD subtypes in the pre-treatment state were selected as covariates. We examined the BCVA, CMT, CCT, and remaining fluid at 1-, 2-, and 3-month after the first injection. After PSM, 43 eyes were included in the faricimab and aflibercept group each. Both groups showed significant improvements in BCVA, CMT, and CCT at 1-, 2-, and 3-month after the initial injection compared with baseline. Meanwhile, no significant differences were observed between the two groups at any time point regarding BCVA, CMT, and CCT. At 1-month, 18.6% of patients in the faricimab group and 41.9% in the aflibercept group demonstrated residual subretinal fluid or intraretinal fluid, with a significant difference between the groups (P = 0.03). The BCVA improved after three loading injections of both faricimab and aflibercept. Faricimab may provide a favorable early treatment response in reducing subretinal fluid in a Japanese cohort.

Elevated aqueous TNF-α levels are associated with more severe functional and anatomic findings in eyes with diabetic macular oedema.

Intravitreal ranibizumab for diabetic macular oedema (DMO) has been recently shown to modulate levels of aqueous cytokines. This study investigates the associations between changes in aqueous cytokine levels following intravitreal ranibizumab therapy and the corresponding anatomical and functional changes in the eye. Twenty-five patients comprising 30 eyes diagnosed with DMO were prospectively recruited. All eyes received three loading dose ranibizumab injections at baseline, week 4 and week 8, followed by pro re nata treatment based on best-corrected visual acuity (BCVA) and central macular thickness (CMT) up to week 48. Prior to ranibizumab administration, aqueous samples were collected from all eyes, and subsequent sampling was performed at week 8. Levels of 32 cytokines were assessed at baseline and at week 8. At baseline, higher aqueous TNF-α levels were associated with poorer BCVA (p = 0.033), greater macular volume (p = 0.017) and worse diabetic retinopathy (p = 0.047). Higher levels of IL-7 were associated with poorer BCVA and greater macular volume (MV). Following treatment with ranibizumab there was a significant correlation with reduction of aqueous TNF-α and improvements in BCVA and MV, both at 6 months (BCVA [r = -0.558, p = 0.001], MV [r = 0.410, p = 0.024]) and 12-months (BCVA [r = -0.413, p = 0.023], MV [r = 0.482, p = 0.008]). The change in VEGF concentration following ranibizumab treatment did not correlate with either BCVA or MV improvements (p > 0.05). Higher levels of aqueous TNF-α and IL-7 correlated with worse DMO, both anatomically and functionally. Reductions in levels of aqueous TNF-α, but not VEGF, post ranibizumab treatment were associated with improvement in BCVA and MV.

Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema.

Diabetic macular edema (DME), a chronic microvascular complication of diabetes, is a leading cause of visual impairment and blindness. Pars plana vitrectomy (PPV) can restore the normal macular structure and reduce macular edema, whereas internal limiting membrane (ILM) peeling is used to treat tractional macular diseases. Despite the advantages, there is limited research on the combined effects of PPV with ILM peeling. To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness (CMT), best-corrected visual acuity (BCVA), cystoid macular edema (CME) volume, and complications in patients with DME. Eighty-one patients (92 eyes) diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone (control group: 41 patients, 47 eyes) or PPV + ILM peeling (stripping group: 40 patients, 45 eyes); a single surgeon performed all surgeries. The two groups were compared preoperatively and 1 and 3 months postoperatively. Preoperatively, both groups had comparable values of CMT, BCVA, and CME volume (P > 0.05). After surgery (both 1 and 3 months), both groups showed significant reductions in CMT, BCVA, and CME volume compared to preoperative levels, with the stripping group showing more significant reductions compared to the control group (P < 0.05). Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time, and interaction effects for CMT, BCVA, and CME volume (P < 0.05). There were no significant differences in the incidence of complications between the groups (retinal detachment: control = 2, stripping = 1; endophthalmitis: Control = 4, stripping = 1; no cases of secondary glaucoma or macular holes; χ 2 = 0.296, P = 0.587). PPV with ILM peeling can significantly improve the visual acuity of patients with DME, reduce CMT, and improve CME with fewer complications.

Swept-source optical coherence tomography early findings in patients with carotid artery disease.

Ocular ischemic syndrome can be the first and only hint of life-threatening carotid artery disease. The early recognition of carotid stenosis-related retinal signs, as well as the comprehension of the pathophysiology behind retinal changes could become relevant for physicians to predict the risk of stroke. The aim of this study is to assess the carotid artery disease-induced early structural retinochoroidal changes by means of swept-source optical coherence tomography (SS-OCT). A prospective observational study was conducted in 72 eyes with carotid stenosis. According to the degree of stenosis, the participants were divided into a normal group (34 eyes), a mild-moderate stenosis group (22 eyes), a severe stenosis group (16 eyes). SS-OCT and OCTA were performed to scan macular fovea. Central macular thickness (CMT), subfoveal choroidal thickness (SCT) and foveal avascular zona (FAZ) area were the major measurements for our study. CMT was significantly thicker in group 3 when compared to group 2 and 1. SCT was significantly thinner in group 3 vs group 1, being thicker in group 2 when compared to group 1. No significant differences were obtained when comparing FAZ in the superficial and middle capillary plexus although it was significant when comparing the FAZ in the deep capillary plexus between group 1 and 3. internal carotid artery stenosis greater than 70% leads to a significant increase in CMT and a decrease in SCT prior the development of clinical findings of ocular ischemia syndrome.

Switching to Intravitreal Brolucizumab after Ranibizumab or Aflibercept Using Treat and Extend Regimen for Neovascular Age-Related Macular Degeneration in Japanese Patients: 1-Year Results and Factors Associated with Treatment Responsiveness.

Objective: To purpose of this study was to retrospectively evaluate the 1-year outcomes and factors associated with the treatment responsiveness of switching to intravitreal brolucizumab (IVBR) for neovascular age-related macular degeneration (nAMD) in Japanese patients refractory to ranibizumab or aflibercept using a treat and extend (TAE) regimen. Methods: A total of 48 eyes of 47 nAMD patients were switched to IVBR, and 36 eyes of 35 patients (27 males and 8 females) underwent 1-year treatment after the switch. Results: The rate of dry macula was significantly higher 12 months after the switch to IVBR (p < 0.001), with a significant decrease in the mean central macular thickness (CMT) and the mean central choroidal thickness (CCT) (p < 0.01 and p < 0.01, respectively). The injection interval was significantly extended from 7.0 ± 1.7 weeks to 10.3 ± 2.5 weeks 12 months after the switch (p < 0.001). In the multivariate analysis, a smaller number of prior anti-VEGF injections (p = 0.025; odds ratio: 0.947; 95% confidence interval: 0.903-0.994) and a pre-switching CCT of less than 250 µm (p = 0.023; odds ratio: 0.099; 95% confidence interval: 0.013-0.731) were associated with the good response group. Conclusions: These results suggest that IVBR may suppress disease activity and prolong the injection interval by switching for AMD patients with an insufficient response to treatment with ranibizumab and aflibercept.

Choroidal Vascularity Index and Subfoveal Choroidal Thickness in Rheumatoid Arthritis Assessed with Enhanced-Depth Imaging Optical Coherence Tomography

ABSTRACT Purpose To evaluate the effects of rheumatoid arthritis (RA) on choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT). Methods The study included 56 eyes of 56 rheumatoid arthritis patients and 65 eyes of 65 age- and sex-matched healthy normal participants. CVIs of all participants were measured by transferring enhanced depth imaging optical coherence tomography (EDI-OCT) images to the image J program that is software used for image binarization and compared between the 2 groups. SFCT, central macular thickness (CMT) and optic disc parameters of all participants were measured with spectral domain OCT and compared. Results The mean CVI values of the RA and control groups were 65.9 ± 1.52 and 68.56 ± 1.62, respectively, and were significantly lower in the RA group (p = 0.001). Mean SFCT values of the RA and control groups were 290.11 ± 15.18 and 332.88 ± 11.04, respectively, and SFCT was significantly lower in the RA group (p = 0.001). RA patients have thin SFCT and low CVI. There was no significant difference between the two groups in terms of CMT and optic disc parameters. Conclusion RA patients have lower CVI and thinner SFCT than healthy participants.

Impact of the Nationwide Avastin Ban at a Tertiary Eye Care Hospital in Pakistan.

To report the impact of a 10-week-long nationwide ban on intra-vitreal bevacizumab (IVB) injection (Avastin®) at a tertiary care hospital in Pakistan. This was a single-center, retrospective, cohort study. Patients scheduled for IVB injections from October 25, 2023to October 29, 2023who arrived in OPD between November 28, 2023and December 15, 2023for their assessment were included in this study. Among the identified 412 patients, only 103 met the inclusion criteria. The mean age was 59.35 ± 9.5 (mean ± SD). About 60.2% were male (n = 62). Diabetic macular edema (DME) was the most common indication (n = 71, 68.9%). The mean total duration of treatment delay was 81.67 ± 17.15 days. While the delay due to the Avastin® ban was 67.47 ± 4.8 days. Eyes that had not received any prior injections were 46 (44.7%) while others had received at least 1 (n = 43, 41.7%) or 2 injections (n = 14, 13.6%) before. Mean central macular thickness (CMT) before and after treatment delay was 362.7 ± 113.4 μm and 398.38 ± 124 μm (p < 0.05), respectively. Among 20 patients with vitreous hemorrhage (VH), 14 patients showed marked improvement (70%), 5 showed no change in severity (20%) and 1 (5%) had further worsening. CMT difference was strongly correlated with the total duration of treatment delay (p < 0.01) and with the number of injections (p < 0.01). The nationwide ban on Avastin® heightened the severity of disease in the patients highlighting the delicate balance between safety precautions and timely access to essential medical interventions.

Comparative analysis of macular characteristics in mCNV and contralateral eyes.

To illustrate the characteristics of perforating scleral vessels in macular regions between mCNV eyes and contralateral eyes in unilateral mCNV patients. This was a retrospective study that included patients with unilateral naive mCNV. The study aimed to identify and analyze the distribution of perforating scleral vessels (PSVs) in the macular region of mCNV eyes and contralateral eyes. The central macular choroidal thicknesses (mChT) were measured using optical coherence tomography angiography (OCTA). The grades of myopic atrophic maculopathy (MAM) and macular myopic diffuse chorioretinal atrophy (DCA) were evaluated within groups. The number of PSVs and mChT were compared between contralateral and mCNV eyes based on the grade of DCA. The ROC curves were utilized to explore the diagnostic indexes for mCNV. A total of 102 eyes from 51 patients with unilateral mCNV were included. There was no significance in the severity of MAM or the grade of DCA between mCNV eyes and contralateral eyes (p = 0.074, p = 0.054, respectively). The mean number of PSVs in mCNV eyes was fewer than the contralateral eyes [1.00 (1.00-2.00) vs. 2.00 (0.75-3.00), p = 0.030]. The mChT in mCNV eyes was thinner than the contralateral eyes [36.00 (25.00-53.75) μm vs. 46.00 (31.00-75.25) μm, p = 0.001]. The mean grade of DCA in mCNV eyes was higher than that in contralateral eyes [3.00 (3.00-3.00) vs. 3.00 (2.00-3.00), p = 0.004]. When DCA involved the macular region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00-2.00) vs. 2.00 (1.00-3.00), p = 0.042]. Similarly, when DCA involved the foveal region, there were more PSVs in contralateral eyes than in mCNV eyes [1.50 (1.00-2.00) vs. 3.00 (2.00-4.00), p = 0.004]. The grade of DCA and mChT were valuable factors for predicting mCNV eyes (AUC = 0.6566, p = 0.021; AUC = 0.6304, p = 0.029; respectively). When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV (AUC = 0.7430, p = 0.003). The mean amount of PSVs was significantly lower in the mCNV eyes compared to the contralateral eyes. When the extent of DCA exceeded the foveal region, the count of PSVs was a good diagnostic factor for predicting mCNV. Myopic eyes with a higher grade of DCA and a thinner mChT were more likely to develop mCNV.

Short-Term Comparison of Switching to Brolucizumab or Faricimab from Aflibercept in Neovascular AMD Patients.

Background and Objectives: In this study, our objective was to assess and compare the changes in visual and structural outcomes among patients with neovascular age-related macular degeneration (nAMD) who were switched from intravitreal aflibercept (IVA) to either intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injections in a clinical setting. Materials and Methods: This observational clinical study included 20 eyes of 20 patients switched to brolucizumab and 15 eyes of 14 patients switched to faricimab from aflibercept in eyes with nAMD. We measured the structural outcome (central macular thickness (CMT)) and the visual outcome (best-corrected visual acuity (BCVA); logMAR) as follows: just before the most recent IVA injection (B0), one month after the most recent IVA injection (B1), just before the first IVBr or IVF injection (A0), one month after (A1) and three months after (A3) the first IVBr or IVF injection. Results: BCVA showed significant improvement at A1 (0.25 ± 0.34) and at A3 (0.19 ± 0.24) compared to A0 (0.38 ± 0.35) in the IVBr group (p = 0.0156, p = 0.0166, respectively). CMT (μm) was significantly thinner at A1 (IVBr: 240.55 ± 51.82, IVF: 234.91 ± 47.29) and at A3 (IVBr: 243.21 ± 76.15, IVF: 250.50 ± 72.61) compared to at A0 (IVBr: 303.55 ± 79.18, IVF: 270.33 ± 77.62) in the IVBr group (A1: p = 0.0093, A3: p = 0.0026) and in the IVF group (A1: p = 0.0161, A3: p = 0.0093). There was no significant difference in BCVA and CMT improvement observed between two groups at any time point (p > 0.05 for all). Conclusions: Switching from aflibercept to either brolucizumab or faricimab has a significant anatomical effect in eyes with nAMD and both treatments appear to be effective short-term treatment options. There is a trend towards greater visual improvements and reductions in CMT with brolucizumab.

Sex Differences in Inflammation-Related Biomarkers Detected with OCT in Patients with Diabetic Macular Edema

PurposeTo investigate sex-based differences in inflammation-related biomarkers on Spectral-Domain Optical Coherence Tomography (SD-OCT). DesignCross-sectional study. ParticipantsPatients with diabetic macular edema (DME) between February 1, 2019, and March 31, 2023, without intravitreal anti–vascular endothelial growth factor (anti-VEGF) injection within the prior six months. MethodsWe reviewed each patient’s medical record for age, biological sex, race and ethnicity, most recent glycated hemoglobin level (HbA1c), visual acuity (VA), and central macular thickness (CMT). OCT biomarkers that have been found in literature to be associated with inflammation, including disorganization of retinal inner layers (DRIL), retinal hyperreflective foci (HRF), hyperreflective choroidal foci (HCF), subfoveal neuroretinal detachment (SND), and perturbation in retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, and inner nuclear layer (INL) thickness were evaluated by graders masked to the clinical characteristics of the patients. We performed multivariable regression analyses with the OCT biomarkers as the outcome variables and sex, age, HbA1c, and CMT as independent variables. Main Outcome MeasuresOCT inflammation-related biomarkers as listed above ResultsFemale patients were on average two years older than male patients (P = 0.041). There were no significant differences in race and ethnicity, HbA1c, VA, or CMT between male and female patients. After controlling for age, HbA1c, and CMT, we found male sex to be associated with more HRF (incidence rate ratio [IRR] = 1.19, 95% confidence interval [CI] = 1.10 – 1.29), more HCF (odds ratio = 2.01, 95% CI = 1.12 – 3.64), and thicker INL (7 μm thicker in males, 95% CI = 2 – 12). Sex was not a significant predictor for either DRIL or SND in the multivariable regression models. Patients with higher HbA1c were more likely to have more HRF (IRR = 1.02 per 1 point increase, 95% CI = 1.00 – 1.04) after controlling for other factors. ConclusionsMale sex was correlated with more inflammation-related biomarkers on OCT including more HRF, more HCF, and thicker INL, after accounting for age, glycemic control, and amount of DME. Further studies are needed to evaluate the potential implications of these sex-based differences for individualized treatment.

One-year Clinical Outcome of Topical Bromfenac in Central Serous Chorioretinopathy

Purpose: To evaluate the efficacy of topical bromfenac in treating central serous chorioretinopathy (CSC) over a 1-year period.Methods: A retrospective analysis was conducted on 57 patients (57 eyes) with CSC followed for &gt; 1 year. Patients were divided into two groups: those treated with bromfenac eye drops twice daily (29 eyes) and a control group (28 eyes). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were measured and compared between the two groups as was the proportion of chronic cases.Results: Significant improvements in CMT and SRF height were noted in both groups over the follow-up period. The bromfenac group demonstrated significantly lower CMT at 6, 9, and 12 months (p = 0.045, 0.042, and 0.023, respectively) and lower SRF height (p = 0.037, 0.048, and 0.046, respectively) compared to the control group. The proportion of chronic cases was significantly lower in the bromfenac group (17.2%) compared to the control group (42.9%, p = 0.035).Conclusions: Topical bromfenac reduced the rate of progression to chronic CSC and showed significant anatomical improvements after 6 months, suggesting its potential as an effective treatment option.

Retinal and choroidal thickness in fuchs uveitis syndrome: a contralateral eye study

BackgroundTo investigate the subfoveal retinal and choroidal thickness in patients with unilateral Fuchs Uveitis Syndrome (FUS).MethodsThis comparative contralateral study was performed in affected eyes with FUS versus fellow eyes. For each eye parameters such as subfoveal choroidal thickness (SCT), subfoveal choriocapillary thickness (SCCT), central macular thickness (CMT), and central macular volume (CMV) were measured; then the measured values of affected and fellow unaffected eye were compared.ResultsThirty-seven patients (74 eyes) including 19 females (51.4%) with a mean age of 36.9 ± 7.6 years were enrolled. The mean SCT was lower in the affected eyes (344.51 ± 91.67) than in the fellow (375.59 ± 87.33) with adjusting for duration of disease and axial lengths (P < 0.001). The mean SCCT, CMT, and CMV were higher in eyes with FUS than in fellow eyes (P < 0.05).ConclusionsThe result of our study demonstrated that affected eyes in patients with FUS tend to have thinner SCT and thicker SCCT and CMT compared to uninvolved fellow eyes.