Changes In Central Foveal Thickness Research Articles

Comparison of macular changes and visual outcomes between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery for high myopic cataract patients

BackgroundTo evaluate differences in log MAR best-corrected visual acuity (BCVA) improvement and postoperative central foveal thickness (CFT) and choroidal thickness (CT) changes between conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) for high-myopia cataracts.MethodsThis was a retrospective and observational study. One hundred and two eyes of 102 patients with high-myopia cataracts were examined. CPS was performed in 54 eyes, and FLACS was performed in 48 eyes. All eyes underwent logMAR BCVA, CFT and CT of three different sectors preoperatively and one week and six months postoperatively.ResultsThe logMAR BCVA improved significantly after surgery in both groups (both P < 0.001), but no difference was observed in BCVA improvement between the groups (P = 0.554). Moreover, no significant differences were reflected in the changes in CFT, nasal 1 mm CT or temporal 1 mm CT between the two groups, and only subfoveal choroidal thickness (SFCT) in the CPS group decreased significantly compared with that in the FLACS group at any postoperative time (P = 0.003 and 0.026). AL, preoperative logMAR BCVA, and CT of the three regions exhibited a notable correlation with postoperative BCVA (all P < 0.05) according to univariate logistic regression analysis. However, only the AL, preoperative logMAR BCVA and SFCT remained significant in the multivariate model. Postoperative logMAR BCVA revealed a positive correlation with AL and preoperative logMAR BCVA but a negative correlation with SFCT.ConclusionsFLACS was not superior to CPS in improving BCVA but had less impact on SFCT in the treatment of high-myopia cataracts. Eyes with a longer AL, worse preoperative logMAR BCVA and thinner SFCT had a high risk of worse postoperative BCVA.

Conversion to faricimab after prior anti-vascular endothelial growth factor therapy for persistent diabetic macular oedema

BackgroundTo assess the anatomical and functional outcomes in eyes with persistent diabetic macular oedema (pDME) on chronic anti-vascular endothelial growth factor therapy switched to intravitreal faricimab.MethodsPatients with pDME on chronic...

REDUCING TREATMENT BURDEN FOR AGE-RELATED MACULAR DEGENERATION PATIENTS: A SYSTEMATIC REVIEW OF RANIBIZUMAB PORT DELIVERY SYSTEM

Introduction and Objective: Ranibizumab port delivery system (PDS) is a newly developed method that provides a continuous, long-term supply of ranibizumab into the vitreous, reducing the burden of monthly intravitreal injection visits for neovascular age-related macular degeneration (nAMD) patients. This review aims to evaluate the efficacy and safety of ranibizumab PDS in nAMD. Methods: An extensive literature search was performed on 4 online databases: PubMed, Cochrane, ProQuest, and ScienceDirect. The inclusion criteria are human studies comparing ranibizumab port delivery system and intravitreal ranibizumab, English language, with full-text journal available. The main outcome measurements are best-corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study (ETDRS) letters, central foveal thickness (CFT), and adverse events. Result: Two randomized controlled trials (RCTs) with a total of 635 adults were evaluated. At week 96, ranibizumab PDS reported observed mean BCVA changes from baseline (-1.0; +4.2; ETDRS letters) compared to monthly intravitreal ranibizumab (-1.1; +6.1; ETDRS letters). However, there was an increase in mean CFT changes from baseline (+9.9; -15.3 vs ?1.3; -21.3, µm) and more severe adverse events frequency (22; 4 vs 4; 0) with ranibizumab PDS versus monthly intravitreal ranibizumab, respectively. Conclusion: Ranibizumab PDS showed comparable visual outcomes to intravitreal ranibizumab while demonstrating marginally inferior anatomical outcomes and higher incidence of severe adverse effects. Despite this, with fewer treatment visits required for up to 24 weeks, ranibizumab PDS can potentially reduce the treatment burden in nAMD patients with poor compliance. Further studies are needed to provide better patient eligibility guidelines and recommendations for adverse event management of ranibizumab PDS.

Reducing Treatment Burden for Age-Related Macular Degeneration Patients: A Systematic Review of Ranibizumab Port Delivery System

Introduction &amp; ObjectivesRanibizumab port delivery system (PDS) is a newly developed method that provides a continuous,long-term supply of ranibizumab into the vitreous, reducing the burden of monthly intravitrealinjection visits for neovascular age-related macular degeneration (nAMD) patients. This review aimsto evaluate the efficacy and safety of ranibizumab PDS in nAMD.&#x0D; MethodsAn extensive literature search was performed on 4 online databases: PubMed, Cochrane, ProQuest,and ScienceDirect. The inclusion criteria are human studies comparing ranibizumab port deliverysystem and intravitreal ranibizumab, English language, with full-text journal available. The mainoutcome measurements are best-corrected visual acuity (BCVA) in Early Treatment DiabeticRetinopathy Study (ETDRS) letters, central foveal thickness (CFT), and adverse events.&#x0D; ResultsTwo randomized controlled trials (RCTs) with a total of 638 adults were evaluated. At week 96,ranibizumab PDS reported observed mean BCVA changes from baseline (-1.0; +4.2; ETDRS letters)compared to monthly intravitreal ranibizumab (-1.1; +6.1; ETDRS letters). However, there was anincrease in mean CFT changes from baseline (+9.9; +22.3 vs ?1.3; ?35.8, ?m) and severe adverseevents frequency (22; 4 vs 4; 0) with ranibizumab PDS versus monthly intravitreal ranibizumab,respectively.&#x0D; ConclusionRanibizumab PDS showed comparable visual outcomes to intravitreal ranibizumab whiledemonstrating inferior anatomical outcomes and higher incidence of severe adverse effects. Despitethis, with fewer treatment visits required for up to 24 weeks, ranibizumab PDS can potentiallyreduce the treatment burden in nAMD patients with poor compliance. Further studies are needed toprovide better patient eligibility guidelines and recommendations for adverse event management ofranibizumab PDS.

Reducing Treatment Burden for Age-Related Macular Degeneration Patients: A Systematic Review of Ranibizumab Port Delivery System

Introduction &amp; ObjectivesRanibizumab port delivery system (PDS) is a newly developed method that provides a continuous,long-term supply of ranibizumab into the vitreous, reducing the burden of monthly intravitrealinjection visits for neovascular age-related macular degeneration (nAMD) patients. This review aimsto evaluate the efficacy and safety of ranibizumab PDS in nAMD.&#x0D; MethodsAn extensive literature search was performed on 4 online databases: PubMed, Cochrane, ProQuest,and ScienceDirect. The inclusion criteria are human studies comparing ranibizumab port deliverysystem and intravitreal ranibizumab, English language, with full-text journal available. The mainoutcome measurements are best-corrected visual acuity (BCVA) in Early Treatment DiabeticRetinopathy Study (ETDRS) letters, central foveal thickness (CFT), and adverse events.&#x0D; ResultsTwo randomized controlled trials (RCTs) with a total of 638 adults were evaluated. At week 96,ranibizumab PDS reported observed mean BCVA changes from baseline (-1.0; +4.2; ETDRS letters)compared to monthly intravitreal ranibizumab (-1.1; +6.1; ETDRS letters). However, there was anincrease in mean CFT changes from baseline (+9.9; +22.3 vs ?1.3; ?35.8, ?m) and severe adverseevents frequency (22; 4 vs 4; 0) with ranibizumab PDS versus monthly intravitreal ranibizumab,respectively.&#x0D; ConclusionRanibizumab PDS showed comparable visual outcomes to intravitreal ranibizumab whiledemonstrating inferior anatomical outcomes and higher incidence of severe adverse effects. Despitethis, with fewer treatment visits required for up to 24 weeks, ranibizumab PDS can potentiallyreduce the treatment burden in nAMD patients with poor compliance. Further studies are needed toprovide better patient eligibility guidelines and recommendations for adverse event management ofranibizumab PDS.

Clinical Outcomes of Faricimab in Patients with Previously Treated Neovascular Age-Related Macular Degeneration

PurposeTo assess the anatomic and functional outcomes in eyes with neovascular age-related macular degeneration (nAMD) previously treated with anti-vascular endothelial growth factor therapy in response to intravitreal faricimab. DesignRetrospective, interventional consecutive case series. Subjects, Participants, and/or ControlsPatients with previously treated nAMD who received at least 4 consecutive injections of faricimab were included. The study period was from March through November 2022. Methods, Intervention, or TestingClinical and imaging data were extracted from the electronic medical record. Central foveal thickness (CFT), maximum fibrovascular pigment epithelial detachment (fvPED) height, and Snellen VA were obtained. Generalized estimated equations were used to analyze the change in CFT, maximum fvPED height, and logMAR VA. Main Outcome MeasuresChange in CFT, maximum fvPED height, and Snellen VA prior to faricimab and after at least four faricimab intravitreal injections. ResultDuring the study period, 218 eyes of 191 patients met inclusion criteria. Mean (range) age was 79.9 years (70.6-89.2). The mean number of intravitreal anti-VEGF injections received prior to faricimab was 34.2 (6.4-62). The following results were found after ≥4 faricimab injections. Mean logarithm of minimum of angle of resolution (logMAR) VA prior to switching to faricimab was 0.58 (∼Snellen VA 20/76, range: 20/22 – 20/264) and was 0.55 (∼Snellen VA 20/71, range: range: 20/21-20/235, p = 0.195) after switching. Mean maximum fvPED height was 195.0 μm (50.2-339.8) prior to switching to faricimab and improved to 165.0μm (33.6 – 296.4, p<0.0001) after switching. Mean CFT was 354.8 μm (184.7- 524.9) prior to switching to faricimab and improved to 306.6 μm (range: 144.4-468.8, p<0.0001) after switching. The proportion of eyes with intraretinal fluid (IRF) was 36.7% (80/218 eyes) prior to switch, and decreased to 24.8% (54/218 eyes, p<0.0001) after switch. The proportion of eyes with subretinal fluid (SRF) was 53.2% (116/218 eyes) prior to switch and decreased to 26.6% (58/218 eyes, p<0.0001) after switch. ConclusionsIntravitreal faricimab may improve anatomic outcomes in patients with previously treated nAMD, while maintaining visual acuity in the short-term.

Optic nerve head perfusion changes in eyes with proliferative diabetic retinopathy treated with intravitreal ranibizumab or photocoagulation: a randomized controlled trial.

Proliferative diabetic retinopathy (PDR) is a serious sight-threatening disease, and half of the patients with high-risk PDR can develop legal blindness within 5 years, if left untreated. This study was aimed at comparing panretinal photocoagulation (PRP) and intravitreal ranibizumab injections in terms of radial peripapillary capillary (RPC) density on optical coherence tomography angiography (OCTA) in patients with treatment-naive PDR. This open-label, prospective, randomized clinical trial included 50 patients with treatment-naive PDR with optic disc neovascularization and randomized them into two groups: group 1, with patients undergoing two sessions of PRP 2 weeks apart, and group 2, with patients received three intravitreal ranibizumab injections (0.5 mg) 1 month apart for 3 consecutive months. Patients underwent a full ophthalmological examination, including best-corrected distance visual acuity (BCDVA) measurement in the logarithm of minimal angle of resolution (logMAR) notation and OCTA before intervention and monthly after the last laser session or the first intravitreal ranibizumab injection for 3 months of follow-up. Visual field (VF) was tested at the beginning and end of 3 months. Forty-two (84%) eyes completed the 3-month follow-up, including 22 eyes in the PRP group (88%) and 20 (80%) eyes in the ranibizumab group. The two groups were comparable in terms of demographic characteristics, diabetes duration, baseline BCDVA, glycated hemoglobin level, OCTA parameters, VF indices, and intraocular pressure (all P > 0.05). The RPC density change from baseline to the 3-month follow-up was significantly lower in the PRP group than in the ranibizumab group (mean difference in RPC density change: - 3.61%; 95% confidence interval: - 5.57% to - 1.60%; P = 0.001). The median (interquartile range) logMAR change from baseline to the 3-month follow-up (0.0 [0.2]) was significantly higher in the PRP group than in the ranibizumab group (- 0.15 [0.3]; P < 0.05). The median changes in central foveal thickness from baseline to the 3-month follow-up differed significantly between the two groups (P = 0.001). In eyes with PDR and neovascularization of the disc RPC density on OCTA increased in the ranibizumab group and decreased in the PRP group. Visual acuity gain was higher in the ranibizumab group than in the PRP group. Future multicenter trials addressing our limitations are required to verify the findings of this study.

Effect of peripheral laser photocoagulation retinopexy on macular morphology and optic nerve fiber layer thickness; a prospective case series

PurposeThe goal of the research was to determine the incidence of microstructural alterations in the macula and optic nerve head (ONH) occurred in eyes treated with peripheral laser photocoagulation retinopexy.MethodsPatients with retinal breaks, retinal holes, retinal dialysis, and lattice degenerations who required peripheral laser photocoagulation retinopexy were recruited in this prospective case series investigation. We performed preoperative and postoperative evaluations, including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) measurement, funduscopic examination, and macular and ONH optical coherence tomography (OCT).ResultsThirty-three eyes of the twenty-three patients enrolled in this study, 14 of which were female. The mean age of the sample was 45.12 ± 9.12 years. The mean refractive error was − 2.45 ± 1.12 Diopters (D). The most prevalent reason for peripheral laser photocoagulation retinopexy was retinal thinning with symptomatic lattice degeneration (90%), followed by retinal hole and break (7%) and retinal dialysis (3%). Between preoperative and postoperative (6-month) evaluation, there was no statistically significant difference in BCVA (P = 0.82), IOP (P = 0.54), central foveal thickness in macular OCT (P = 0.39), or global retinal nerve fiber layer (RNFL) thickness (P = 0.51). There was no association between changes in central foveal thickness and global RNFL thickness and total laser spot numbers (r = − 0.17 P = 0.21, r = 0.06 P = 0.60, respectively). None of patients developed cystoid macular edema (CME) or macular epiretinal membrane (ERM) .ConclusionWe found that OCT parameters were not significantly affected by laser retinopexy in patients with high-risk peripheral retinal lesions, also none of our patients had developed ERM, vitromacular traction or CME at 6 months follow up periods.

DEEP LEARNING-BASED PREDICTION OF OUTCOMES FOLLOWING NONCOMPLICATED EPIRETINAL MEMBRANE SURGERY.

We used deep learning to predict the final central foveal thickness (CFT), changes in CFT, final best corrected visual acuity, and best corrected visual acuity changes following noncomplicated idiopathic epiretinal membrane surgery. Data of patients who underwent noncomplicated epiretinal membrane surgery at Severance Hospital from January 1, 2010, to December 31, 2018, were reviewed. Patient age, sex, hypertension and diabetes statuses, and preoperative optical coherence tomography scans were noted. For image analysis and model development, a pre-trained VGG16 was adopted. The mean absolute error and coefficient of determination (R 2 ) were used to evaluate the model performances. The study involved 688 eyes of 657 patients. For final CFT, the mean absolute error was the lowest in the model that considered only clinical and demographic characteristics; the highest accuracy was achieved by the model that considered all clinical and surgical information. For CFT changes, models utilizing clinical and surgical information showed the best performance. However, our best model failed to predict the final best corrected visual acuity and best corrected visual acuity changes. A deep learning model predicted the final CFT and CFT changes in patients 1 year after epiretinal membrane surgery. Central foveal thickness prediction showed the best results when demographic factors, comorbid diseases, and surgical techniques were considered.

Impact of the COVID-19 pandemic on visual outcomes of diabetic macular edema patients at a tertiary care veterans affairs center.

PurposeThere are limited studies on factors that impacted retina clinic patient outcomes during the COVID-19 pandemic. We aimed to evaluate visual and anatomic outcomes in patients with diabetic macular edema (DME) requiring anti-VEGF injections at the veterans’ affairs tertiary care eye clinic in Houston, TX.MethodsPatient volume from April 2020 was compared to that of April 2019 to determine attendance changes. To evaluate outcomes, we reviewed patients with DME who had scheduled appointments during April 2020. We tracked changes in central foveal thickness (CFT) and Snellen visual acuity (VA) measurements. Patient outcomes were classified as poor (defined as worsening VA or CFT at follow-up) or good (no worsening of either at follow-up). Regression analysis identified characteristics associated with poor outcomes.ResultsTo prevent the spread of COVID-19, patients were called to reschedule clinic appointments. Attendance frequency decreased from 523 patients in April 2019 to 246 patients in April 2020. 134 patients met inclusion criteria (mean age of 64.7 ± 8.8 years). 19/134 of patients were seen on schedule, 89/134 had delayed appointments (average follow-up interval of 115.2 ± 50.0 days), and 26/134 were lost to follow-up. Patients with delayed appointments had higher odds of poor outcome at follow-up compared to patients seen on schedule (OR = 4.03, 95% CI: 1.14–16.92, p = 0.04). Patient’s baseline visual acuity, macular thickness, comorbidities, and diabetic retinopathy severity, and demographics did not affect visual outcome at follow-up.ConclusionsOn average, patients were rescheduled to a visit 2.4 months later than their usual visit. Over half these patients experienced worsening of vision or edema. This demonstrates that lapses in care result in worsening of DME. However, there is no clear association between baseline characteristics and risk of disease progression.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40200-022-01049-5.

Short-term and long-term results after intravitreal bevacizumab therapy for macular oedema in branch retinal vein occlusion.

Objectives: The aim of this study was to determine the possible correlation between the short- and long-term effects of intravitreal bevacizumab on macular oedema after branch retinal vein occlusion (BRVO).Material and methods: This prospective clinical study included fifteen eyes of patients with macular oedema after BRVO. Corrected distance visual acuity (CDVA), recorded in LogMAR units, central foveal thickness (CFT) and maximum foveal thickness (MFT) were evaluated at one month after first application and at least every 2 months for one year. PRN treatment protocol was used for all patients. Statistical calculation was performed with SPSS for Windows and Microsoft Excel.Results: Mean CFT decreased significantly (p<0,0001) from baseline 471,2 ± 151,7 μm to 285,9 ± 79,82 μm at 12 months. CDVA improved significantly (p<0,0001) from baseline 0,58 ± 0,34 to 0,1 ± 0,25 at the end of follow up period. Change from baseline in the CDVA after one month was significantly positively correlated with the change in CDVA after 12 months (r=0,76, p=0,001). Change in CFT after one month had a strong positive correlation (r=0,78, p=0,001) with change after 12 months. There was no statistically significant correlation between the number of injections and the changes in CDVA, CFT, MFT after a single injection.Conclusions: Single injection effects of bevacizumab may indicate long-term results on macular oedema after BRVO, but further and larger studies are necessary.Abbreviations: BRVO = Branch retinal vein occlusion, RVO = Retinal vein occlusion, CFT = Central foveal thickness, MFT = Maximum foveal thickness, VEGF = Vascular endothelial growth factor, MO = Macular oedema, CDVA = Corrected distance visual acuity, PRN = Pro-re-Nata, SD-OCT = Special-domain optical coherence tomography, FT = Foveal thickness, LogMAR = Logarithm of the Minimum Angle of Resolution, WHO = World Health Organization, RPE = Retinal pigment epithelium

Outcomes after switching eyes that were stable on aflibercept to ranibizumab versus continuing aflibercept in neovascular age-related macular degeneration.

To describe outcomes of neovascular age-related macular degeneration (nAMD) eyes that were stable on aflibercept but switched to ranibizumab compared to eyes maintained on aflibercept over the same period. In this retrospective cohort study, eyes switched from aflibercept to ranibizumab due to intraocular inflammation (IOI) concerns with aflibercept were identified. Data was gathered from 3 visits pre-switch, switch visit (Sw), and 3 visits post-switch (P1, P2, P3). Similar data was gathered on eyes eligible to switch but continued on aflibercept with the middle visit considered the "presumed switch." Outcome measures included visual acuity (VA) and central foveal thickness (CFT). A total of 142 eyes were analyzed with 71 in each of the switch and aflibercept groups. In the switch group, mean CFT increased from 165.7µm at Sw to 184.7µm at P1 (p = 0.009), 180.9µm at P2 (p = 0.007), and 183.3µm at P3 (p = 0.004). VA changed from logMAR 0.43 (20/54) at Sw to 0.49 (20/61) at P1 (p = 0.02), 0.54 (20/69) at P2 (p = 0.008), and 0.53 (20/68) at P3 (p = 0.04). In the aflibercept group, no significant change in CFT was found over the same period. VA changed from logMAR 0.56 (20/72) at the "presumed switch" to 0.58 (20/76) at P1 (p = 0.085), 0.62 (20/83) at P2 (p = 0.001), and 0.59 (20/77) at P3 (p = 0.14). nAMD eyes that were stable or improving on aflibercept but were switched to ranibizumab worsened, while those in a comparable group maintained on aflibercept remained fairly stable, suggesting a potential efficacy difference between the two drugs.

Treat-and-Extend vs. Pro Re Nata Regimen of Ranibizumab for Diabetic Macular Edema-A Two-Year Matched Comparative Study.

PurposeTo compare 2-year treatment outcomes of ranibizumab using treat-and-extend (T&E) or pro re nata (PRN) regimens for diabetic macular edema (DME) in clinical settings.MethodsWe retrospectively enrolled 34 patients (34 eyes) with DME treated with ranibizumab using the T&E regimen, and 34 patients (34 eyes) treated with ranibizumab using the PRN regimen and matched to cases in the treat-and-extend group by baseline best-corrected visual acuity (BCVA) and central foveal thickness (CFT). BCVA and CFT changes, number of injections and recurrence of macular edema over 2 years were compared between the groups.ResultsThe average BCVA gain in the T&E and PRN groups was 16.2 and 7.6 ETDRS letters at 2 years (p = 0.011), respectively. The mean CFT reduction was 145.5 ± 127.3 and 97.3 ± 152.5 μm in the T&E and PRN groups at 2 years (p = 0.035), respectively. The T&E group had a higher proportion of patients with BCVA gain ≥ 15 letters at months 18 (p = 0.015) and 24 (p = 0.029) than the PRN group. During the 2-year treatment periods, the T&E group received more injections than the PRN group (11.0 ± 3.2 vs. 6.2 ± 2.0; p < 0.001), while the PRN group had more recurrence of macular edema than the T&E group (71 vs. 41%; p = 0.015).ConclusionsAfter 2-year ranibizumab treatment for DME, better visual and anatomical improvement and less recurrence of macular edema were achieved in the T&E group, with more injections administered.

Effect of foveal herniation on surgical outcomes in patients with idiopathic epiretinal membrane.

This study aimed to compare the anatomical and visual outcomes of idiopathic epiretinal membrane peeling surgery, with and without foveal herniation. This retrospective, comparative, two-center study included age- and sex-matched patients exhibiting an idiopathic epiretinal membrane with and without foveal herniation (epiretinal membrane + foveal herniation group and epiretinal-membrane-only group, respectively). The baseline best-corrected visual acuity and central foveal thickness were compared within the groups through months 1, 3, 6, and 12 of follow-up postoperatively. Then, changes in these two parameters at all follow-up points were compared between the groups. We enrolled 16 patients per study group. The baseline best-corrected visual acuity and central foveal thickness were not significantly different between the two groups (p&gt;0.05). Compared with the baseline, both the best-corrected visual acuity and central foveal thickness improved significantly in both groups in all follow-ups (p&lt;0.05), except for the best-corrected visual acuity of the epiretinal-membrane-only group after month 1 (p&lt;0.05). The mean best-corrected visual acuity improvement after month 1 and the mean central foveal thickness reduction after months 1, 3, and 6 were significantly better in the foveal herniation + epiretinal membrane group than in the epiretinal-membrane-only group (p&lt;0.05). However, the best-corrected visual acuity and central foveal thickness changes were not significantly different between the groups at the final visit (p&gt;0.05). Although epiretinal membrane + foveal herniation demonstrated prompt anatomical and functional improvement, foveal herniation occurrence did not affect the final surgical outcomes in patients with idiopathic epiretinal membrane.

Impact of macular fluid features on outcomes of anti-vascular endothelial growth factor treatment for type 3 macular neovascularization

We evaluated the impact of macular fluid features on visual and anatomical outcomes in type 3 macular neovascularization (MNV) patients treated with anti-vascular endothelial growth factor (VEGF). We retrospectively enrolled 89 eyes with type 3 MNV with at least 12 months of follow-up. All patients were treatment-naïve and received a monthly loading injection of anti-VEGF for three months, followed by further injections as required. The association of baseline macular morphology, including intraretinal fluid (IRF) and subretinal fluid (SRF), with visual and anatomical outcomes was analyzed. At baseline, IRF was present in all enrolled patients (100%), and SRF was present in 43.8% (39/89) of them. After 12 months of treatment, no significant difference was found in terms of best-corrected visual acuity (BCVA) and changes in central foveal thickness between the eyes with (39) and without (50) SRF at baseline. In addition, the proportion of improved or worsened (gain or loss of more than three lines in the BCVA) visual acuity at 12 months was not significantly different among the groups. Incidence of macular atrophy during the treatment showed no difference between the groups, regardless of the presence of SRF. In conclusion, the macular fluid morphology, specifically SRF, in type 3 MNV showed no significant correlation with visual and anatomical outcomes during anti-VEGF treatment.

Fovea sparing versus complete internal limiting membrane peeling for myopic traction maculopathy: a meta-analysis.

Myopic traction maculopathy (MTM) is the leading cause of visual loss in high myopia. The purpose of this study was to compare the outcomes of pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane (ILM) peeling and complete ILM peeling for MTM. A comprehensive literature search was performed to find relevant studies. A meta-analysis was conducted by comparing the weighted mean differences (WMD) in the change of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) from baseline and calculating the odd ratios (OR) for rates of complete reattachment (CR) and postoperative macular hole (MH) formation. Ten studies were selected, including 417 eyes (172 eyes in the fovea-sparing ILM peeling group (FSIP) and 245 eyes in complete ILM peeling group (CIP)). There was no significant difference in terms of mean change in CFT from baseline and the rate of CR(WMD = 3.53, 95% CI, -25.56 to 32.63, P = 0.81, and OR = 1.41, 95% CI, 0.81 to 2.44, P = 0.22). FSIP was superior to CIP in terms of mean change of logMAR BCVA post operation (WMD = -0.09, 95% CI, -0.15 to -0.03, P = 0.003), and associated with a significantly lower frequency of postoperative MH formation (OR = 0.19, 95% CI, 0.07 to 0.50, P = 0.0008). FSIP resulted in similar anatomic outcomes compared to CIP, but resulted in better visual acuity and lower rates of postoperative MH development.

Result of intravitreal aflibercept injection for myopic choroidal neovascularization

BackgroundThe current study aimed to evaluate the efficacy of intravitreal aflibercept injections as the primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularization (CNV) by using optical coherence tomography (OCT). Optical coherence tomography angiography (OCTA) was further used for some patients to detect the changes of CNV after treatment.MethodsIn the present study, 21 treatment-naive eyes of 21 patients with subfoveal/juxtafoveal myopic CNV received primary intravitreal aflibercept injections and were under follow-up for a minimum duration of 12 months. Among the 21 patients, 12 underwent OCTA to evaluate the changes in central foveal thickness, selected CNV area, and flow area.ResultsThe mean best-corrected visual acuity (BCVA) pertaining to all the patients significantly improved from the baseline value of 0.7 to 0.3 logMAR after treatment for 12 months (P = 0.001). However, the improvements in the median BCVA after treatment for three and 12 months were not statistically significant in the younger group (< 50 years), compared to the older group (≥ 50 years). One aflibercept injection resolved the CNV in 47.6% (10/21) of the patients. The younger group displayed greater improvement in the median central foveal thickness, compared to the older group.OCTA revealed interlacing or disorganized pattern at the level of the outer retinal layer in 12 subjects with myopic CNV. After 3 months of treatment, both groups displayed a decrease in the size of the selected CNV area and flow area. The interlacing group displayed a trend towards better anatomical improvements.ConclusionIntravitreal aflibercept injection provides long-term improvement in visual acuity in patients with myopic CNV. Eyes with the interlacing pattern on OCTA displayed a greater decrease in size and flow after aflibercept injection.Trial registrationBefore data collection, written informed consent was obtained from each participant, whose identity information was protected by encryption and conversion to a non-identifiable format and removing data links. This study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (KSVGH21-CT1–17).

Comparison of Intravitreal Dexamethasone Implant and Ranibizumab in Vitrectomized Eyes with Diabetic Macular Edema.

Purpose This retrospective study aimed to compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) for pseudophakic vitrectomized eyes with diabetic macular edema (DME) in a single institution. Methods Pseudophakic vitrectomized eyes with treatment-naïve center-involved DME were enrolled, with one eye in each patient. They were divided into two groups: one group receiving IDI every 3 to 4 months and another group receiving IVR using 3 monthly plus treat-and-extend injections, all with monthly follow-up for 6 months. Switch of intravitreal drugs or deferred macular laser was not allowed. Primary outcome measures included change in central foveal thickness (CFT) in 1 mm by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA) at Month 6. Results Twenty-two eyes were included in the IDI group and 26 eyes in the IVR group. The baseline demographics, glycosylated hemoglobin level, intraocular pressure (IOP), BCVA, and CFT did not significantly differ (p > 0.05). Compared to baseline data, CFT decreased and BCVA improved significantly after either IDI or IVR at Month 6 (p < 0.05). Significantly better mean final BCVA (0.38 logMAR vs. 0.62 logMAR, p=0.04), more mean visual gain (−0.30 logMAR vs. −0.15 logMAR, p=0.02), lower mean final CFT (310.9 μm vs. 384.2 μm, p=0.04), and larger mean CFT decrease (−150.0 μm vs. −60.1 μm, p=0.03) were found in the IDI group compared to those in the IVR group. A smaller mean treatment number (2.6 vs. 5.6, p < 0.001) and higher rate of postinjection ocular hypertension requiring topical hypotensive agent therapy (27.3% vs. 0%, p=0.0002) were demonstrated in the IDI group than those in the IVR group. Conclusion We concluded that IDI and IVR can both effectively treat vitrectomized eyes with DME. Dexamethasone implants had significantly better visual/anatomical improvement, smaller treatment number, and higher rate of elevated IOP after injection than IVR in pseudophakic vitrectomized eyes with DME in a 6-month period.

Long-term outcome of intravitreal anti-vascular endothelial growth factor treatment for pachychoroid neovasculopathy

To compare the long-term effectiveness of intravitreal anti-vascular endothelial growth factor (VEGF) treatment for pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization (PCV/AT1), and typical neovascular age-related macular degeneration (nAMD). Forty-one eyes with PNV, 68 eyes with PCV/AT1, and 56 eyes with typical nAMD were retrospectively included for analysis. All patients were treatment-naïve and received a three-monthly loading injection of anti-VEGF, followed by further injections, as required. The visual and anatomical outcomes after treatment were evaluated up to 36 months from baseline. No significant intergroup difference was found in terms of best-corrected visual acuity (BCVA) and changes in central foveal thickness at 12, 24, and 36 months after the baseline. In addition, no significant difference was found between the groups regarding the proportions of improved or worsened (increased or decreased more than 3-lines) visual acuity. However, the PNV group participants received significantly fewer anti-VEGF injections (11.7 ± 6.9) than those in the PCV/AT1 (12.4 ± 7.0; P = 0.031) and typical nAMD groups (13.2 ± 7.4; P = 0.016). The incidence of macular atrophy (MA) development was also significantly lower for the PNV (4/41 eyes, 9.8%) than the typical nAMD (15/56 eyes, 26.8%; P = 0.033) eyes. There was no significant difference between PNV, PCV/AT1, and typical nAMD regarding visual acuity improvement after anti-VEGF treatment over 36 months. However, the number of injections for PNV was significantly lower compared to that for PCV/AT1 and typical nAMD, and the incidence of MA development was significantly lower than in typical nAMD.

Clinical study: Evaluation of the effect of topical nepafenac on central foveal thickness and visual acuity post panretinal photocoagulation in diabetic retinopathy

Objectives: To study the effect of topical nepafenac in patients with diabetic retinopathy following PRP in terms of Central foveal thickness (CFT) and Best corrected visual acuity(BCVA). Materials and Methods: This is a hospital based randomized control study conducted in Minto ophthalmic hospital, Regional institute of ophthalmology and Bowring and Lady Curzon hospital, from November 2018 to May 2020. Patients with proliferative diabetic retinopathy (PDR) without macular edema were subjected to PRP after detailed clinical evaluation and were divided into test and control groups. All the patients in two groups were matched based on: age, gender, type of diabetes, HBA1C levels and duration of type II diabetes. All patients underwent three sittings of PRP with a gap of one week interval between the sittings. Nepafenac eye (Nevanac, Alcon Laboratories Inc, Texas, USA) drops were used three time a day for a month followed by two time a day for three months in the test group and moxifloxacin eye drops (placebo)(moxicip, Cipla Ltd, India) three time a day for a month followed by two times for 3 months were used in the control group following PRP. Results: The patients in both test and control group were followed up at 1,2 and 4 months after PRP completion and the changes in CFT and BCVA were recorded. There was increase in CFT on each follow up visit in both test and control group. However increase in CFT in test group was less compared to control group which is statistically significant.(p=0.0001) There was worsening of BCVA in the test group was less compared to control group which is clinically significant but statisticially insignificant. Conclusion: Using topical Nepafenac eye drops following PRP for PDR is effective in reducing central foveal thickness and preventing the corresponding worsening of BCVA. Keywords: Panretinal Photocoagulation, OCT, Central Foveal Thickness, Nepafenac.