Central Macular Thickness Research Articles

ARTIFICIAL INTELLIGENCE-ENHANCED ANALYSIS OF RETINAL VASCULATURE IN AGE-RELATED MACULAR DEGENERATION.

To investigate associations between quantitative vascular measurements derived from intravenous fluorescein angiography (IVFA) and baseline characteristics on optical coherence tomography (OCT) in neovascular age-related macular degeneration (nAMD) patients. The authors prospectively recruited patients with active choroidal neovascularization secondary to AMD over 50 years old, presenting to a single center in Toronto, Canada from 2017 to 2023. Ultra-widefield IVFA images were processed using the artificial intelligence RETICAD FAassist system to extract quantitative information on blood flow, perfusion, and blood-retinal-barrier (BRB) permeability. Associations between IVFA parameters with functional and anatomical outcomes were examined using univariable and multivariable regression models. Eighty-one nAMD eyes and seven healthy control eyes were included. Compared with healthy controls, BRB permeability in the central and peripheral retina was significantly higher in nAMD patients (P < 0.001). On univariable analysis, BRB permeability measured centrally was significantly associated with central macular thickness (P = 0.035), whereas perfusion and blood flow measured centrally were significantly associated with macular volume (P = 0.043 and 0.037, respectively). On multivariable analysis, BRB permeability remained significantly associated with central macular thickness (P = 0.026). Central BRB permeability measured on IVFA was significantly associated with baseline central macular thickness in nAMD patients. Future work should longitudinally explore associations between IVFA parameters and clinical characteristics in diverse nAMD populations.

Evaluation of Long-term Posterior Segment Parameters in Children Who Had Recovered From Multisystem Inflammatory Syndrome.

To evaluate long-term posterior segment findings in children recovering from multisystemic inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2. Our study included 22 patients who were admitted to an intensive care unit with a diagnosis of MIS-C between November 2021 and March 2022, and 25 healthy controls. The study included pediatric patients who had an eye examination an average of 12.35 ± 2.18 months after recovery from MIS-C. Detailed eye examinations and measurements of all participants were obtained retrospectively from patient files. Posterior segment parameters were measured using swept-source optical coherence tomography (OCT) and OCT-angiography (OCT-A); these parameters included peripapillary retinal nerve fiber layer (pRNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SCT), macular vascular densities (VD), and foveal avascular zone (FAZ) area. Mean age was 9.7 ± 3.6 years in the MIS-C group and 10.6 ± 2.8 years in the healthy control group (P = 0.316). There were no statistically significant differences between the MIS-C group and the healthy control group in terms of pRNFL thickness, CMT, and SCT. However, in the MIS-C group, the macular superficial vascular plexus and deep vascular plexus showed significantly lower VD in the superior, inferior, nasal, and temporal quadrants compared to the healthy controls (P < 0.05 for all). A comparison of the superficial and deep FAZ area parameters of both groups showed no statistically significant difference (P > 0.05). We showed that patients who had recovered from MIS-C had retinal vascular damage at the long-term follow-up. Following up with these patients after recovery with OCT and OCT-A, which are noninvasive methods commonly used in the detailed evaluation of the posterior segment of the eye, could be beneficial for understanding the long-term effects of MIS-C on retinal microvasculature. [Ophthalmic Surg Lasers Imaging Retina 2024;55:518-526.].

Topical three-drug combination in the management of pseudophakic cystoid macular edema

The purpose was to report the outcome after usage of three topical eyedrops combination, consisting of one steroid, one carbonic anhydrase inhibitor (CAI), and one non-steroidal anti-inflammatory drug (NSAID) in the treatment of pseudophakic cystoid macula edema (PCME) or Irvine–Gass syndrome. Treatment response monitoring of two patients with PCME to the combination of three eyedrops in a fixed dose regimen done using Optical Coherence Tomography. In both cases, significant improvement was documented within 1 week of starting the treatment, with respect to both visual acuity as well as central macular thickness and intraretinal fluid or cystoid macula edema (CME) resolution. The combination of three topical drugs of difluprednate (steroid), dorzolamide (CAI), and nepafenac (NSAID) is highly effective in treating select cases of pseudophakic CME and negates the need for usage of intravitreal (IVT) or posterior sub-Tenon’s injection of drugs such as triamcinolone acetonide, i.e., IVT triamcinolone acetonide, or posterior subtenon thus avoiding its associated complications.

INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND POOR VISUAL ACUITY.

To investigate the significance of intravitreal anti-vascular endothelial growth factor treatment in patients with neovascular age-related macular degeneration and poor visual acuity. Retrospective study of patients with neovascular age-related macular degeneration with baseline best-corrected visual acuity of ≤20/200. Patients were divided into regular treatment and scarce treatment groups according to whether they underwent consecutive intravitreal anti-vascular endothelial growth factor treatments at intervals of ≤4 months or not. A total of 131 eyes were included: 87 and 44 eyes in the regular treatment and scarce treatment groups, respectively. The regular treatment group showed significantly improved preservation of lesion size at both Years 1 and 2, with significantly fewer incidences of new subretinal hemorrhage. Improvements in visual acuity, reduction in central subfield macular thickness, and maximal height of choroidal neovascularization were significantly favorable in the regular treatment group at Year 1, and central subfield macular thickness was significantly decreased at Year 2. Survival analysis revealed that the regular treatment group had significantly greater preservation of visual acuity and lesion size than that in the scarce treatment group. Maintaining intravitreal anti-vascular endothelial growth factor treatment for patients with neovascular age-related macular degeneration and poor vision showed significant advantages in visual acuity and lesion size stability and reduced the incidence of new subretinal hemorrhage, which suggests preservation of paracentral vision.

Targeting the Tie-2 Receptor With Faricimab in Central Serous Chorioretinopathy: A Case Series Motivated by a Genetic Finding

PurposeTo investigate the effects of faricimab, a bispecific antibody targeting VEGF and Ang-2 (thus increasing Tie-2 activity), in patients with CSC based on a recent genetic study that implicated Tie-2 signaling in CSC pathophysiology. DesignA retrospective interventional multicenter case series. MethodsWe included patients with chronic CSC (persistent or recurrent SRF for ≥6 months) who received at least one faricimab 6mg injection between January 1 2022 and April 1 2024. Study sites included Massachusetts Eye and Ear and University of California San Francisco. Patients with evidence of a choroidal neovascular membrane on color photos, optical coherence tomography (OCT) and/or fluorescein angiography were excluded. 16 eyes (15 patients) met the inclusion criteria. The median central macular thickness at each visit from 52 weeks before to 52 weeks after the first faricimab injection was calculated using automated Heidelberg Spectralis ETDRS subfield measurements. ResultsPrior to treatment with faricimab, CSC had been diagnosed a median of 4.1 years (range 0.9–8) earlier and SRF (and intraretinal fluid [IRF] in a subset) had been continuously present for a median of 30 weeks (range 9–257). Decreases in macular thickness were observed in 14/16 eyes after the first faricimab injection and in 14/16 eyes in the full follow-up period compared with prior, 10 of which experienced complete resolution of SRF following the start of the first series of injections at a median of 4 weeks (range 2—25). One eye worsened after the second injection. The median improvement in macular thickness was 40μm [range -3 to 89.5] (P=0.0007). Upon review of OCT images, reductions in macular thickness were consistent with reductions in SRF and/or IRF. Visual acuity improved by 2 lines or more in 6/16 eyes. ConclusionsIn a retrospective case series of patients with chronic CSC and longstanding SRF, we observed improvement in macular thickness after intravitreal faricimab. While the small number of patients and variable natural history of CSC preclude definitive conclusions, a randomized controlled trial seems warranted.

Overview of latent tuberculosis-related central serous chorioretinopathy: Review and case report

We present a case of multifocal central serous chorioretinopathy (CSCR) in a 40-year-old male who presented with gradual loss of vision in both of his eyes during the previous 3 months. The anterior segment examination was normal; the dilated fundus examination revealed severe retinal elevation in the macular area in both eyes. Optical coherence tomography confirmed the presence of subretinal fluid with a central macular thickness of 353 μm OD and 356 μm OS. On the basis of ocular findings, a diagnosis of multifocal CSCR was made. One month later, the patient complained of further vision loss. His erythrocyte sedimentation rate was elevated, and the Mantoux test (22 mm × 22 mm), the QuantiFERON TB gold (5 IU/ml), and the cytomegalovirus immunoglobulin G (2277.92 AU/ml) yielded positive results. A diagnosis of latent tuberculosis infection was made. After 2 months of starting antitubercular treatment, the patient’s visual acuity improved.

Comparison of two laser power levels in the subthreshold micropulse yellow laser treatment of acute central serous chorioretinopathy

AimsTo compare the efficacy of two power levels in the 577 nm sub-threshold micro pulse laser (SML) treatment of acute central serous chorioretinopathy (aCSC). MethodsA retrospective comparative study was conducted. A total of 65 patients (65 eyes) with aCSC were enrolled. Of which, 32 patients received low power treatment and 33 patients received high power treatment of 577 nm SML. Best-corrected visual acuity (BCVA), central macular thickness (CMT), fundus-monitored microperimetry and height of subfoveal choroidal thickness (SFCT) as well as subretinal fluid (SRF) were evaluated at baseline and 3 months. ResultsThe height of SFCT and retinal sensitivity in the low power treatment group was significantly better than that in the high power treatment group at 4 weeks (all p < 0.001). Mean BCVA improved from baseline to 3 months after treatments but with no significant difference between the two groups after 3 months (p > 0.05). In the low power group, the CMT decreased from 379.76 ± 139.23 μm at baseline to 176.56 ± 37.78 μm at 3 months, and in the high power group, the CMT decreased from 364.97 ± 143.08 at baseline to 191.77 ± 38.26 μm at 3 months. There was no significant difference at 3 months between the two groups (p > 0.05). Similar results were also found in term of SRF. ConclusionsTimely intervention with 577 nm SML with low power treatment can improve visual acuity, and included anatomic success without adverse events.

A gender-based analysis of retinal microvascular alterations in patients with diabetes mellitus using OCT angiography

PurposeTo assess the difference in microvascular changes between males and females with diabetes mellitus (DM) without diabetic retinopathy (NoDR) and with mild-to-moderate non-proliferative diabetic retinopathy (NPDR) using Optical Coherence Tomography Angiography (OCT-A). DesignRetrospective cross-sectional study. Methods267 DM patients, 133 females (49.81 %), 111 with NoDR (41.57 %) and 156 NPDR (58.43 %) were included. Foveal-centered 3 × 3 mm OCT-A images corresponding to the superficial (SCP), intermediate (ICP) and deep capillary plexus (DCP), and full retinal (RET) slab were used for analysis. For each slab, FAZ area, perimeter, and circularity index (CI) were determined, following manual delineation of the FAZ; perfusion (PD) and vessel density (VD), fractal dimension (FD), vessel length density (VLD), geometric perfusion deficits (GPD) were also computed. Flow voids (FV) were determined in the choriocapillaris plexus; and perfused capillary density (PCD) in the RET slab. ResultsFemales showed larger FAZ CI in SCP and greater FAZ area and perimeter than males in NPDR group. Males had higher central macular thickness than females in NPDR group. All density metrics at the level of ICP and DCP were affected in the NPDR group with no gender differences. Of note, the same significant findings were found in type 1 DM patients, and not in type 2 DM patients. ConclusionsOur OCT-A findings suggest significant microvascular changes in females with NPDR compared to males, but no such differences in patients without DR. Therefore, gender-related vascular alterations might be present in early stages of DR with potential role.

Association between time to treatment and outcome in branch retinal vein occlusion.

To investigate the association between the time from onset to initial treatment and changes in visual acuity or the number of treatments in patients with branch retinal vein occlusion (BVO). Retrospective. Thirty-nine eyes of 39 consecutive patients with untreated acute-phase BVO who visited the University of Tokyo Hospital and were followed up for at least one year were included. The patients were initially treated with anti-vascular endothelial growth factor (VEGF) therapy and additional pro re nata therapy within six months of onset. The patients were classified according to the time from disease onset to the first treatment (group A: 28days or less, group B: over 28days). The mean (SD) age was 73 ± 8years, and 19 patients were male. The mean (SD) time to the first treatment was 31.6 ± 17.9days. The mean (SD) logMAR visual acuity at first treatment was 0.37 ± 0.30. After 12months of treatment, the mean (SD) logMAR change was -0.15 ± 0.23, and the mean number (SD) of treatments was 3.1 ± 1.7. No significant association was observed between the timing of treatment initiation and changes in logMAR visual acuity. Patients in group A and central macular thickness at the initial visit were independently associated with the greater number of treatments at one year (p = 0.03 and p = 0.01, respectively). At one year, the time between onset and the start of anti-VEGF therapy for BVO was not associated with subsequent visual acuity changes. Meanwhile, it may have significant association with the number of treatments.

Development and validation of optical coherence tomography (OCT) and OCT angiography prediction model for short-term vitreous haemorrhage secondary to polypoidal choroidal vasculopathy

AimsTo construct and validate an optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) image model for predicting the occurrence of short-term vitreous haemorrhage (VH) in polypoidal choroidal vasculopathy...

Evaluation of the effect of ocular dominance on macular microcirculation via swept-source optical coherence tomography angiography

PurposeTo determine the existence of differences in the retinal microcirculation of dominant and non-dominant eyes, as well as of interocular differences in macular microcirculation, using swept-source optical coherence tomography angiography (OCTA). MethodsIn total, 122 eyes of 61 individuals were enrolled in this cross-sectional study. Measurements were taken using the swept-source optical coherence tomography Triton device (Topcon Corp, Tokyo, Japan) coupled with non-invasive OCTA technology. Macular perfusion parameters were assessed, including superficial vascular complex, vascular density of the deep vascular complex, vascular density of the choriocapillaris vascular complex, superficial foveal avascular zone and deep foveal avascular zone. Ocular dominance was determined among individuals with healthy eyes using the hole-in-the-card test. ResultsOcular dominance was found in 68.9 % of right eyes and 31.1 % of left eyes. The mean age of the subjects was 34.45 ± 16.48 years (range: 18–73 years). We found that 16 (30.76 %) males and 22 (31.42 %) females had left-eye dominance (p > 0.05). None of the OCTA parameters differed between the eyes based on dominance (p > 0.05). Central macular thickness and sub-foveal choroidal thickness did not show significant differences (p > 0.05). When comparing interocular parameters, a significant difference was observed only in the inferior sector of the superficial vascular complex (p = 0.04). ConclusionThere was no significant difference in OCTA parameters between dominant and non-dominant eyes. There was no predominant interocular difference in the measurements.

The efficacy of intravitreal anti-VEGF for radiation maculopathy: a systematic review and meta-analysis.

Anti-vascular endothelial growth factor (VEGF) therapy is the primary approach for managing radiation maculopathy. However, a noticeable gap exists in meta-analyses evaluating the efficacy of anti-VEGF therapy specifically in the context of radiation maculopathy. We conducted a review of comparative studies on anti-VEGF treatment up to October 2023. References were sourced from PubMed, EMBASE, and the Cochrane Library. The Cochrane Risk of Bias tool assessed the quality of randomized controlled trials (RCTs), while the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool evaluated non-RCTs. Thirteen articles originating from eleven trials involving 2,525 eyes of 2408 patients were included. Four trials with 2226 eyes examined the effect of preventive anti-VEGF. Four trials with 189 eyes assessed the effect of anti-VEGF for preexisting maculopathy, and three trials with 110 eyes compared different anti-VEGF treatment modalities. In the preventive anti-VEGF treatment meta-analysis over a 24-month follow-up, the anti-VEGF group exhibited significantly fewer cases of radiation maculopathy (OR: 0.40; 95% CI: 0.25, 0.66, P= .0003, I2 =45%). For the meta-analysis of anti-VEGF treatment for pre-existing radiation maculopathy over a 6-month follow-up, the anti-VEGF group showed improved visual acuity (SMD: -1.13, 95% CI: -1.69 to -0.56, P < .0000, I2 = 47%) and decreased central macular thickness (SMD: -0.59, 95% CI: -1.13 to -0.05, P = 0.03, I2 = 62%). Prophylactic anti-VEGF effectively prevents radiation maculopathy and is also beneficial in treating pre-existing radiation maculopathy. Intensive treatment initially provides early benefits, but the efficacy diminishes after transitioning to a treat-and-extend regimen.

Comparison of subconjunctival TRIamcinolone acetonide injection and intravitreal dexamethasone (OZurdex) injection for uveitic and postoperative macular oedema: the TRIOZ study

AimsTo compare effectiveness of subconjunctival triamcinolone acetonide injections and intravitreal injections of dexamethasone 700 µg implants in reducing central macular thickness (CMT) in uveitic and postoperative macular oedema (ME).MethodsWe conducted...

Two-year Outcomes of Intravitreal Aflibercept Injection for Neovascular Age-related Macular Degeneration with "Observe before Treat-and-Extend" Method.

To evaluate 2-year outcomes of intravitreal aflibercept injection for neovascular age-related macular degeneration (nAMD) treated with "observe before treat-and-extend (O-TAE)" strategy in the real-world setting. This retrospective study included treatment-naive nAMD patients treated with aflibercept using O-TAE regimen and followed up for more than 2 years. Patients were observed bimonthly to check recurrence after three monthly loading injections. In case of recurrence, treatment was resumed using the TAE regimen starting from the fourth injection. In case of nonrecurrence, observation was continued. Best-corrected visual acuity (BCVA), central macular thickness (CMT), number of injections, TAE intervals, and proportion of recurrence after dry-up following three loadings were analyzed. A total of 38 eyes of 34 patients were included. Follow-up period was 37.0 ± 11.0 months. BCVA by logarithm of minimal angle of resolution improved from 0.33 ± 0.29 at baseline to 0.24 ± 0.23 in the first year (p = 0.010) and 0.25 ± 0.22 in the second year (p = 0.054). CMT decreased significantly from 357.43 ± 74.53 μm at baseline to 269.62 ± 48.12 μm in the first year (p < 0.001) and 279.14 ± 54.64 μm in the second year (p < 0.001). Number of injections were 5.11 ± 1.69 in the first year and 3.84 ± 2.39 in the second year. The percentage of eyes with a TAE interval of ≥12 weeks was 37.0% in the first year and 34.4% in the second year. Of the 36 eyes that dried up after three loadings, 28 eyes (77.8%) recurred, and the average period of recurrence was 6.5 months. The remaining eight eyes (22.2%) had no recurrence during the mean follow-up period of 29.7 months. This study showed that the newly suggested O-TAE strategy can reduce the treatment burden significantly reducing the number of injections while improving BCVA and CMT in the first and second year.

Choroidal imaging biomarkers as predictors of conversion to exudative age-related macular degeneration.

Predicting the progression of intermediate AMD (iAMD) to neovascular AMD (nAMD) will help to identify high-risk patients and improve treatment outcomes. The present study assessed whether choroidal OCT biomarkers could predict conversion to nAMD. This retrospective study included patients with clinically stable iAMD who either converted to nAMD (C group) or did not convert (NC group) during one year of follow-up. OCT parameters included subfoveal choroidal thickness (SFCT), central macular thickness (CMT), Haller vascular thickness (HVT), inner choroidal thickness (ICT), and double-layer sign (DLS). Of 116 total eyes, there were 37 in the NC group and 79 in the C group. Baseline SFCT was significantly lower in the C group compared to the NC group (169.0 ± 63.2μm vs. 218.0 ± 97.8μm, p = 0.01). Baseline HVT and ICT were lower in the C group (105.2 ± 40.6μm vs. 121.0 ± 56.6μm, p = 0.17 and 61.9 ± 35.5μm vs. 77.5 ± 41.7μm, p = 0.09). HVT was decreased at all time points in the C group vs NC (p > 0.05). The ICT was reduced in the C group at each time point except at conversion time (p > 0.05). Of all eight eyes who presented DLS at baseline, 100% converted to nAMD (p < 0.001). Lower SFCT at baseline may signal conversion to nAMD within 12months.

Changes in Macular Pigment Optical Density after Intravitreal Faricimab in Neovascular Age-Related Macular Degeneration: A Pilot Study.

Background: This study aimed to evaluate the effects of faricimab intravitreal injections in patients with exudative age macular degeneration (nAMD) after the loading dose using spectral domain optical coherence tomography (SD-OCT) and macular pigment optical density (MPOD). Methods: In this observational prospective study, we enlisted a total of 12 consecutive eyes of 12 patients (six females, six males; mean age 70.47 ± 2.46 years) affected by nAMD who consecutively presented to the Eye Clinic of the University of Naples "Federico II" and Monaldi Hospital of Naples, from June 2023 to December 2023. All patients received four once-monthly intravitreal injections of faricimab (6 mg/0.05 mL) (loading phase). At baseline and 1 month after the fourth faricimab monthly injection, all patients underwent assessment of best correct visual acuity (BCVA) and ophthalmic examination, including slit-lamp biomicroscopy, intraocular pressure (IOP), fundus biomicroscopy, SD-OCT, and MPOD. Results: A total of 12 eyes of 12 patients (six women, six men; mean age 70.47 ± 2.46 years) were included in this study. A statistically significant raise in BCVA and MOPD parameters was shown between baseline and after the loading phase (p < 0.001). Conclusions: Intravitreal injections of faricimab led in the short term to a significant functional and MPOD improvement along with a decrease in central macular thickness (CMT) and thus appears to be an effective treatment option without relevant adverse effects. MOPD may be considered as a prognostic factor associated with a good visual prognosis after intravitreal injections treatment.

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.

Neuroretinal and microvascular retinal features in dementia with Lewy body assessed by optical coherence tomography angiography.

To explore retinal changes in patients with Dementia with Lewy Bodies (DLB) using Spectral Domain-Optical Coherence Tomography (SD-OCT) and Optical Coherence Tomography Angiography (OCTA), aiming to identify potential biomarkers for diagnosis and monitoring. A cross-sectional study analyzed 15 DLB patients and 18 matched controls. Participants underwent physical, neurological, neuropsychological, and ophthalmological evaluations, including SD-OCT and OCTA. Logistic regression, adjusted for age, sex, and inter-eye correlation, was employed to identify retinal alterations in patients affected by DLB. OCTA revealed that DLB is associated with reduced superficial and deep vessel densities (SVD and DVD) in the macula (p < 0.01), as well as decreased peripapillary vessel density (ppVD, p < 0.01). SD-OCT parameters showed correlations with DLB, including reduced central macular thickness (CMT, p < 0.001) and thinning of the ganglion cell layer-inner plexiform layer (GCL-IPL, p < 0.01). Logistic regression (R²=0.26) identified reduced ppVD as a significant predictor of DLB (p = 0.030). Impairments in retinal capillaries, especially lower ppVD, might mirror cerebral hypoperfusion in DLB, potentially due to reduced Vascular Endothelial Growth Factor (VEGF) levels and increased α-synuclein. Further investigations are warranted to confirm the causal relationship between these observations, disease severity, and progression, as well as their potential role as biomarkers for DLB.

Efficacy comparison of multipoint and single point scanning panretinal laser photocoagulation in non-proliferative diabetic retinopathy treatment.

Non-proliferative diabetic retinopathy (NPDR) poses a significant challenge in diabetes management due to its microvascular changes in the retina. Laser photocoagulation, a conventional therapy, aims to mitigate the risk of progressing to proliferative diabetic retinopathy (PDR). To compare the efficacy and safety of multi-spot vs single-spot scanning panretinal laser photocoagulation in NPDR patients. Forty-nine NPDR patients (86 eyes) treated between September 2020 and July 2022 were included. They were randomly allocated into single-spot (n = 23, 40 eyes) and multi-spot (n = 26, 46 eyes) groups. Treatment outcomes, including best-corrected visual acuity (BCVA), central macular thickness (CMT), and mean threshold sensitivity, were assessed at predetermined intervals over 12 months. Adverse reactions were also recorded. Energy levels did not significantly differ between groups (P > 0.05), but the multi-spot group exhibited lower energy density (P < 0.05). BCVA and CMT improvements were noted in the multi-spot group at one-month post-treatment (P < 0.05). Adverse reaction incidence was similar between groups (P > 0.05). While energy intensity and safety were comparable between modalities, multi-spot scanning demonstrated lower energy density and showed superior short-term improvements in BCVA and CMT for NPDR patients, with reduced laser-induced damage.

Clinical Outcomes of Double-dose Aflibercept Treatment for Refractory Wet Age-related Macular Degeneration

Purpose: To evaluate the clinical outcomes and prognostic factors of double-dose aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD).Methods: We reviewed the medical records of nAMD patients treated with a double dose of aflibercept (4 mg/0.1 mL) due to an inadequate response to standard 8-weekly intravitreal injections of 2 mg/0.05 mL aflibercept. The assessment at week 8 after treatment included changes in subretinal/intraretinal fluid (SRF/IRF) and best-corrected visual acuity, with patients showing absence or reduction in SRF/IRF classified as the response group. Baseline factors influencing clinical outcomes were analyzed, including central macular thickness (CMT), central choroidal thickness (CCT), size of choroidal neovascularization (CNV), CNV subtype, and maximum height of SRF and IRF.Results: The study included 95 eyes of 95 subjects, with 61 eyes (64.2%) categorized as the response group following double-dose treatment. Responders exhibited thicker CCT (290.4 μm vs. 194.0 μm, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), thinner CMT (251.2 μm vs 311.1 μm, &lt;i&gt;p&lt;/i&gt; = 0.018), smaller CNV area (2.718 mm&lt;sup&gt;2&lt;/sup&gt; vs. 3.964 mm&lt;sup&gt;2&lt;/sup&gt;, &lt;i&gt;p&lt;/i&gt; = 0.034), and a higher prevalence of type 1 CNV (85.2% vs. 58.8%, &lt;i&gt;p&lt;/i&gt; = 0.011) compared to the non-response group. Multivariate binary logistic regression analysis identified thicker CCT (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, r = 1.016), thinner CMT (&lt;i&gt;p&lt;/i&gt; = 0.014, r = 0.988), smaller CNV area (&lt;i&gt;p&lt;/i&gt; = 0.015, r = 0.662), and type 1 CNV (&lt;i&gt;p&lt;/i&gt; = 0.001, r = 0.061) as factors associated with better anatomical outcomes.Conclusions: Double-dose aflibercept was effective in 64% of patients with refractory nAMD, suggesting it may be considered for those with small CNV areas, thinner CMT, and thicker CCT.