Intraretinal Cysts Research Articles

An osmolarity dependent mechanism partially ameliorates retinal cysts and rescues cone function in a mouse model of X-linked retinoschisis

IntroductionX-linked retinoschisis (XLRS) is a vitreoretinal dystrophy caused by RS1 gene mutations which disrupt retinoschisin-1 (RS1) function. Vital for retinal architecture, the absence of functional RS1 leads to the development of intraretinal cysts. Intravitreal injection of a gene therapy for treating XLRS caused ocular inflammation in high dose groups in a phase I/II clinical trial. This study investigates a low dose subretinal gene therapy in Rs1 knockout (Rs1-KO) mice compared to injection of buffer alone. Observation of an unexpected therapeutic effect following the subretinal injection of the hypertonic buffer led to novel findings in XLRS.MethodsRs1-KO mice were subretinally injected with an AAV2/4 vector (n = 10) containing the RS1 gene driven by an Ef1α promoter, a hypertonic buffer (n = 15) (180 mM NaCl 0.001% F68/PBS (pH 7.4)), or isotonic buffer (n = 7) (155.2 mM NaCl 0.001% F68/PBS, pH 7.0). A sham puncture group was also included (n = 6). Endpoints included electroretinogram (ERG), optical coherence tomography (OCT), a visually guided swim assay (VGSA), and immunohistochemistry.ResultsUnexpectedly, hypertonic buffer-injected eyes had reduced cyst severity at 1-month post-injection (MPI) (p < 0.0001), higher amplitudes in cone-dominant ERGs persisting to 5 MPI (5 Hz flicker; p < 0.0001; 3.0 flash; p = 0.0033) and a trend for improved navigational vision in the light compared to untreated Rs1-KO eyes. To investigate the role of tonicity on this effect, an isotonic buffer-injected cohort was created (155.2 mM NaCl 0.001% F68/PBS, pH 7.0) (n = 7). Surprisingly, hypertonic buffer-injected eyes exhibited a greater reduction in cyst severity and demonstrated improved cone-dominant ERG metrics over isotonic buffer-injected and sham puncture eyes. An immunohistochemistry assay demonstrated greater cone density in hypertonic buffer-injected eyes than untreated Rs1-KO eyes at 5–6 MPI (p = 0.0198), suggesting a possible cone preservation mechanism. Moreover, our findings reveal a negative correlation between the peak severity of cysts and long-term ERG amplitudes in cone-dominant pathways, implying that effectively managing cysts could yield enduring benefits for cone function.Discussion/conclusionThis study presents evidence that cyst resolution can be triggered through an osmolarity-dependent pathway, and early cyst resolution has long-term effects on cone signaling and survival, offering potential insights for the development of novel treatments for XLRS patients.

BNT162b2 vaccine booster dose did not influence the activity of the exudative form of age-related macular degeneration during anti-vascular endothelial growth factor therapy.

Due to safety concerns, patients were hesitant to receive a booster dose of COVID-19 vaccine. In this study, we investigated whether neovascular age-related macular degeneration activity deteriorated after receiving the booster dose of the BNT162b2 vaccine. Optical coherence tomography (OCT) of the macula, best-corrected visual acuity (BCVA), and slit-lamp examination data were collected from 89 patients. All these individuals were diagnosed with neovascular age-related macular degeneration (AMD) and treated with intravitreal injections of aflibercept or ranibizumab. During the process of treatment, patients received a booster dose of the BNT162b2 vaccine. Time points included two visits before (marked as "-2", "-1") and two visits after (marked as "1", "2") the uptake of the booster dose. There were significant differences in the average thickness and total volume of the macula during follow-up. Moreover, a decreased average thickness, total volume, total thickness of the macula, subretinal fluid thickness, and subretinal complex thickness was observed between the time points "-2" and "2", but only in the aflibercept group. There were no significant differences in the frequency of occurring intraretinal cysts, subretinal fluid, serous retinal pigment epithelial detachments retinal hemorrhage, subretinal hyperreflective material, complete RPE and outer retinal atrophy, and BCVA before and after the booster dose. These results demonstrate that the BNT162b2 vaccine booster dose did not deteriorate the course of neovascular AMD.

CYSTOID MACULAR EDEMA IN BIRDSHOT RETINOCHOROÏDITIS: Long-Term Treatment Study in 142 Patients.

To assess the long-term efficacy and safety of treatments for cystoid macular edema in birdshot retinochoroïditis. Observational retrospective study of 142 HLA-A29-positive patients with cystoid macular edema; the main outcome was the optical coherence tomography intraretinal cysts resolution. During the mean follow-up of 75 months (12-178), 61.3% of patients were successfully treated using 1 to 3 treatment steps, while the others needed more steps. At 6 months, there were no significant effects on ME for anti-TNF (tumor necrosis factor) and IVIg (immunoglobulin) in contrast to antimetabolites (OR 1.98), systemic GCS (glucocorticosteroids), CsA (cyclosporine A) and tocilizumab (odds ratio closed to 2.7), intraocular injected GCS (odds ratio of 4.2), and interferon (odds ratio of 4.4). The percentages of therapeutic success trend to decrease from the initial three treatment steps to the subsequent treatment steps, for systemic GCS (84% to 70%), for anti-TNF (42% to 33%), and for CsA (71% to 33%); the success percentages did not decrease for injected GCS (83% to 89%). Macular edema recurrence occurred with the highest percentage for injected GCS (86.8%, P = 0.01) and the lowest for tocilizumab (10.5%, P = 0.001). Interferons-α and tocilizumab were associated with the lowest prednisone daily doses. The classical uveitic cystoid macular edema therapeutic algorithm could be adapted to birdshot retinochoroïditis.

Importance of optical coherence tomography before cataract surgery

PurposeTo determine the importance of optical coherence tomography (OCT) in patients scheduled for cataract surgery who present with no pathologies in biomicroscopic fundus examination.DesignRetrospective study.MethodsIn this study, the routine ophthalmologic examination of patients who were recommended cataract surgery was performed.Occult retinal pathologies were evaluated using OCT in patients without any pathologies in biomicroscopic fundus examination.According to whether retinal pathologies were detected on OCT, the patients were divided into two groups: normal and abnormal OCT.The findings of patients with retinal pathologies on OCT and their distribution according to age were also evaluated.ResultsA total of 271 eyes from 271 patients were evaluated.The number of patients with retinal pathologies on OCT despite normal fundoscopic examination findings was 38(14.0%).Of these patients,15(39.4%) had an epiretinal membrane,10(26.3%) had age-related macular degeneration, eight(21%) had vitreomacular traction, two(5.2%) had a lamellar hole, and 1(2.6%) patient each had a full-thickness macular hole, an intraretinal cyst, and photoreceptor layer damage.The age distribution of the patients with retinal pathologies was as follows: two patients,<60 years; six patients,60–70 years;14 patients,70–80 years; and 16 patients,>80 years.The rate of patients aged > 70 years and above was 78.9%.There was no statistically significant difference between the normal and abnormal OCT groups in terms of age, gender, the presence of systemic diseases, visual acuity, central macular thickness, and cataract type or density(p > 0.05 for all).ConclusionIn one of seven patients evaluated, retinal pathologies were detected on OCT despite normal fundoscopic examination findings.OCT can be used to detect occult retinal pathologies that cannot be detected by biomicroscopic fundus examination before cataract surgery.

Treatment and Characteristics of Pachychoroid Neovasculopathy Accompanying Recalcitrant Intraretinal Cysts.

To evaluate the clinical characteristics associated with chronic pachychoroid neovasculopathy (PNV) accompanying recalcitrant intraretinal cysts. This is a retrospective, single-center, case-series study involving 20 eyes of 18 patients with PNV who did not respond to bevacizumab or ranibizumab and had to switch to aflibercept. Optical coherence tomography images were assessed before and after switching of intravitreal injection drug. The intraretinal cysts involved the outer nuclear layer and inner nuclear layer in 15 patients (75.0%), and involved only the inner nuclear layer in five patients (25.0%). All participants showed retinal pigment epithelium atrophy and outer retinal layer defect including external limiting membrane defect co-localized to the intraretinal cystic lesion. With the initial injection, bevacizumab and ranibizumab injections did not show a significant decrease in choroidal thickness (CT). Twenty (100.0%) patients showed poor response of intraretinal cyst response (IRCR). After a switch to aflibercept, IRCR was good in 17 (85.0%) patients and poor in three (15.0%) patients. Reduction of CT was great in aflibercept injections (from 229.0 μm to 204.0 μm, median, p < 0.001). Best-corrected visual acuity did not show significant improvement before or after switching drugs. Intravitreal aflibercept injections were more effective in the reduction of CT and IRCR than bevacizumab and ranibizumab injections. The primary source of the intraretinal cyst fluid could be from the choroid.

CDH23-Associated Usher Syndrome: Clinical Features, Retinal Imaging, and Natural History.

The purpose of this study was to analyze the clinical spectrum and natural history of CDH23-associated Usher syndrome type ID (USH1D). Molecularly-confirmed individuals had data extracted from medical records. Retinal imaging was extracted from an in-house database. The main outcome measurements were retinal imaging and electroretinography (ERG) and clinical findings, including age of onset, symptoms, best-corrected visual acuity (BCVA), outer nuclear layer (ONL) thickness, ellipsoid zone width (EZW), and hyperautofluorescent ring area. Thirty-one patients were identified, harboring 40 variants in CDH23 (10 being novel). The mean (range, ±SD) age of symptom onset was 10.1years (range = 1-18, SD = ±4.1). The most common visual symptoms at presentation were nyctalopia (93.5%) and peripheral vision difficulties (61.3%). The mean BCVA at baseline was 0.25 ± 0.22 in the right eyes and 0.35 ± 0.58 LogMAR in the left eyes. The mean annual loss rate in BCVA was 0.018 LogMAR/year over a mean follow-up of 9.5years. Individuals harboring the c.5237G>A p.(Arg1746Gln) allele had retinitis pigmentosa (RP) sparing the superior retina. Seventy-seven percent of patients had hyperautofluorescent rings in fundus autofluorescence. Full-field and pattern ERGs indicated moderate-severe rod-cone or photoreceptor dysfunction with relative sparing of macular function in most patients tested. Optical coherence tomography (OCT) revealed intraretinal cysts in the transfoveal B-scan of 13 individuals (43.3%). The rate of EZW and ONL thickness loss was mild and suggestive of a wide window of macular preservation. Despite the early onset of symptoms, USH1D has a slowly progressive phenotype. There is high interocular symmetry across all parameters, making it an attractive target for novel therapies.

Fluid aspiration from intraretinal cysts for refractory diabetic macular edema

PURPOSE: To report the surgical outcome of fluid aspiration in intraretinal cysts as a novel treatment approach for the refractory cystoid macular edema (CME) associated with diabetic retinopathy. METHODS: This retrospective consecutive case series examined eight patients with refractory CME who underwent intraretinal cyst fluid aspiration using a 38-gauge subretinal infusion needle during pars plana vitrectomy. We reviewed changes in central retinal thickness (CRT), best-corrected visual acuity (BCVA), and central sensitivity among patients followed up for 12 months post-surgery. RESULTS: CRT on optical coherence tomography (μm) significantly improved at 12 months post-surgery (308 ± 99) compared to before surgery (480 ± 141) (P &lt; 0.005). During the follow-up period, CME relapsed in one eye. The BCVA (logarithm of the minimal angle of resolution) at 12 months post-surgery (0.23 ± 0.32, Snellen equivalent: 20/50) was significantly better than the preoperative BCVA (0.39 ± 0.29, Snellen equivalent: 20/63) (P &lt; 0.01). The mean deviation value of central sensitivity did not significantly change between preoperative (-2.5 ± 2.1) and postoperative (-2.2 ± 2.2) assessments (P = 0.07). CONCLUSIONS: Fluid aspiration in intraretinal cysts may be a treatment option for refractory CME in eyes with diabetes.

Quantitative Multimodal Imaging Characterization of Intraretinal Cysts versus Degenerative Pseudocysts in Neovascular Age-Related Macular Degeneration

ObjectiveTo differentiate intraretinal fluid (IRF) cysts from degenerative pseudocysts in neovascular age-related macular degeneration by quantitative multimodal imaging. DesignObservational, cross-sectional. ParticipantsPatients affected by macular neovascularization (MNV) secondary to AMD. MethodsAll patients were analyzed by optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and dense ART (DART) OCTA. Newly onset cysts were considered IRF, whereas those cysts that were found to be persistent persistent for at least 3 months have been categorized as degenerative pseudocysts. Intraretinal cysts were automatically segmented to calculate cyst circularity. Peri-cyst space was quantitatively analyzed to assess the presence of perfusion signal and hyperreflective foci (HF). Main Outcome MeasuresBest-corrected visual acuity (BCVA), cyst circularity, peri-cyst perfusion, peri-cyst HF, fibrosis, outer retinal atrophy. ResultsWe analyzed 387 cysts collected from 35 eyes of 35 neovascular AMD patients (14 males; mean age 80±5 years). We classified 302 IRF cysts and 85 degenerative pseudocysts. IRF cysts were characterized by significantly higher circularity (0.86 (range 0.81-0.91), perfusion signal in the peri-cyst space and peri-cyst HF in 89% of cases (all p<0.05). Degenerative pseudocysts showed significantly lower circularity (0.68 (range 0.64-0.76), no perfusion signal in the peri-cyst space and peri-cyst HF only in 29% of cases (all p<0.05). The adopted quantitative metrics significantly correlated with disease duration, number of injections, fibrosis and outer retinal atrophy. ConclusionsIRF can be discriminated from degenerative pseudocysts by quantitative multimodal imaging approach. These findings resulted clinically relevant and should be included in future training models for artificial intelligence algorithms to improve the diagnostic power and the fluids monitoring in neovascular AMD.

Relationship between lymphocytes and idiopathic macular hole

BackgroundAn idiopathic macular hole (IMH) is a full-thickness anatomic defect extending from the internal limiting membrane to the photoreceptor layer of the macula without any known cause. Recently, clinical laboratory markers of systemic inflammatory status derived from complete blood counts have been evaluated in ocular diseases. This study aimed to explore whether they could predict the development and progression of IMHs.MethodsA retrospective review of 36 patients with IMH and 36 sex-and-age-matched patients with cataracts was conducted. We collected complete blood counts of all participating individuals and calculated systemic immunoinflammatory indicators. The maximum base diameter of the IMH (BD), minimum diameter of the IMH (MIN), height of the IMH (H), area of the intraretinal cyst (IRC), and curve lengths of the detached photoreceptor arms were measured on optical coherence tomography (OCT) images. We used these values to calculate the macular hole index (MHI), tractional hole index (THI), diameter hole index (DHI), hole form factor (HFF), and macular hole closure index (MHCI). We performed a receiver operating characteristic (ROC) curve analysis of 30 patients with IMH who were followed up 1 month after surgery.ResultsLymphocyte counts were significantly higher in the IMH group. No other significant differences were observed between the IMH and control groups. Lymphocyte counts in the IMH group were significantly negatively correlated with MIN and BD and were significantly positively correlated with MHI, THI, and MHCI. However, lymphocyte counts were not significantly correlated with H, IRC, DHI, and HFF. In the ROC analysis, BD, MIN, MHI, THI, and MHCI were significant predictors of anatomical outcomes. According to the cut-off points of the ROC analysis, lymphocyte counts were compared between the above-cut-off and below-cut-off groups. Lymphocyte counts were significantly higher in the MIN ≤ 499.61 μm, MHI ≥ 0.47, THI ≥ 1.2, and MHCI ≥ 0.81 groups. There were no significant differences between the above-cut-off and below-cut-off BD groups.ConclusionsAlthough inflammation may not be an initiating factor, it may be involved in IMH formation. Lymphocytes may play a relatively important role in tissue repair during the developmental and postoperative recovery phases of IMH.

Intensive Glycemic Management Is Associated With Reduced Retinal Structure Abnormalities on Ocular Coherence Tomography in the DCCT/EDIC Study.

To investigate quantitative and qualitative changes in retinal structure using optical coherence tomography (OCT) and their associations with systemic or other risk factors in individuals with type 1 diabetes (T1D). In the Epidemiology of Diabetes Interventions and Complications (EDIC) study, OCT images were obtained during study years 25-28 (2019-2022) in 937 participants; 54% and 46% were from the original intensive (INT) and conventional (CONV) glycemic management treatment groups, respectively. Average age for participants was 61 years old, diabetes duration 39 years, and HbA1c 7.6%. Participants originally in the CONV group were more likely to have disorganization of retinal inner layers (DRIL) (CONV 27.3% vs. INT 18.7%; P = 0.0003), intraretinal fluid (CONV 24.4% vs. INT 19.2%; P = 0.0222), and intraretinal cysts (CONV 20.8% vs. INT 16.6%; P = 0.0471). In multivariable models, sex, age, smoking, mean updated systolic blood pressure, and history of "clinically significant" macular edema (CSME) and of anti-VEGF treatment were independently associated with changes in central subfield thickness, while HbA1c, BMI, and history of CSME and of ocular surgery were associated with DRIL. Visual acuity (VA) decline was associated with significant thinning of all retinal subfields except for the central and inner nasal subfields. Early intensive glycemic management in T1D is associated with a decreased risk of DRIL. This important morphological abnormality was associated with a history of macular edema, a history of ocular surgery, and worse VA. This study reveals benefits of intensive glycemic management on the retina beyond features detected by fundus photographs and ophthalmoscopy.

Association between obstructive coronary disease and diabetic retinopathy: Cross-sectional study of coronary angiotomography and multimodal retinal imaging

AimsTo investigate the association between diabetic retinopathy (DR) and coronary artery disease (CAD) using coronary angiotomography (CCTA) and multimodal retinal imaging (MMRI) with ultra-widefield retinography and optical coherence tomography angiography and structural domain. MethodsSingle-center, cross-sectional, single-blind. Patients with diabetes who had undergone CCTA underwent MMRI. Uni and multivariate analysis were used to assess the association between CAD and DR and to identify variables independently associated with DR. ResultsWe included 171 patients, 87 CAD and 84 non-CAD. Most CAD patients were males (74 % vs 38 %, P < 0.01), insulin users (52 % vs 38 %, p < 0.01) and revascularized (64 %). They had a higher prevalence of DR (48 % vs 22 %, p = 0.01), microaneurysms (25 % vs 13 %, p = 0.04), intraretinal cysts (22 % vs 8 %, p = 0.01) and areas of reduced capillary density (46 % vs 20 %, p < 0.01). CAD patients also had lower mean vascular density (MVD) (15.7 % vs 16.5,%, p = 0.049) and foveal avascular zone (FAZ) circularity (0.64 ± 0.1 vs 0.69 ± 0.1, p = 0.04). There were significant and negative correlations between Duke coronary score and MVD (r = −0.189; p = 0.03) and FAZ circularity (r = −0,206; p = 0.02). CAD, DM duration and insulin use independently associated with DR. ConclusionsCAD patients had higher prevalence of DR and lower MVD. CAD, DM duration and insulin use were independently associated with DR.

PREDICTIVE FACTORS ASSOCIATED WITH THE VISUAL PROGNOSIS AFTER SURGERY FOR IDIOPATHIC VITREOMACULAR TRACTION.

To investigate the predictive factors for postsurgical visual prognosis in patients with vitreomacular traction (VMT). This retrospective study enrolled 31 eyes from 29 patients who underwent vitrectomy for idiopathic VMT with a follow-up period of ≥3 months. The VMT was divided into three grades based on optical coherence tomography images: Grade 1 denoted partial vitreomacular separation with foveal attachment; Grade 2 exhibited intraretinal cysts or cleft with grade 1 findings; and Grade 3 was Grade 2 plus the subretinal fluid. Three eyes developed a full-thickness macular hole after surgery, all of which were Grade 3 patients. In the rest 28 eyes, the mean postoperative follow-up period was 23.3 ± 25.8 months. The postoperative central foveal thickness ( P = 0.001) and final best-corrected visual acuity (BCVA; P < 0.001) were both significantly improved from baseline. Fifteen eyes (53.8%) gained ≥ two Snellen lines. Multilinear regression analysis showed that the worse the baseline BCVA ( P = 0.004), or the more advanced the VMT grade ( P = 0.049), the worse the final BCVA. Baseline BCVA was negatively associated with the postoperative visual improvement ( P < 0.001). Those Grade 3 patients with baseline Snellen BCVA of ≥20/40 were more likely to achieve a final Snellen BCVA of ≥20/25 ( P = 0.035). The VMT grade is an important predictive factor for the postsurgical visual prognosis. Surgical intervention should be performed as early as possible for Grade 3 patients to prevent further disease progression and maximize the postsurgical visual benefit.

Automatic Identification and Severity Classification of Retinal Biomarkers in SD-OCT Using Dilated Depthwise Separable Convolution ResNet with SVM Classifier

Purpose Diagnosis of Uveitic Macular Edema (UME) using Spectral Domain OCT (SD-OCT) is a promising method for early detection and monitoring of sight-threatening visual impairment. Viewing multiple B-scans and identifying biomarkers is challenging and time-consuming for clinical practitioners. To overcome these challenges, this paper proposes an image classification hybrid framework for predicting the presence of biomarkers such as intraretinal cysts (IRC), hyperreflective foci (HRF), hard exudates (HE) and neurosensory detachment (NSD) in OCT B-scans along with their severity. Methods A dataset of 10880 B-scans from 85 Uveitic patients is collected and graded by two board-certified ophthalmologists for the presence of biomarkers. A novel image classification framework, Dilated Depthwise Separable Convolution ResNet (DDSC-RN) with SVM classifier, is developed to achieve network compression with a larger receptive field that captures both low and high-level features of the biomarkers without loss of classification accuracy. The severity level of each biomarker is predicted from the feature map, extracted by the proposed DDSC-RN network. Results The proposed hybrid model is evaluated using ground truth labels from the hospital. The deep learning model initially, identified the presence of biomarkers in B-scans. It achieved an overall accuracy of 98.64%, which is comparable to the performance of other state-of-the-art models, such as DRN-C-42 and ResNet-34. The SVM classifier then predicted the severity of each biomarker, achieving an overall accuracy of 89.3%. Conclusions A new hybrid model accurately identifies four retinal biomarkers on a tissue map and predicts their severity. The model outperforms other methods for identifying multiple biomarkers in complex OCT B-scans. This helps clinicians to screen multiple B-scans of UME more effectively, leading to better treatment outcomes.

Predicting the effectiveness of organ-preserving treatment of choroidal melanoma using optical coherence tomography data

This study was conducted to identify OCT signs that adversely affect the outcome of organ-preserving CM treatment. OCT scan images of 30 patients who underwent organ-preserving treatment and were under observation were selected for this study. Brachytherapy (BT) as monotherapy was performed in 27 patients (in 2 cases - twice, and in 1 case - three times), in one patient - in combination with the previous transpupillary thermotherapy (TTT). Multiple TTT (4 sessions within 4 months) as monotherapy were performed in 2 patients. In 9 cases, a single organ-preserving treatment (BT - 6 patients, TTT - 3 patients) was ineffective. In these cases, the effectiveness of the first stage of organ-preserving treatment was taken into account. Seven signs of an unfavorable prognosis of the performed treatment were identified by analyzis of tomograms and statistical processing of the obtained data. These signs include: the presence of intraretinal edema, detachment of the neuroepithelium (NED) over the tumor, including with a break in the photoreceptors, accumulation of transudate over the tumor, the presence of large cysts, intraretinal cavities and NED near the tumor (secondary retinal detachment). A combination of three or more signs were observed in all cases of inefficiency of the first stage of treatment. Most often, intraretinal edema and NED over the tumor were combined with the accumulation of subretinal transudate and NED near the tumor. The presence of 6 or all 7 signs took place in cases of a negative therapeutic effect after local destruction. When planning organ-preserving CM treatment, in addition to biometric parameters, it is necessary to pay special attention to the identification of such morphological signs as NED over and near the tumor, accumulation of transudate under the NED, the presence of intraretinal edema, large intraretinal cysts and cavities.

A Case of Vogt-Koyanagi-Harada-like Syndrome Associated with Immunotherapy (Pembrolizumab)

Purpose: To report a case of Vogt-Koyanagi-Harada-like syndrome that occurred during immunotherapy (pembrolizumab) in a patient with non-small-cell lung cancer (NSCLC).Case summary: A 64-year-old female visited our clinic complaining of decreased visual acuity in both eyes. The patient had NSCLC and had been prescribed immunotherapy (pembrolizumab) by the Department of Pulmonology. Fundus examination and optical coherence tomography revealed multiple intraretinal cysts and subretinal fluid in both eyes. After evaluation using fluorescein and indocyanine green angiography, Vogt-Koyanagi-Harada (VKH) disease was diagnosed in both eyes and oral prednisolone 40 mg/day was prescribed for 2 weeks. At an outpatient visit at that time, the symptoms had improved, and fundus examination and optical coherence tomography revealed decreases in the number of intraretinal cysts and the subretinal fluid level. Oral prednisolone was reduced to 20 mg/day for 2 weeks. At an outpatient visit at that time, the symptoms had further improved; no cysts or subretinal fluid were apparent on fundus examination or optical coherence tomography, and only a small amount of subretinal fluid was present near the macula of the right eye.Conclusions: VKH disease may develop during immunotherapy (pembrolizumab) but can be rapidly diagnosed and treated with oral steroids.

Acute Macular Neuroretinopathy after SARS-CoV-2 Infection: An Analysis of Clinical and Multimodal Imaging Characteristics.

This study aimed to analyze clinical and multimodal imaging characteristics of acute macular neuroretinopathy (AMN) post-recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Retrospective observational study. Medical records and multimodal imaging of 12 AMN eyes of eight patients (six female and two male) with recent SARS-CoV-2 infection were retrospectively analyzed. Four patients (50%) presented with bilateral AMN. Fundus ophthalmoscopy revealed a reddish-brown lesion around the macula, and two eyes had cotton-wool spots at the posterior pole. Three eyes showed mild hypo-autofluorescence. All FFA images (7 eyes) showed no abnormal signs. On OCT scans, all eyes showed outer nuclear layer (ONL) thinning, 8 eyes (66.7%) showed ONL hyperreflectivity, 5 eyes (41.7%) showed outer plexiform layer (OPL) hyperreflectivity, 8 eyes (66.7%) showed interdigitation zone (IZ) disruption, 11 eyes (91.6%) showed ellipsoid zone (EZ) disruption, 2 eyes (16.7%) showed cotton-wool spots and inner plexiform layer (IPL) hyperreflectivity, 1 eye (8.3%) had intraretinal cyst and 1 eye (8.3%) had inner nuclear layer (INL) thinning. Persistent scotoma, ONL hyperreflectivity and IZ/EZ disruption as well as recovery of OPL hyperreflectivity were reported after follow-up in three cases. AMN post-SARS-CoV-2 mostly affected young females and could present unilaterally or bilaterally. Dark lesions on IR reflectance and outer retinal hyperreflectivity on OCT are useful in diagnosing AMN. OPL/ONL hyperreflectivity on OCT could disappear after follow-up, but ONL thinning and IZ/EZ could persist.

Abstract 11425: Association Between Obstructive Coronary Disease and Diabetic Retinopathy: A Cross-Sectional Study of Coronary Angiotomography and Digital Retinal Images

Introduction: Diabetic retinopathy (DR) and obstructive coronary artery disease (OCAD) are the main microvascular and macrovascular complications of diabetes mellitus (DM), respectively. The assessment of DR by means of spectral domain optical coherence tomography (SD-OCT) and angiography (OCTA) conferred a remarkable progress. Objective: investigate if SD-OCT and OCTA can detect DR that is associated with OCAD, determined by coronary angiotomography (CCTA) Hypothesis: DR, assessed by OCTA and OCT-SD, is associated with OCAD, assessed by CCTA Methods: In this single-center, cross-sectional, single-blind study, patients with DM who had undergone CCTA in the previous 3 years (independent indication) were eligible. They were divided according to the presence of OCAD in two groups and underwent SD-OCT and OCTA. The association between OCAD and DR was evaluated through uni and multivariate analysis and another analysis was performed to identify variables independently associated with the presence of DR. Results: We included 171 patients, 87 OCAD and 84 without OCAD. Age (66 vs 64 y,p=0.28), DM duration (12 vs 13 y, p=0.5) and HbA1c (7.5% vs 6,9%,p=0.08) did not differ. Patients with OCAD were more frequently men (74% vs 38%, P&lt;0.01), had a higher prevalence of insulin use (52% vs 38%, p&lt;0.01) and 64% had already undergone some type of revascularization. SD-OCT and OCTA revealed a higher prevalence of DR (48% vs 22%,p=0.01). The main findings were: microaneurysms (25% vs 13%,p=0.04), intraretinal cysts (22% vs 8%, p=0.01) and areas of reduced capillary density in the superficial retinal plexus (46% vs 20%,p&lt;0.01).We also found lower mean vascular density (MVD) (15.7 vs 16.5, p=0.049) and lower circularity of the foveal avascular zone(FAZ) (0.64±0.1 vs 0.69±0.1, p= 0.04).There were significant and negative correlations between Duke coronary score and MVD (r=-0.189; p=0.03) and circularity of the FAZ (r=-0,206; p= 0.02). In an adjusted model, presence of OCAD increased the chance of DR (OR 4.05 [1.4 -11.6], p&lt;0.01). OCAD, DM duration and insulin use were independently associated to DR. Conclusions: OCAD was associated with a greater chance of presenting DR. OCAD, longer DM duration and insulin use were independently associated to the presence of DR.

OIMHS: An Optical Coherence Tomography Image Dataset Based on Macular Hole Manual Segmentation

Macular holes, one of the most common macular diseases, require timely treatment. The morphological changes on optical coherence tomography (OCT) images provided an opportunity for direct observation of the disease, and accurate segmentation was needed to identify and quantify the lesions. Developments of such algorithms had been obstructed by a lack of high-quality datasets (the OCT images and the corresponding gold standard macular hole segmentation labels), especially for supervised learning-based segmentation algorithms. In such context, we established a large OCT image macular hole segmentation (OIMHS) dataset with 3859 B-scan images of 119 patients, and each image provided four segmentation labels: retina, macular hole, intraretinal cysts, and choroid. This dataset offered an excellent opportunity for investigating the accuracy and reliability of different segmentation algorithms for macular holes and a new research insight into the further development of clinical research for macular diseases, which included the retina, lesions, and choroid in quantitative analyses.

Biomarkers determining treatment interval of diabetic macular edema after initial resolution by anti-vascular endothelial growth factor.

To identify predictive factors that help determine the interval of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection after the initial resolution of diabetic macular edema (DME). This retrospective case-control study enrolled treatment-naïve DME patients who had achieved DME resolution after intravitreal anti-VEGF injections. Patients were classified into the recurrence and no-recurrence groups, depending on the development of recurrent DME after deferring intravitreal anti-VEGF injection. The demographics and clinical features, including optical coherence tomography findings, were compared between the two groups. We enrolled 105 eyes. Sixty eyes (57.1%) belonged to the no-recurrence group, and 45 (42.9%), belonged to the recurrence group. The severity of diabetic retinopathy at baseline was related to early DME recurrence (P = 0.009). At the treatment deferring point, the non-recurrence group had both thinner central subfield thickness (289.5 ± 27.2μm vs. 307.0 ± 38.2μm, P = 0.011) and thinner central retinal thickness (214.9 ± 41.4μm vs. 231.8 ± 41.2μm, P = 0.043) compared to the recurrence group. Intraretinal cyst was observed in 34 eyes (56.7%) in the no-recurrence group and 42 eyes (93.3%) in the recurrence group at the deferring point (P < 0.001). A low risk of early DME recurrence is anticipated in the eyes with foveal thinning and no intraretinal cyst when anti-VEGF injection is deferred. These predictive biomarkers can be useful for patient monitoring and determining treatment strategies for DME patients.

The Localization of Intraretinal Cysts Has a Clinical Role on the 2-Year Outcome of Neovascular Age-Related Macular Degeneration

To assess the relationship between ≥ 1 localizations of intraretinal fluid (IRF) within retinal layers and the 2-year outcome in a cohort of neovascular age-related macular degeneration (AMD) eyes. Retrospective case series. Two hundred forty-three eyes of 243 AMD patients affected by type 1 and type 2 macular neovascularization (MNV). We analyzed data considering MNV onset, 1-year, and 2-year timepoints. Optical coherence tomography images were used to classify MNV types, distinguish different types of fluids and assess IRF localization within retinal layers. A subcohort of eyes were also analyzed by OCT angiography. The association between IRF cyst localization and both visual outcome and onset of outer retinal atrophy at 2-year follow-up. Macular neovascularizations were distributed as type 1 (69%) and type 2 (31%). The mean number of intravitreal injections was 7 ± 2 at 1-year follow-up and 5 ± 2 at 2-year follow-up. Baseline best-corrected visual acuity was 0.4 ± 0.3 logarithm of the minimum angle of resolution, improving to 0.3 ± 0.4 at 2-year follow-up (P < 0.01). Outer retinal atrophy occurred in 24% of cases at 1 year and 39% of cases at 2-year follow-up. Intraretinal fluid localizations at the level of IPL-INL and OPL-ONL at baseline were associated with the worst functional and anatomical outcome. Moreover, the presence of IRF at baseline was associated with greater impairment of the intraretinal vascular network. The localization of IRF at the level of IPL-INL and OPL-ONL retinal layers represents a negative prognostic biomarker for the morphologic and functional outcomes of neovascular AMD. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.