Foveal Thickness Research Articles

Characteristics of Patients Who Drop Out of Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Associated with Branch Retinal Vein Occlusion.

To investigate the dropout rate of anti-vascular endothelial growth factor (VEGF) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and identify the characteristics of dropout cases. We studied 235 eyes of 235 treatment-naïve BRVO-ME patients receiving intravitreal injection of ranibizumab. Additional intravitreal anti-VEGF drug was given when ME relapsed or persisted, and photocoagulation was performed as needed. Adherence until treatment completion was defined as disappearance of ME within 2 years after the first injection without recurrence for more than 6 months or mild ME remaining but no visual deterioration for more than 6 months without additional anti-VEGF drug. In patients with ME recurrence, those who were followed for more than 2 years were considered adherence, and those followed for less than 2 years were considered dropout. The clinical course and background of the two groups were compared. 179 patients (76.2%) adhered to treatment and 56 patients (23.8%) dropped out. Mean follow-up periods in adherence and dropout groups were 23.4 and 7.1 months, respectively. There were no significant differences between the two groups in demographic and baseline factors of age, gender ratio, distance from home to hospital, visual acuity, and foveal thickness (FT). At the last follow-up, visual acuity was significantly poorer in the dropout group than in the adherence group (0.23 vs. 0.11 logMAR, p=0.003), and FT was significantly greater in the dropout group than in the adherence group (316 vs. 273 µm, p=0.002). Reasons for dropout included patient declining further treatment in 12.5%, progression of dementia in 8.9%, others, and unknown in 64.3%. The clinical outcome of patients who dropped out of anti-VEGF therapy for BRVO-ME was worse compared to patients who adhered to therapy, and the reasons for discontinuation varied.

Pre‐operative OCT in idiopathic epiretinal membrane surgery: The importance of biomarkers in predicting visual outcomes

Aims/Purpose: To evaluate the influence of inner segment (IS)/outer segment (OS) junction integrity in the post‐operative visual outcomes in patients submitted to idiopathic epiretinal membrane surgery.Methods: This was a retrospective observational study that included patients who underwent plana vitrectomy with internal limiting membrane (ILM) peeling between 2017 and 2022 our centre. All patients were submitted to a complete ophthalmological observation and high‐resolution (HR) spectral domain optical coherence tomography (SD‐OCT) (Spectralis® Heidelberg) scans centred on the fovea. Best corrected visual acuity (BCVA) and OCT morphology were evaluated pre‐operatively and at 1, 3, 6 and 12 months after the surgery. Our main outcome was to understand if there was a statistical correlation between the pre‐operative IS/OS junction integrity status and post‐operative BCVA gain.Results: This retrospective study included 39 eyes from 39 patients (19 male and 20 female) with a mean age of 70.9 ± 7.8 years. Pre‐operatively, mean BCVA was 0.23 ± 0.12. Pre‐operative OCT scans revealed a mean central foveal thickness (CFT) of 549 ± 110 μm. BCVA showed a mean post‐operative improvement of 0.09 ± 0.14 at 1 month, 0.19 ± 0.17 at 3 months, 0.26 ± 0.21 at 6 months and 0.29 ± 0.23 at 12 months. There was a mean CFT reduction of 77 ± 87 μm, 129 ± 116 μm, 136 ± 121 μm and 160 ± 135 μm at 1, 3, 6 and 12 months post‐operatively. Regarding IS/OS junction status, 20 patients presented with an intact IS/OS junction and 19 patients with a disrupted or irregular junction. At 6 and 12 months post‐operatively, the correlation between visual acuity gain and IS/OS status was statistically very significant (p‐value = 0.008 and 0.002, respectively).Conclusions: IS/OS junction status in pre‐operative OCT seems to be a strong predictor of visual outcomes in patients submitted to vitreoretinal surgery for idiopathic epiretinal membrane. This biomarker should be taken into account regarding the visual prognosis of these patients.

Effect of Vitreous Reflux after Intravitreal Aflibercept Injection for Macular Edema with Branch Retinal Vein Occlusion: A Real-World Study.

This study aimed to evaluate the therapeutic effect of vitreous reflux (VR) after intravitreal aflibercept injection (IVAI) for macular edema (ME) following naïve branch retinal vein occlusion (BRVO). Eighty patients with ME following BRVO were divided into three groups according to the conjunctival bleb diameter after IVAI as follows: group A (no VR), group; B (<3 mm VR), and group C (>3 mm VR). Each patient received single IVAI. The treatment response was evaluated with the best-corrected visual acuity (BCVA) and optical coherence tomography measurements of the retinal foveal thickness (RFT) before treatment and 1 month after the first injection. RFT >375 μm was defined as recurrence and received additional IVAI. The recurrence rate of ME and total numbers of IVAI were investigated at 12 months. The BCVA values at 1 month were 0.17 ± 0.29 in group A (n = 41), 0.18 ± 0.17 in group B (n = 18), and 0.19 ± 0.26 in group C (n = 21). The RFT at 1 month were 270 ± 45 μm in group A, 279 ± 24 μm in group B, and 290 ± 43 μm in group C, respectively. ME recurred in 29 out of 41 patients in group A, 15 out of 18 in group B, and 14 out of 21 in group C. The total numbers of IVAI were 2.50 ± 1.24 in group A, 2.59 ± 1.06 in group B, and 2.29 ± 1.27 in group C, respectively. In the above mentioned comparisons, no significant differences were found following an IVAI (P > 0.05). VR after IVAI did not affect the therapeutic effect in patients with ME following BRVO. Thus, we do not need to pay excess attention to VR in the case of IVAI.

Changes in Ocular Functions after Bariatric Surgery: A Cross-sectional Study

Introduction: Obesity is a critical problem worldwide, as it contributes to many pathological diseases. Therefore, Bariatric Surgery (BS) is considered an optimal treatment modality for achieving ideal weight. However, the eye and its functions can be affected after surgery due to the changes that occur throughout the body. Aim: To investigate and analyse visual functions following BS. Materials and Methods: This was a cross-sectional study conducted at Elite Hospital in Riyadh City, Saudi Arabia, from January 2023 to June 2023. A total of 16 subjects (32 eyes) were enrolled in the study. The subjects were categorised into three groups: preoperative BS (Group I), postoperative six months (Group II), and postoperative duration of one to two years (Group III). All participants underwent complete ophthalmological examinations, including Visual Acuity (VA) measurement using the Snellen chart, refractive error measurement by autorefractometer, colour vision testing using the Ishihara test, Intraocular Pressure (IOP) measurement, and anterior segment examination using a slit lamp. Additionally, a dryness assessment was performed using clinical tests. Finally, choroidal thickness and Retinal Nerve Fiber Layer (RNFL) measurements were obtained using Optical Coherence Tomography (OCT). Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Software Grad Pack Base version 28.0. One-way Analysis of Variance (ANOVA) and Kruskal-Wallis tests were used to compare the mean values of the three groups. Post-hoc tests were employed for multiple comparisons between groups. The significance level was set at 5%. Results: The range of the participants’ ages was 24 to 47 years. It was revealed that Body Mass Index (BMI) was significantly influenced by the time elapsed since BS (p-value=0.04). In contrast, the effect of BS was not statistically significant between groups for both systolic and diastolic measurements (p-value&gt;0.05). Moreover, the automated Central Foveal Thickness (CFT) showed a statistically significant difference between groups, with p-values of 0.013 for the right eye (OD) and 0.016 for the left eye (OS). Although there was no statistical difference in the effect of BS on the OD Ganglion Cell Complex (GCC) (p-value=0.338), there was a significant effect on the OS GCC (p-value=0.03). Post-hoc analysis indicated that participants in Group I had a higher BMI than participants in Group III, with a p-value of 0.036. CFT was significantly increased in Group II OS compared to Group I (p-value=0.016). Group III showed a significantly higher GCC than Group II (p-value=0.028). There was a significant difference in Goldmann IOP among the three groups (p-value=0.009). Additionally, a negative correlation was found between the duration of BS and BMI (r=-0.615, p-value=0.011) as well as for systolic measurements (r=-0.592, p-value=0.016). A strong negative correlation was also observed between Goldmann IOP and BS, which was statistically significant for the OD (r=-0.788*, p-value&lt;0.001) but not for the OS (r=-0.346, p-value=0.189). There was a statistically significant difference in OD nasal choroidal thickness at 500 μm (p-value=0.03) and at 1000 μm (p-value=0.03) among the three groups. Conclusion: Hence, it can be concluded that some ocular functions were positively altered while others were negatively affected after BS. Choroidal thickness decreased in the six-month postsurgery group but increased in the one to two-year group. IOP decreased in the six-month postsurgery group and further decreased in the one to two-year group. CFT increased in the sixmonth group but decreased in the one to two-year postoperation group. GCC thickness decreased in the six-month group and increased in the one to two-year post-BS group. Measurement of such parameters could serve as a preoperative assessment, especially for glaucomatous and hypertensive individuals who are planning for future BS. These evaluations could also aid in the treatment of eye diseases after surgery. Additionally, normal individuals should undergo pre- and postoperative evaluations of their visual refraction, as this may be altered due to changes in posterior segment parameters, such as choroidal thickness. However, more studies are needed to validate these results.

Exploratory analysis of choriocapillaris vasculature as a biomarker of idiopathic epiretinal membrane.

To investigate the preoperative choriocapillaris perfusion (CCP) as a biomarker in patients with idiopathic epiretinal membrane (iERM). 28 patients (28 eyes) with unilateral iERM who received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling were included for retrospective observational study. Optical coherence tomography (OCT) and angiography (OCTA) was performed before and after PPV. Area, perimeter, and circularity of superficial foveal avascular zone (FAZ) were analyzed preoperatively in both eyes using OCTA. Preoperative CCP was also analyzed with binarized en-face OCTA images. Measurements of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) by OCT were conducted at the baseline and 6 months following the surgery. The correlations of preoperative OCT parameters with postoperative BCVA and CFT reduction were analyzed. CCP was significantly lower (p < 0.001) and FAZ had shrunk (p < 0.001) in eyes with iERM compared to unaffected fellow eyes before surgery. BCVA and CFT became significantly improved after surgery (p = 0.001, p < 0.001). Multiple regression analysis revealed that preoperative CCP was significantly related with BCVA improvement (β = 0.185, p = 0.005), postoperative BCVA (β = 0.108, p = 0.023) and ratio of post- to preoperative CFT (β = 0.106, p = 0.044). Preoperative CCP is a biomarker for poor functional and anatomical prognosis after surgery in iERM.

Optical coherence tomography angiography of the foveal avascular zone after successful macula‐off rhegmatogenous retinal detachment repair

Aims/Purpose: To investigate the size and shape of the foveal avascular zone (FAZ) after successful macula‐off rhegmatogenous retinal detachment (RRD) repair using swept source OCT angiography (SS OCTA).Methods: A prospective comparative cross‐sectional study including 21 eyes of 21 patients with macula‐off RRD that were successfully repaired. The size of the superficial FAZ was assessed by its area, length of perimeter, and Feret's diameter, and the shape by the circularity, axial ratio, roundness and solidity. The correlations between each parameter and the clinical and OCT findings were statistically determined. The unaffected fellow eyes were used as controls.Results: The mean initial BCVA was 1.92 ± 0.41 Log MAR (20/2000 Snellen's equivalent). The mean BCVA at OCTA acquisition (3 months) was 0.78 ± 0.39 Log MAR (20/100 Snellen's equivalent) (p &lt; 0.001). FAZ was significantly larger (323.09 ± 129.03 μm2 vs. 245.27 ± 93.15 μm2; p = 0.038), with longer perimeter (2.31 ± 0.35 mm vs. 2.07 ± 0.31 mm; p = 0.048), and irregular shaped (mean circularity: 0.73 ± 0.72 vs. 0.78 ± 0.5; p = 0.019 and mean solidity: 0.90 ± 0.02 vs. 0.93 ± 0.02; p = 0.002) in operated eyes than in the control group. The average Feret's diameter was 0.77 ± 0.10 mm versus 0.71 ± 0.88 mm (p = 0.076). The average axial ratio was 1.25 ± 0.20 versus 1.22 ± 0.22 (p = 0.531), and the average roundness was 0.81 ± 0.11 versus 0.83 ± 0.11 (p = 0.531). Mean central foveal thickness (CFT) was significantly lower in operated eyes than in control eyes (178.23 ± 40.59 μm vs. 247.44 ± 38.2 μm (p &lt; 0.001)). There was a significant inverse correlation between FAZ area and post‐operative outer nuclear layer thickness (r = −0.520, p = 0.016) and CFT (r = −0.571, p = 0.007) in operated eyes. There was no significant correlation between the post‐operative visual acuity and FAZ parameters.Conclusions: Enlargement and irregularities of FAZ after successful macula‐off RRD repair, as demonstrated by SS OCTA, might suggest an ischaemic macular damage caused by RRD that may affect post‐operative functional outcome.

Comparison of the Efficiency and Safety of Photodynamic Therapy Combined Intravitreal Bevacizumab and Intravitreal Triamcinolone Treatments in Age-Related Macular Degeneration

Objective: This study aims to retrospectively examine the mid and long-term results of the photodynamic therapy (PDT) +IVTA group and the PDT +IVB applied Group in the treatment of choroid neovascularization (CNV) due to age-related macular degeneration (AMD) and to compare the results with the results of multicenter clinical studies. Materials and Methods: 64 eyes of 64 patients admitted to Haseki Training and Research Hospital, Department of Ophthalmology, Retina unit between June 2003 and March 2009, diagnosed with CNV secondary to age-related macular degeneration and treated, were included in the study. Thirty-five eyes with PDT +IVTA were classified as Group I, and 29 with PDT +IVTA were classified as Group II. Visual acuities of the cases were evaluated with ETDR and Snellen charts and converted to their equivalents on the Logarithm of Minimal Angle of Resolution (logMAR) scale. All patients underwent an ophthalmological examination before and after the treatment; fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed to see if there was any recurrence in the patients. Patients who were found to have relapsed were re-treated. Results: There were 26 (40.6%) female cases and 38 (59.4%) male cases. The ages ranged from 55 to 88, with a mean age of 73.85±7.26. The follow-up period of the patients ranged from 5 months to 69 months; the mean was 17.65±13.48 months. When evaluated according to FFA images, 40 (62.5%) were occult, 12 (18.8%) were minimal-classical, and 12 (18.8%) were dominant-classical. After treatment, visual acuity decreased in 20% of the PDT +IVTA group and increased or remained the same in 80%. In the PDT +IVB group, blurred vision decreased by 27.6% and increased or remained the same by 72.4%. There was no statistically significant difference between the groups regarding the change in visual acuity after treatment compared to before treatment (p&gt;0.05). In OCT, the decrease in the mean central foveal thickness (CFT) after treatment compared to the mean CFT before treatment in Group I was statistically significant (p&lt;0.05). In Group II - the decrease in the mean CFT after treatment compared to the mean CFT before treatment was statistically significant (p&lt;0.01). In Group I, there was no statistically significant change in the mean lesion diameter after treatment compared to the mean lesion diameter before treatment (p&gt;0.05). However, the decrease in Group II was statistically significant (p&lt;0.01). While the increase in CFT (central foveal thickness) and lesion diameter was more pronounced in the PDT+IVTA group post-treatment compared to the pre-treatment group, no significant difference was observed in visual acuity change within the PDT+IVTA group. Conclusion: In the treatment of choroidal neovascularization secondary to age-related macular degeneration, the combination of Triamcinolone or Bevacizumab with photodynamic therapy has proven to be both effective and safe. This approach helps preserve the current vision and even enhance visual outcomes. Combination therapy reduces the frequency and number of monotherapies used to achieve visual success.

A Case of Full Thickness Parafoveal Hole Associated with Chorio-Retinal Atrophy.

An idiopathic full-thickness parafoveal hole (PFH) in the absence of trauma or intraocular surgery is a rare finding. A 60-year-female who did not gain good vision following an uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye (RE) consulted a retina specialist, one year after her cataract surgery. There was no history of trauma, radiation exposure, reduced scotopic vision, or any other intraocular surgery. Her personal and family history were unremarkable for any systemic or ocular diseases. Routine blood investigations, an electrocardiogram, and a detailed ocular examination were done. She had the best corrected visual acuity (BCVA) of LogMAR 1.0 (20/200; 6/60) in the right eye. The right eye had an axial length (AL) of 23.50 mm and an intraocular lens power of 21.0 dioptres. The ultrawide field fundus examination saw parafoveal chorio-retinal atrophy without significant peripheral myopic degeneration. On optical coherence tomography (OCT), a central foveal thickness of 138 microns with foveal scarring was noticed. There was a full-thickness parafoveal hole between the fovea and optic disc having a height of 198 microns; base diameter of 240 microns; arm lengths of 203 microns and 206 microns; and a minimum linear dimension of 42 microns. The optical coherence tomography angiography scan showed a reduced vessel density in the superficial and deep retina; and increased visibility of choroidal vessels in outer retina chorio-capillaries, chorio-capillaries, and choroid slab at the parafoveal hole The ultrasound B scan was anechoic and there was no posterior vitreous detachment (PVD). The axial length, intraocular lens power and fundus examination did not indicate pathological myopia. As there was no preceding posterior vitreous detachment or retinal surgery, the underlying retinochoroidal atrophy most probably caused the full-thickness parafoveal hole.

Use of Ranibizumab for evaluating focal laser combination therapy for refractory diabetic macular edema patients: an exploratory study on the RELAND trials

Anti-vascular endothelial growth factor (VEGF) therapy is the first-line treatment for diabetic macular edema (DME), but is less effective in some patients. We conducted a prospective study to determine whether laser combination therapy with anti-VEGF was more effective than Ranibizumab monotherapy in anti-VEGF-resistant DME patients. There was no significant difference in the improvement of the best-corrected visual acuity (BCVA) between the laser combination therapy and Ranibizumab monotherapy groups (3.2 letters and -7.5 letters, p = 0.165). BCVA did not significantly change between visits 1 and 7 (the laser combination group, 64.3 letters 70.3 letters, respectively, p = 0.537; the Ranibizumab monotherapy group, 72.3 letters and 64.8 letters, respectively, p = 0.554), with no significant improvements in central foveal retinal thickness (the laser combination therapy group, 9.3%: the Ranibizumab monotherapy groups, − 7.3%; p = 0.926). There was no significant difference in the number of Ranibizumab intravitreal therapy (IVT) sessions between the groups (laser combination therapy, 5.2; ranibizumab monotherapy, 6.0; p = 0.237). This study did not show that laser combination therapy was significantly more effective for anti-VEGF-resistant DME than anti-VEGF monotherapy alone. Therefore, for anti-VEGF-resistant DME, alternative therapeutic approaches beyond combined laser therapy may be considered.

Intravitreal Brolucizumab for Pachychoroid Neovasculopathy Associated With Chronic Central Serous Chorioretinopathy.

To evaluate the anatomical and functional outcomes of intravitreal brolucizumab in eyes with chronic central serous chorioretinopathy complicated by pachychoroid neovasculopathy. Retrospective analysis of 34 eyes treated with intravitreal brolucizumab. Twenty-five eyes (73.5%) had been treated with other anti-vascular endothelial growth factor agents before switching to brolucizumab, whereas nine eyes were naïve. Outcome measures included the change of central foveal thickness and subfoveal choroidal thickness, evaluation of sub/intraretinal fluid on optical coherence tomography, and change in best-corrected visual acuity. Before starting brolucizumab, 23 eyes showed subretinal fluid, 8 both subretinal and intraretinal fluid, and 3 intraretinal fluid only. At the last visit, 22 eyes (64.7%) showed complete reabsorption of both intraretinal and subretinal fluid, whereas subretinal fluid was still present in 8 eyes (23.5%), and both intraretinal and subretinal fluid in 4 eyes (11.8%). The mean number of brolucizumab injections required to achieve complete fluid reabsorption was 2.8 ± 1.8. central foveal thickness decreased from 317.8 ± 109.3µm to 239.8 ± 74.8µm (P = 0.0005) and subfoveal choroidal thickness decreased from 399.3 ± 86.2µm to 355.5 ± 92.7µm at the end of the follow-up period (P = 0.0008). The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.4 ± 0.2 to 0.3 ± 0.2 at 1 month after the first injection and remained stable at the same values at the end of the follow-up period (P = 0.04). Intravitreal brolucizumab is effective for the treatment of naïve and recalcitrant pachychoroid neovasculopathy. Intravitreal brolucizumab may represent an option in patients with pachychoroid neovasculopathy complicating chronic central serous chorioretinopathy.

Different approaches for treating myopic choroidal neovascularization: a network Meta-analysis.

To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients. Two researchers independently searched PubMed, Cochrane Library, Web of Science, and other databases to screen studies comparing best-corrected vision acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. Post-treatment chorioretinal atrophy (CRA) is a secondary outcome indicator. The retrieval time limit is from the database construction to January 30, 2023. A total of 1072 eyes in 16 articles were included. In the RCTs, intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) were superior to PDT (MD=0.18, 95%CI: 0.02, 0.40, MD=0.18, 95%CI: 0.01, 0.42) in improving BCVA of mCNV patients (P<0.05). The relative effectiveness in improving BCVA, from high to low, appeared to be IVR, intravitreal aflibercept (IVA), IVB, LT, PDT, and sham first followed by IVA (Sham/IVA). While improving the FCT from high to low was IVA, IVR, IVB, PDT. In retrospective studies, the results of BCVA after long-term treatment showed that all the therapeutic effects from high to low was IVA, intravitreal conbercept (IVC), IVR, IVB, IVB/IVR, PDT with IVB/IVR, PDT. The effect of improving FCT was IVA, IVR, IVC, PDT, and IVB from high to low. And in the effects of improving CRA, the IVB appeared to be higher than IVR, while the PDT was the smallest, but none of the differences in the results were statistically significant. Anti-VEGF has the best effect on long-term vision improvement in mCNV patients, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT. There is no significant difference in the improvement of visual acuity, macular edema, and CRA in mCNV patients treated with any different anti-VEGF drugs.

Study of OCT based biomarkers as a predictor of visual outcome in diabetic macular edema

To determine the association between optical coherence tomography (SD-OCT) based biomarkers and visual acuity (VA) in diabetic macular edema (DME). This cross-sectional study was conducted at a tertiary care teaching hospitalbetweenJanuary 2021 and July 2022.The study included 54 eyes (30 patients) with DME. Based on the early treatment diabetic retinopathy study (ETDRS) grading system, these were classified as mild (n=1), moderate (n=31), severe (n=14), and very severe (n=8) non-proliferative diabetic retinopathy (NPDR). The demographics, VA recorded using ETDRS chart and ETDRS scoring system, slit lamp biomicroscopy findings, colour fundus pictures and biomarkers determined using macular scans on SD-OCT were noted. Six eyes with proliferative diabetic retinopathy (n-4) and considerable media opacity (n-2) were excluded. The data was entered into Microsoft Excel spreadsheet 2021and IBM's SPSS 26 statistical program was used to calculate the results.VA and biomarkers, which included central macular thickness, disorganisation of retinal inner layers (DRIL), ellipsoid zone disruption (EZD), choroidal thickness were measured on SD-OCT.: The mean age was 59.4±9.4 years, and male to female ratio was 1.3:1. Mean uncorrected and best corrected VA were 46 and 61 letters, 55.12±1.76 and 67.25±10.05 letters for moderate NPDR, 43.07±3.95 and 52.14±17.83 letters for severe NPDR, and 26.50±16.53 and 36±16.38 letters for very severe NPDR, respectively. VA deteriorated with increasing disease severity. Poorer VA was associated with increased average foveal and macular thickness and increased mean horizontal disruption of the inner retinal layers (DRIL). Average choroidal thickness positively correlated with increasing DR severity. : Poorer VA was associated with increasing DR severity, increased central retinal thickness, increased mean horizontal DRIL and increased average foveal choroidal thickness. We found no statistically significant correlation between VA and ellipsoid zone disruption.

Seven-year outcomes of combined treatment of anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy; according to polypoidal lesion regression

PurposeTo evaluate the long-term prognosis of polypoidal choroidal vasculopathy (PCV) treated with anti-vascular endothelial growth factor (anti-VEGF) combined with verteporfin photodynamic therapy (PDT), according to polypoidal lesion regression.MethodsThis study retrospectively reviewed the data of 33 naïve eyes with PCV treated with anti-VEGF combined with verteporfin PDT and followed-up for at least 7 years. The collected data included demographic profile, best-corrected visual acuity (BCVA), central foveal thickness (CFT), PED volume, and presence of submacular hemorrhage. Regression of polypoidal lesion was determined using indocyanine green angiography and optical coherence tomography. All eyes were divided into regression or persistent groups, based on the polypoidal lesion regression one year after the initial combined treatment.ResultsBCVA improvement was maintained for 3 years in the regression (p = 0.001) and 1 year in the persistent (p = 0.006) groups, respectively. The mean BCVA of the regression group was better than that of the persistent group over 7 years, but the difference was significant only at 1 year (p = 0.037). The number of eyes which maintained BCVA less than or equal to 0.3 logMAR at 7 years was 11 eyes (64.7%) in regression group and 4 eyes (25.0%) in persistent group (p = 0.022).ConclusionsRegression of the polypoidal lesion at 1 year after the initial combination treatment was associated with favorable long-term visual prognosis, particularly in terms of maintaining good visual acuity.

Longitudinal Changes of Retinal Structure in Molecularly Confirmed C1QTNF5 Patients With Late-Onset Retinal Degeneration.

The purpose of this study was to present our findings on the natural history of late-onset retinal degeneration (LORD) in patients with molecularly confirmed C1QTNF5 heterozygous pathogenic variants and assess suitability of retinal structure parameters for disease monitoring. Sixteen patients with C1QTNF5-LORD were retrospectively identified from Moorfields Eye Hospital, UK. Fundus autofluorescence (FAF), optical coherence tomography (OCT) scans, and best-corrected visual acuity (BCVA) were collected. Area of atrophy (AA) was manually drawn in FAF images. Ellipsoid zone (EZ) width and foveal retinal thickness of the whole retina and outer retina were extracted from OCT scans. Age-related changes were tested with linear-mixed models. Patients had median age of 62.3years (interquartile range [IQR]=58.8-65.4years) at baseline, and median follow-up of 5.1years (IQR=2.6-7.6years). AA, EZ width, and retinal thickness parameters remained unchanged until age 50years, but showed significant change with age thereafter (all P < 0.0001). AA and EZ width progressed rapidly (dynamic range normalized rates=4.3-4.5%/year) from age 53.9 and 50.8years (estimated inflection points), respectively. Retinal thickness parameters showed slower progression rates (range=1.6-2.5%/year) from age 60 to 62.3. BCVA (median=0.3 LogMAR, IQR=0.0-1.0 at baseline) showed a rapid decline (3.3%) from age 70years. Findings from patients with earlier disease showed FAF atrophy manifests in the temporal retina initially, and then progresses nasally. Patients with LORD remained asymptomatic until age 50years, before suffering rapid outer retinal degeneration. EZ width and AA showed rapid progression and high interocular correlation, representing promising outcome metrics. Clinical measures also capturing the temporal retina may be preferable, enabling earlier detection and better disease monitoring. Area of atrophy in FAF images and OCT-measured EZ width represent promising outcome metrics for disease monitoring in patients with C1QTNF5-LORD.

Stripping of the Posterior Hyaloid for the Treatment of Vitreomacular Traction.

To describe and evaluate the effectiveness of stripping the posterior hyaloid as vitreomacular traction treatment. This prospective, consecutive, interventional study examined 10 eyes of 10 patients who underwent vitrectomy for vitreomacular traction. The best-corrected visual acuity improved from 20/63 (0.5 ± 0.18 logMAR) preoperatively to 20/36 (0.25 ± 0.15 logMAR) 3 months after the surgeries. Optical coherence tomography analysis showed a reduction of the mean foveal thickness from 462 ± 82 µ to 372 ± 28 µ at 3-month follow-up in all the eyes. No postoperative complications were reported. Stripping of the posterior hyaloid for the treatment of vitreomacular traction could improve the symptoms and visual acuity of patients, alleviating the traction on the macula and avoiding secondary retinal damage as macular hole formation.

PEELING AND INTERNAL LIMITING MEMBRANE REPOSITION (PAIR) FOR MYOPIC FOVEOSCHISIS.

To report the outcomes of the Peeling and Internal Limiting Membrane Reposition (PAIR) technique in myopic foveoschisis. A retrospective case series of eyes with myopic foveoschisis that underwent vitrectomy and PAIR. Visual acuity, fundus photographs, and optical coherence tomography measurements were obtained and analyzed. Data are presented as medians (ranges). A total of seven eyes underwent PAIR and were followed up for 339 days (188-436 days). No intraoperative complications were noted. One eye exhibited postoperative macular hole formation, but the hole was healed through fluid-gas exchange. At the last follow-up, the visual acuity had improved from 20/66 (20/332-20/40) to 20/40 (20/100-20/25), and the central foveal thickness had decreased from 576 µ m to 269 µ m. A repositioned internal limiting membrane (ILM) was observed in six of the eyes, and inner retinal dimples were noted in only two eyes. However, retinal wrinkles under the repositioned or perifoveal ILM were noted in five eyes. The PAIR technique relieved traction, restored the ILM, and achieved functional and morphological improvement in eyes with myopic foveoschisis. Limited occurrence of inner retinal dimples and retinal thinning was noted, but retinal wrinkles occurred, likely due to ILM contracture.

A randomized non-inferiority trial of 577nm subthreshold micropulse laser versus half-dose photodynamic therapy for acute central serous chorioretinopathy

PurposeTo compare the effectiveness of 577nm subthreshold micropulse laser (SML) with half-dose photodynamic therapy (Hd-PDT) for acute central serous chorioretinopathy (CSC). MethodA non-inferiority clinical trial was performed with a non-inferiority margin of eight letters. Sixty-eight eyes of 68 patients with acute CSC were randomized to the Hd-PDT group or 577 nm SML group. Best-corrected visual acuity (BCVA ), the subretinal fluid (SRF), and the central foveal thickness (CFT) were evaluated at 6 months. ResultsThe visual acuity significantly improved from 70.38 ± 10.37 at baseline to 83.24 ± 3.03 at 6 months after treatment in the SML group (P < 0.001), from 71.09 ± 10.50 to 84.35 ± 2.09 in the PDT group (P < 0.001). SML was non-inferior to the PDT (mean difference: -0.41, 95% CI: -5.51 – 4.68, P = 0.0021). At the endpoint, CFT was significantly reduced in the two groups, but no statistical difference (P = 0.7694). The complete resolution of SRF reached 82.35% (28/34) in the SML group and 91.18% (31/34) in the PDT group, respectively,but no statistical difference (P = 0.3724). ConclusionsSML was non-inferiority to half-dose PDT in improving the visual acuity for CSC, and it is a viable alternative, especially when the verteporfin in PDT is unavailable.

Correlations between subfoveal choroidal thickness, macular thickness, and visual outcome in neovascular age-related macular degeneration using swept source OCT: insights from intravitreal aflibercept treatment

BackgroundAge-related macular degeneration (AMD) is a leading cause of visual impairment among individuals aged 50 and above, often resulting in irreversible vision loss (1). Currently, antiangiogenic therapy is the primary treatment approach for neovascular AMD (2). The choroid has gained significant attention in recent years due to its involvement in various ocular pathologies (7). The objective of this study was to evaluate visual acuity and correlate pre-treatment variables, such as foveal thickness and choroidal thickness, with post-treatment outcomes.Materials and MethodsThis study was designed as a prospective interventional study to investigate the changes in choroidal and macular thickness in patients with neovascular AMD who received intravitreal aflibercept injections. The study utilized medical records and employed Swept Source Optical Coherence Tomography (OCT-SS) for evaluation. The data was collected from patients treated in Presidente Prudente, Brazil, during a three-month load dose period.ResultsThe best-corrected mean visual acuity significantly improved from 1.0 logarithm of the minimum resolution angle (logMAR) units to 0.55 logMAR after treatment with aflibercept (p < 0.001). Patients undergoing treatment exhibited a significant decrease in average macular thickness from 323 μm to 232 μm (p = 0.001), as well as a reduction in choroidal thickness from 206 μm to 172 μm (p = 0.031), while maintaining intraocular pressure within the normal range (p = 0.719) without significant variation. Statistically significant associations were found between the difference in pre- and post-treatment choroidal thickness and the pretreatment values of macular thickness (p = 0.005) and choroidal thickness (p = 0.013). There was also a statistically significant correlation between the difference in pre- and post-treatment macular thickness and the pretreatment macular thickness value (p < 0.001).ConclusionIn this study, aflibercept exhibited remarkable effectiveness in reducing macular and choroidal thickness, as evaluated using OCT-SS, and significantly improved visual acuity in patients with neovascular AMD. The assessment of both choroidal and macular changes, as well as their correlations, can provide valuable insights for clinicians, enabling them to make well-informed therapeutic decisions and effectively monitor treatment outcomes. Notably, this study contributes to the existing body of literature as the first to establish a correlation between pretreatment foveal thickness, variation in choroidal thickness, and post-treatment choroidal thickness.

Correlation between retinal sensitivity and retinal vascular perfusion after idiopathic epiretinal membrane peeling.

To evaluate the correlations between anatomical and functional changes after idiopathic epiretinal membrane (iERM) surgery. In this prospective, observational, single-center study, consecutive patients who underwent iERM peeling were enrolled. Reported data were pre- and postoperative best-corrected visual acuity (BCVA), retinal sensitivity (RS) and fixation stability values on microperimetry, structural macular features on SD-OCT and OCTA. RS of foveal and parafoveal area was analysed and two sub-groups were identified whether RS improved or remained unchanged/worsened after surgery; consequently, vascular perfusion density (VPD) of the same area was studied. Twenty-nine eyes of 29 patients were examined. The post-operative improvement in terms of BCVA, RS and fixation within the central 4 degrees was significant (p < 0.001, p < 0.001, p = 0.001), as well as the foveal thickness and macular volume change/reduction (p < 0.001). The pre-operative superficial VPD, choriocapillaris VPD and capillary free zone (CFZ) area were significantly reduced compared to the fellow healthy eye (p = 0.001, p = 0.02, p < 0.001). Choriocapillaris VPD showed a statistically significant increase after surgery (p < 0.02). Superficial, deep and choriocapillaris VPD of the improved RS group showed a significant increase both in foveal (p = 0.03, p = 0.03, p = 0.01) and parafoveal areas (p = 0.01, p = 0.03, p = 0.001). We reported a higher VPD in the retinal area that experienced a retinal sensitivity improvement 6 months after ERM surgery. This result objectifies the tight bond between visual function and retinal perfusion in ERM patients.

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.