Macular Patients Research Articles

Comparison of ganglion cell-inner plexiform layer thickness among patients with intermittent exotropia according to fixation preference: a retrospective observational study.

This study was performed to compare the thickness of the ganglion cell-inner plexiform layer (GCIPL) depending on the presence or absence of fixation preference in patients with intermittent exotropia (IXT) with refractive values close to emmetropia and with no amblyopia. The study recruited pediatric patients diagnosed with IXT with a spherical equivalent within ±1.25 diopter and no amblyopia. The patients were categorized into two groups: a monocular exotropia group with fixation preference and an alternating exotropia group without fixation preference. GCIPL thickness was measured using spectral domain optical coherence tomography, and the macula was divided into nine sectors according to the Early Treatment Diabetic Retinopathy Study (ETDRS). GCIPL thickness in each sector was compared between the monocular and alternating exotropia groups. In the monocular exotropia group, GCIPL thickness was significantly thinner in the dominant eye than in the nondominant eye in the S1 sector (91.2±7.4 μm vs. 93.3±5.2 μm, p=0.019). However, in the alternating exotropia group, there were no significant differences between the eyes across all ETDRS sectors. When comparing the interocular differences in GCIPL thickness between the two groups, the monocular exotropia group (absolute value of the dominant eye minus the nondominant eye) exhibited significantly greater differences in several ETDRS sectors than the alternating exotropia group (absolute value of the right eye minus the left eye). The significant interocular difference in GCIPL thickness in the monocular exotropia group suggests that fixation preference may influence the anatomical structure of the macula in patients with IXT.

Evaluation of lamina cribrosa parameters, nerve fiber thickness, and macular thickness in primary open-angle glaucoma and pseudoexfoliation glaucoma using optical coherence tomography.

To evaluate the lamina cribrosa, retinal nerve fiber layer (RNFL), and macula in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) and healthy individuals using enhanced depth imaging (EDI) of spectral-domain optical coherence tomography (SD-OCT). A total of 158 eyes were included in the study, comprising 58 eyes of 29 patients with POAG, 50 eyes of 25 patients with PEXG, and 50 eyes of 25 healthy individuals. The lamina cribrosa thickness (LCT) (at three locations), lamina cribrosa depth (LCD), RNFL thickness, and the macular thickness were measured using the EDI mode of the SD-OCT. The results were compared among the three groups. In both POAG and PEXG groups, the LCT was significantly thinner in the center, mid-superior, and mid-inferior areas in both eyes than in the control group (p < 0.001). However, no statistically significant difference was observed between the POAG and PEXG groups in terms of LCT at all three measurement locations in both eyes (p > 0.05). The LCD was significantly lower in the control group compared to the POAG and PEXG groups (p < 0.05), but there was no significant difference between the POAG and PEXG groups (p > 0.05). The RNFL thickness was significantly lower in both the POAG and PEXG groups compared to the control group in both eyes (p < 0.05). The LCT and LCD of patients with POAG and PEXG were thinner than those of healthy individuals, but there was no significant difference between the patients with POAG and PEXG.

OCT Angiography of the Retina and the Choroid in the Macula in Patients with Normal Tension Glaucoma and Primary Open Angle Glaucoma.

The aim of this study was to compare vessel density (VD) in the retina and choroid in eyes with primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and controls. Patients with POAG, NTG and controls underwent OCT scanning of the macula and the disc followed by 6 × 6 mm macula OCT angiography (OCTA) imaging. Global and hemifield VD were recorded for the superficial (SVP) and deep (DVP) vascular plexus and the choriocapillaris (CC). The OCT thickness of the nerve fiber layer (NFL) and ganglion cell layer (GCC) was also measured. Data from 65 POAG, 33 NTG and 40 control eyes matched for age were analyzed. Mean SVP VD was lower in NTG and POAG eyes compared to controls (38.8 ± 5.3, 40.7 ± 6.8 and 48.5 ± 4.0%, p < 0.001). Mean DVP VD was lower in NTG and POAG eyes compared to controls (43.1 ± 6.1, 44.5 ± 7.6 and 48.6 ± 5.8%, p = 0.002). There was no difference in SVP VD or DVP VD between the glaucoma groups (p > 0.050). No difference was noted in CC VD between the groups (68.3 ± 2.3, 67.6 ± 3.7 and 68.5 ± 2.6%, p = 0.287). Lower SVP and DVP VD was seen in eyes with glaucoma compared to normal eyes. NTG and POAG eyes had similar VD loss. Eyes with glaucoma manifested similar CC VD compared to controls.

Natural History of Visual Acuity and Microperimetry-Based Functional Outcome Measures of the Macula in Patients with Geographic Atrophy: A Retrospective Chart Review Study in Germany.

Background/Objectives: Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) leading to the progressive and irreversible loss of visual function. Characteristics of GA include atrophic lesions resulting from the loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. During GA progression, atrophic lesions typically advance from the macular periphery to the center, affecting foveal light sensitivity and visual acuity. This study analyzed changes in light sensitivity and visual acuity during the natural course of GA progression using the topographic analysis of structural and functional changes based on Early Treatment Diabetic Retinopathy Study (ETDRS) charts, multimodal imaging, and microperimetry assessment. Methods: Medical chart data of GA patients between 2014 and 2022 from the Internationale Innovative Ophthalmochirurgie GbR (I.I.O.) research center (Düsseldorf, Germany) were retrospectively analyzed. All patient eyes fulfilling the phase 3 OAKS study inclusion criteria were included and followed up for 60 months. The imputation of missing measurements and dropouts was performed by linear mixed models. Results: A total of 20 GA eyes from 13 GA patients were included in the study. At the index, 53.8% of patients had bilateral GA, with 70.0% of the eyes showing multifocal GA and 30.0% subfoveal encroachment (SFE). A total of 35.0% of the eyes had 2-5, and 15.0% over 20, areas of atrophy. Over time, the GA lesion size increased from 6.4 mm2 to 11.8 mm2 (1.08 mm2/year). After an average observation time of 2.9 years, 78.6% of the initially unaffected study eyes developed SFE. The percentage of study eyes without visual impairment decreased from 55.0% to 30.0%, with mean normal-luminance best-corrected visual acuity (NL-BCVA) reducing from 63.7 to 55.7 ETDRS letters. The share of absolute scotoma points in microperimetry assessment increased from 15.7% to 43.5% while overall average macular sensitivity declined from 15.7 dB to 7.4 dB. Conclusions: The substantial deterioration of macular outcomes and visual function was comprehensively detected. The results were a documentation of structural and functional aspects of the natural progression of GA for a 60-month follow-up, providing a typical outline for AMD patients with GA.

Factors Affecting Post-Cataract OCT Parameters in Open-Angle and Angle-Closure Glaucoma Eyes: Optic Disc Head Analysis

Purpose: The aim of this study was to investigate whether there are differences in the effects of cataract surgery based on the type of glaucoma and changes in the retinal nerve fiber layer (RNFL) thickness and Bruch's membrane opening-minimum rim width (BMO-MRW) thickness around the optic nerve and macula in patients with glaucoma. Furthermore, the factors influencing these effects were explored.Methods: 68 patients with glaucoma were enrolled, and changes in RNFL thickness and BMO-MRW before and after cataract surgery were measured using SD-OCT. The patients were divided into angle-closure and open-angle glaucoma groups and values before and after cataract surgery were analyzed.Results: The male-female ratio was 26:42, with an average age of 71.72 years at the time of surgery. There were 35 eyes with open-angle glaucoma and 33 eyes with angle-closure glaucoma. After cataract surgery, both RNFL and BMO-MRW values significantly increased. In the angle-closure glaucoma group, preoperative visual acuity was significantly better and RNFL image Q was significantly higher before cataract surgery. In a multivariate linear regression analysis, the factor influencing the increase in RNFL thickness was found to be the preoperative RNFL thickness in both the overall open angle glaucoma group and the angle closure glaucoma group. In other words, patients with thinner RNFL thickness before cataract surgery showed an increase in RNFL thickness after the surgery. In the angle closure glaucoma group, it was observed that worse preoperative visual acuity was associated with an increase in RNFL thickness after surgery. Conversely, no factors affecting BMO-MRW thickness were identified.Conclusions: The factors influencing the increase in RNFL thickness after cataract surgery were the preoperative RNFL thickness in open angle glaucoma group and the preoperative visual acuity in the angle closure glaucoma group.

Comparison of proportional macular thinning in normal and diabetic patients without diabetic retinopathy in tertiary hospital, Bhavnagar – An observational comparative study

Patients with diabetes mellitus are found to exhibit decreasing thickness in the macula with progression of disease severity and consistent elevation in the HbA1C levels. The study compares the thinning of macula in diabetic patients without retinopathy and non-diabetic patients using Optical Coherence Tomography (OCT).This observational cross-sectional design was conducted on 200 eyes of 100 patients, who reported to the tertiary care centre OPD in Bhavnagar. The study group included 50 diabetic individuals without retinopathy and 50 were non diabetic patients as controls. The macular thickness between groups was assessed using OCT. The correlation of CMT values with HbA1C levels were also evaluated in patients with diabetes.The macula thickness in patients with diabetes was found to be thinner when compared to non-diabetic patients (P&amp;#60;0.05), and the thickness of macula increased with a consistent increase in the HbA1C levels in diabetic patients without diabetic retinopathy (P&amp;#60;0.05). OCT remains a promising diagnostic imaging tool in evaluating accurately the thickness of macula in patients with diabetes. According to the study's findings, diabetic individuals without retinopathy at a tertiary care facility in Bhavnagar had thinner macula.

OPTICAL COHERENCE TOMOGRAPHY CHARACTERISTICS OVER TIME IN BEHÇET'S UVEITIS.

To analyze the characteristics of macular optical coherence tomography in patients with Behçet's uveitis (BU). Retrospectively analyzing optical coherence tomography images and clinical data of patients with Behçet's uveitis who visited our hospital from January 2010 to July 2022. One hundred and one patients (174 eyes) were included. We analyzed the development of optical coherence tomography changes in these patients and its relationship with acuity vision and found that cystic macular edema, hyperreflexive retinal spots, inner nuclear layer edema, and outer nuclear layer edema appeared at any time during the disease course. Epiretinal membranes appeared beginning 1 to 2 weeks after onset and worsened over time, and foveal atrophy occurred beginning at 2 to 4 weeks. Foveal atrophy, foveal layers disappear, ellipsoid zone (EZ) disruption, retinal pigment epithelium (RPE) disruption, RPE hyperreflection, and choroidal hyperreflection were correlated with visual acuity. Kaplan‒Meier survival analysis showed at 60 months of follow-up, and almost all patients with foveal atrophy, EZ disruption, RPE disruption, RPE hyperreflection, and choroidal hyperreflection had visual acuity less than logMAR 1.0. EZ disruption and RPE disruption were reversible with aggressive treatment from 4 to 12 months after onset, but was less recoverable after 2 years. In advanced stages, optical coherence tomography manifested as structural disturbances and atrophy of the macular area, highly reflective material deposition in the RPE layer, and a thick macular epimembrane. Optical coherence tomography showed that severe lesions occurred in macula of patients with Behçet's uveitis in early stage. Aggressive treatment can partially reverse it.

Воспроизводимость результатов мануального измерения толщины хориоидеи с помощью спектральной оптической когерентной томографии у пациентов с патологической миопией

Changes in choroidal thickness (CT) may indicate the presence of macular diseases and be used to monitor their course and treatment. Automatic segmentation of the choroid is not currently available, and semi-automatic segmentation is laborious and time-consuming. Purpose. To evaluate the reproducibility of CT manual measurement results using spectraldomain optical coherence tomography (SD-OCT) in patients with pathological myopia. Material and methods. A retrospective analysis of SD-OCT (Optovue RTVue-100) data from the macula of patients with myopic choroidal neovascularization treated with anti-VEGF therapy (ranibizumab, aflibercept) was performed. The study group consisted of 37 patients (43 eyes), incl. 31 women, mean age 53.4 years, mean length of the anterior-posterior axis of the eye – 28.42 mm. Three researchers performed independent measurements of CT in manual mode at five points (subfoveolar, nasal, temporal, upper and lower, located 3 mm from the center of the foveola) before the start of antiangiogenic therapy and in dynamics after 1 year of treatment. Results. CT values before treatment were minimal at the nasal point (mean – 35.5 µm) and increased in the following sequence: lower point (60.9 µm), subfoveolar (74.1 µm), temporal (85.7 µm), upper (91.0 µm). The same ratio of indicators persisted at 12 months after the treatment initiation, however, the absolute values decreased, amounting to 35.1, 56.5, 66.3, 83.7 and 85.8 µm, respectively. Statistical analysis performed using the Kruskal – Wallis test showed a statistically significant (p &lt; 0.05) difference in the data obtained between researchers 1 and 2 in one case, between researchers 2 and 3 in 5 series of measurements; the difference between the results obtained by researchers 1 and 3 did not find statistical confirmation. Conclusion. Our results correspond to the literature data and confirm the importance of CT assessment in patients with degenerative myopia, and manual measurement of the parameter using SD-OCT, due to its simplicity and accessibility, can be used by ophthalmologists to solve daily clinical issues. For a more accurate quantitative assessment of CT in scientific research, it is advisable to use more sensitive and reproducible methods. Keywords: choroidal thickness, spectral-domain optical coherence tomography, manual mode, pathological myopia, myopic choroidal neovascularization

Vascular Changes in the Macula of Patients after Previous Episodes of Vision Loss Due to Leber Hereditary Optic Neuropathy and Non-Arteritic Ischemic Optic Neuropathy.

to assess the vasculature and thickness of the macula using OCT-A in patients who had experienced a previous episode of Leber hereditary optic neuropathy (LHON) or non-arteritic anterior ischemic optic neuropathy (NA-AION). twelve eyes with chronic LHON and ten eyes with chronic NA-AION and eight NA-AION fellow eyes were examined using OCT-A. The vessel density was measured in the superficial and deep plexus of the retina. Moreover, the full and inner thicknesses of the retina were assessed. There were significant differences in all sectors between the groups in regard to the superficial vessel density and the inner and full thicknesses of the retina. The nasal sector of the macular superficial vessel density was affected more in LHON than in NA-AION; the same with the temporal sector of the retinal thickness. There were no significant differences between the groups in the deep vessel plexus. There were no significant differences between the vasculature of the inferior and superior hemifields of the macula in all groups and no correlation with the visual function. The superficial perfusion and structure of the macula assessed with OCT-A are affected both in chronic LHON and NA-AION, but more in LHON eyes, especially in the nasal and temporal sectors.

Reply.

Iwahashi, Chiharu MD1; Matsushita, Itsuka MD2; Kuniyoshi, Kazuki MD1; Kondo, Hiroyuki MD2; Kusaka, Shunji MD1 Author Information

The Function of Retinal Thickness and Microvascular Alterations in the Diagnosis of Systemic Sclerosis.

In this study, we aim to investigate retinal thickness (RT) and superficial vascular density (SVD) differences between patients with systemic sclerosis (SSc) and healthy controls (HCs) by optical coherence tomography angiography (OCTA). Sixteen patients with a definitive SSc diagnosis without clinical signs of retinopathy and 16 normal control subjects were recruited. All individuals underwent OCTA scanning to assess macular RT and SVD. We divided each image into nine subregions as the early treatment diabetic retinopathy study (ETDRS). Visual acuity (VA) was considerably different between patients with SSc (32 eyes) and control subjects (32 eyes) (p < 0.001). Compared to the control group, individuals with SSc had decreased inner RT in inner superior, outer superior, outer temporal, inner temporal, center, and inner nasal regions (p < 0.05). Outer RT was decreased in the outer and inner temporal regions, and full RT was decreased in the regions of outer superior, inner superior, inner temporal, and outer temporal, in comparison to the control group (p < 0.05). Patients with SSc had significant reduction of SVD in the inner and outer of both superior and temporal, besides outer nasal regions than controls. (p < 0.05). Moreover, SVD was significantly associated with the outer temporal region of patients suffering from SSc (p < 0.05). Diagnostic Sensitivity of RT and SVD of Inner Superior Regions in SSc, as indicated by areas under curves of the Receiver Operating Characteristic (ROC), were 0.874 (95% CI: 0.786-0.962) and 0.827 (95% CI: 0.704-0.950), respectively. In conclusion, VA may be affected by RT variations inside the macula in patients with SSc. Measuring RT with OCTA could be a useful predictor of early diagnosis.

Characteristics and significance of outer retinal thickness changes in reticular macular disease

Objective: To study the characteristics and significance of changes in the thickness of the outer retinal layer (ORL) outside the macula in patients with reticular macular disease (RMD). Methods: A cross-sectional study was conducted. The clinical data of patients who visited the Department of Ophthalmology of the First Affiliated Hospital of Guangzhou Medical University from February to September 2019 were retrospectively collected. Thirty-one patients with at least one eye (54 eyes in total) diagnosed with early/mid-stage age-related macular degeneration (AMD) were consecutively included in the AMD group, and 33 patients with at least one eye (64 eyes in total) showing subretinal wart-like deposits on optical coherence tomography images were consecutively included in the RMD group. Thirty-two volunteers aged between 50 to 90 years with a normal fundus in both eyes (64 eyes in total) were consecutively included in the healthy control (HC) group. Frequency domain optical coherence tomography was applied to examine and analyze the thickness features of the ORL, inner retinal layer and choroid at the macular fovea (F), 2 mm of the temporal edge (T), the nasal edge (N), the superior edge (S) and inferior edge (I) of the macular fovea in each group. The correlations of the thickness of ORL with the choroidal thickness and the blood flow density of the choriocapillaris layer in patients with RMD were also analyzed. Results: The thickness of ORL at the F, T, S and I sites in the RMD group was significantly thinner than that in the AMD and HC groups. The difference was most obvious at the F site [(90.27±8.93), (98.04±11.7) and (97.19±7.02)μm] in the RMD, AMD and HC groups, respectively; all P<0.01). In the logistic regression model with independent variables of the ORL thickness at the macular F site, gender and age, there was a significant association between the thickness of ORL at the F site and the incidence of RMD (odds ratio=0.926, P<0.05). The ORL and choroid in the eyes of patients with RMD were significantly thinner at the F site [(90.27±8.93) and (163.21±72.43) μm, respectively; both P<0.01] compared with the AMD [(98.04±11.7) and (235.34±64.15) μm, respectively] and HC [(97.19±7.02) and (240.08±62.27) μm, respectively] groups. However, the ORL and choroidal thickness did not show significant and strong linear correlations at multiple sites. In contrast, there was a significant linear correlation between the blood flow density of the choriocapillaris layer and the thickness of ORL at the F, T and S sites in patients with RMD (r=0.487, 0.722, 0.467, respectively; all P<0.05). Conclusions: The thickness of ORL outside the macula of eyes with RMD is thinner than that of healthy eyes and eyes with early/mid-stage AMD. The thinning of ORL outside the macula is related to the decrease in the blood flow density of the choriocapillaris layer in patients with RMD.

THE ROLE OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH PREECLAMPSIA.

To investigate the changes in the microvascular structure of the retina and optic disk by comparing the optical coherence tomography angiography findings in preeclamptic patients with those in healthy pregnant women and healthy nonpregnant women and also to evaluate the preeclamptic patients after delivery by showing whether the changes are permanent or not. Fifty preeclamptic, 50 healthy pregnant, and 50 healthy nonpregnant women enrolled in three groups (preeclamptic pregnant women group, healthy pregnant women group, and nonpregnant women group; respectively). Patients in the preeclamptic pregnant women group were evaluated at three different time points including up to 3 hours before delivery (Group 1), 2, or 3 days after delivery (Group 2), and 6 weeks after delivery (Group 3), and compared with each other. All patients underwent a comprehensive ophthalmologic examination including optical coherence tomography angiography. Choriocapillaris blood flow area, deep foveal density, deep temporal density, deep nasal density, and radial peripapillary capillary inside disk density values were significantly lower in the preeclamptic pregnant women group than in the healthy pregnant women group. Deep foveal density and deep nasal density values were significantly higher in Group 3 than in Group 1 and 2, and deep temporal density was significantly higher in Group 3 than in Group 1. Optical coherence tomography angiography diagnosed decreased deep retinal capillary density values in the macula of patients with preeclampsia, but these results improved after delivery.

EFFICACY OF INNER WALL RETINECTOMY FOR BULLOUS SCHISIS CAVITY HANGING OVER OR THREATENING THE MACULA IN PATIENTS WITH CONGENITAL X-LINKED RETINOSCHISIS.

To present the clinical characteristics, surgical outcomes, and surgical complications of patients with congenital X-linked retinoschisis who underwent vitrectomy for bullous schisis cavity hanging over or threatening the macula. Nine patients with congenital X-linked retinoschisis (12 eyes) who underwent vitrectomy at three tertiary hospitals and completed ≥3 years of postoperative follow-up were retrospectively investigated. Data were collected from patients' charts, including age at vitrectomy, surgical procedures, and postoperative complications. The age at vitrectomy ranged 4 months to 103 months (median: 14 months). Inner wall retinectomy was performed during the initial vitrectomy in eight eyes. Among the eight eyes that initially underwent inner wall retinectomy, one (12.5%) required subsequent retinal surgery for postoperative complication. Furthermore, four eyes did not undergo initial inner wall retinectomy but required subsequent retinal surgeries for postoperative complications. Three of five eyes (60.0%) treated with silicone oil tamponade and two of seven eyes (28.6%) that were not treated with silicone oil tamponade during the initial vitrectomy required subsequent retinal surgeries for postoperative complications. All eyes maintained a clear central visual axis at the last examination. Inner wall retinectomy seems beneficial in achieving a clear visual axis in eyes with bullous schisis cavity hanging over or threatening the macula in patients with congenital X-linked retinoschisis.

Change in Central Macular Thickness on OCT after Pan Retinal Photocoagulation

Background: Proliferative diabetic retinopathy is the proliferation of retinal neo vessels due to uncontrolled diabetes mellitus and long duration of this disease that leads to advance diabetic eye disease . proliferative diabetic retinopathy is treated by pan retinal photocoagulation which reduces retinal oxygen demand by retinal photocoagulation. Retinal photocoagulation leads to the laser tissue interaction called thermal damage leading to coagulative necrosis of the retinal pigment epithelial cells as these cells contain melanin a dark pigment that has the ability to absorb light energy in argon laser spectrum. Objective: To determine the mean change in central macular thickness after pan retinal photocoagulation on optical coherence tomography of the macula in patients with proliferative diabetic retinopathy . Material &amp; Methods: Our study was a Quasi experimental study conducted at Department of Ophthalmology, Services Hospital Lahore for duration of six months from April 2021 to September 2021. In this study 40 eyes from 40 patients with proliferative diabetic retinopathy were selected who underwent pan retinal photocoagulation in one sessions with 1500 burn marks. Patients in the age group of 15 to 70 years, male and female, with proliferative diabetic retinopathy in at least one eye with no history of ocular surgery or ocular trauma in last one year were included in this study . Optical coherence tomography of macula was performed before and four weeks after the session of pan retinal photocoagulation. CMT (central macular thickness) was measured for mean change in central macular thickness. Results: In this study , the mean age of patients was 48.68±1.52 years, and gender ratio of female to male patients was 1:0.77,The mean CMT before start of treatment that was considered as baseline was 230.55±5.0 and the mean CMT value after four weeks of pan retinal photocoagulation was 238.50±6.43. (p-value=0.001) Conclusion: No significant change in CMT was found from baseline CMT to four weeks after pan retinal photocoagulation. Keywords: Optical coherence tomography, pan retinal photocoagulation, Central Macular Thickness, proliferative diabetic retinopathy

EFFECT OF RANIBIZUMAB AND AFLIBERCEPT ON RETINAL PIGMENT EPITHELIAL DETACHEMENT, SUBRETINAL AND INTRARETINAL FLUID IN AGE-RELATED MACULAR DEGENERATION.

The aim of the study was to compare the effect of three initial doses of the anti-VEGF ranibizumab and aflibercept medication on serous pigment epithelial detachment (PED), subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula of treatment naive neovascular AMD (nvAMD) patients. The cohort consists of 148 patients, of which 74 patients were treated with ranibizumab (51 females and 23 males) and 74 with aflibercept (46 females and 28 males). The data was recorded prospectively from the moment of diagnosis and start of treatment for a period of 3 months. At the moment of diagnosis and 3 months later, an OCT examination (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) was performed. The OCT examination included a macular scan with 25 scans. Using the OCT instrument software, we measured the maximum anterior-posterior elevation of serous PED, the highest thickness of SRF and the largest diameter of the intraretinal cystic space. The statistical significance of differences between groups was evaluated using the t-test for continuous data and the Fisher exact test for categorical data. Changes in values of continuous variables over time were evaluated using the Wilcoxon paired test. Paired comparisons of binary parameters were determined by the McNemar test. Full regression of PED, SRF and IRF occurred in 3 (4.1%), 25 (39%) and 20 (51%) patients treated with ranibizumab, and in 5 (7.9%, p = 0.470), 28 (47%, p = 0.470) and 25 (57%, p = 0.827) patients treated with aflibercept, respectively. The average regression of PED, SRF and IRF was -60.4 &#956;m (median -37.5 &#956;m), -84.3 &#956;m (median -85 &#956;m) and -109.3 &#956;m (median -81 &#956;m) in patients treated with ranibizumab, and -46.3 &#956;m (median -30 &#956;m, p = 0.389), -127.7 &#956;m (median -104 &#956;m, p = 0.096) and -204.4 &#956;m (median -163 &#956;m, p = 0.005) in patients treated with aflibercept, respectively. We did not show a statistically significant difference in the regression rates of PED, SRF and IRF between the ranibizumab and aflibercept groups. (in patients with IRF after adjustment of the higher baseline IRF volumes in patients treated with aflibercept, p = 0.891). We are convinced that ranibizumab and aflibercept have the same effect on serous PED, SRF and IRF in the macula in patients with treatment naive nvAMD during the initial loading phase.

Longitudinal Microstructure Changes of the Retina and Choroid in Retinitis Pigmentosa

To investigate longitudinal changes in the retinal and choroidal microstructure of the macula in patients with retinitis pigmentosa (RP). Retrospective, observational cohort study. A total of 69 patients with RP and 69 age- and sex-matched controls who underwent optical coherence tomography (OCT) over a 4-year follow-up period were included. The severity of RP was classified into 3 stages according to the integrity of the inner segment ellipsoid zone. The retinal and choroidal layers were segmented manually from OCT images. The areas of retinal pigment epithelium (RPE) atrophy and choroidal vascular index (CVI) were also analyzed. Longitudinal changes in the OCT parameters were compared among the groups. Significant decreases (median [interquartile range]) in the thickness of the ganglion cell inner plexiform layer (GCIPL; -1.04 [-2.41 to -0.17]), outer nuclear layer (ONL; -1.44 [-1.86 to -0.28]), and inner segment ellipsoid (ISE; -0.74 [-1.33 to -0.49]) at the moderate stage and retinal nerve fiber layer (RNFL; -1.49 [-2.08 to -0.66]) and GCIPL (0.58 [-1.79 to 0.06]) at the advanced stage were observed. Choroidal thickness decreased significantly from -7.62 to -9.40 μm per year at all stages. RPE atrophy and CVI reduction were observed at the advanced stage. There was no change in the control group. ONL and GCIPL thicknesses decreased at the moderate and advanced stages of RP; RNFL thickness decreased only at the advanced stage; and choroidal thickness decreased continuously. In addition, RPE atrophy and CVI reduction were prominent at the advanced stage. These results indicate that there is a temporal variation in the damage of each retinal layer and the choroid in RP patients.

Fluid Control in Neovascular Age-Related Macular Degeneration with Brolucizumab: An Analysis of the HAWK and HARRIER Phase 3 Trials

Introduction: Neovascular age-related macular degeneration (nAMD) is characterized by exudation of fluid from abnormally growing blood vessels in the macula. Anti-vascular endothelial growth factor (VEGF) therapy is standard treatment for nAMD. Fluid resolution is used both as an indicator of disease control and to guide the frequency of treatment because of anti-VEGF therapy effectiveness in reducing neovascularization-related exudation. Herein reports a post hoc assessment of the HAWK and HARRIER trials comparing the efficacy and safety of brolucizumab with aflibercept in patients with nAMD. Materials and Methods: HAWK randomized 1,078 patients with untreated, active choroidal neovascularization due to AMD in the study eye to receive brolucizumab 3, 6 mg or aflibercept 2 mg. In HARRIER, 739 patients received brolucizumab 6 mg or aflibercept 2 mg. Brolucizumab was injected at weeks 0, 4, and 8, and thereafter q12w unless disease activity was identified (injection interval: q8w). Aflibercept was injected q8w after the loading phase, aligned with approved dosing at study initiation. The objective of this analysis was to assess effects of brolucizumab versus aflibercept on retinal fluid resolution during two phase 3 trials (HAWK and HARRIER) in patients with nAMD. Anatomical assessments for intraretinal fluid (IRF) and subretinal fluid (SRF) were performed every 4 weeks by spectral domain optical coherence tomography. Sustained dryness was defined as a patient being fluid-free (SRF and IRF) on ≥3 consecutive visits. Time to sustained dryness was determined by Kaplan-Meier estimates. Results: At week 96, fluid resolution (absence of IRF and SRF) was achieved by more brolucizumab- (6 mg; 76.1%) versus aflibercept-treated patients (63.1%; p = 0.0002, HAWK); 75.4% versus 61.8% (p < 0.0001, HARRIER). More patients achieved sustained dryness with brolucizumab versus aflibercept: at 96 weeks, 87.9% (brolucizumab 3 mg) and 86.1% (brolucizumab 6 mg) versus 82.0% (aflibercept) in HAWK, and 91.2% (brolucizumab) versus 78.0% (aflibercept) in HARRIER. Sustained dryness was achieved faster and hence with fewer brolucizumab injections. Discussion/Conclusion: Brolucizumab dried the macula in patients with nAMD faster and to a greater degree than aflibercept. Achieving sustained dryness faster, and therefore with fewer injections, provides an opportunity for earlier decisions relating to treatment interval extension potentially reducing treatment burden.

Management of Patients with Thyroid-Associated Ophthalmopathy: Role of Spectral Domain Optical Coherence Tomography

AIM: To demonstrate the changes in optic nerve head (ONH), retinal nerve fiber layer (RNFL) and macula in patients with thyroid-associated ophthalmopathy (TAO) by spectral domain optical coherence tomography (SD-OCT). &#x0D; METHODS: We included forty-one eyes of 41 patients with a diagnosis of TAO and forty-eight eyes of 48 age- and sex-matched healthy subjects (control group) from June 2016 to July 2018. The ONH parameters, RNFL and macular thicknesses in the nine macular quadrants according to ETDRS were measured with SD-OCT. Proptosis level was determined by Hertel exophthalmometer. Clinical activity score (CAS) according to the European Group of Graves' Orbitopathy (EUGOGO) guidelines was determined in all patients. &#x0D; RESULTS: Superior, inferior and average RNFL thicknesses were significantly lower in the TAO group compared to the control group (p &lt; 0.05). Optic disc area was significantly larger in the TAO group. Outer quadrant macular thicknesses and average macular thickness were significantly lower in the TAO group (p &lt; 0.05). CAS had a weak correlation with RNFL thickness and average macular thickness. &#x0D; CONCLUSION: Alterations in RNFL thicknesses and macular thicknesses according to ETDRS template can be detected before the development of ocular symptoms in patients with TAO. OCT is a convenient, non-invasive tool for the evaluation and follow-up of macular structural changes. Patients can be diagnosed at an early stage prior to the development of functional damage. However, the low number of studies investigating this subject and the conflicting findings of existing studies necessitate further studies.

Особенности зрительных функций, их корреляция с показателями ОКТ-ангиографии макулы у пациентов с начальной меланомой хориоидеи

Background: choroidal melanoma is the most common malignancy in ophthalmological practice. However, it is difficult to diagnose its early stages, since patients report non-specific symptoms. A delay in malignant tumor diagnosis is associated with metastasis and fatal outcome. Optical coherence tomography angiography (OCT-A) enables to visualize the ocular fundus microcirculation and, as a result, to achieve an earlier diagnosis of choroidal melanoma. Aim: to describe characteristics of the visual functions and their correlation with ophthalmoscopy and OCT-A findings in patients with small choroidal melanoma. Patients and Methods: the study involved 46 (92 eyes) patients with small choroidal melanoma, 17–84 years old (mean 59.67±14.2). All patients were split into 3 groups based on the tumor size. Group 1 (n=17): a prominence is 1.3±0.3 mm and a basal diameter is 6.8±2.2 mm; group 2 (n=12): a prominence is 1.7±0.4 mm and a basal diameter is 8.3±2.01 mm; group 3 (n=17): a prominence is 2.4±0.74 mm and a basal diameter is 9.75±0.47 mm. The control group consisted of healthy paired-eyes (n=46). Visometry with the evaluation of the uncorrected and maximum-corrected distance visual acuity was performed in all patients. Results: a correlation was found between the decrease in the uncorrected and maximum-corrected distance visual acuity and the tumor size (р&lt;005). According to the OCT-A results, an area and perimeter of the foveolar avascular zone expanded with an increase in tumor size (p&lt;0.05). As shown, a decrease in density of the perfusion and vessels in the superficial and deep capillary plexuses in all quadrants of the perifoveolar zone was associated with the tumor growth (p &lt;0.05). Conclusion: the characterization of visual functions and their correlation with ophthalmoscopy is important for identifying the first signs of choroidal melanoma development. The assessment of OCT-A findings is a unique diagnostic criterion enabling to detect the first signs of macular microvascular disorders accompanying the manifestation and growth of extramacular choroidal melanoma. A timely diagnosis of small choroidal melanoma offers the opportunities of adequate treatment and, ultimately, improves the vital prognosis for patients with malignant tumor. Keywords: visual functions, OCT-angiography, maculopathy, small choroidal melanoma. For citation: Myakoshina E.B., Saakyan S.V. Characteristics of visual functions and their correlation with OCT-angiography of the macula in patients with small choroidal melanoma. Russian Journal of Clinical Ophthalmology. 2022;22(4):216–223 (in Russ.). DOI: 10.32364/2311- 7729-2022-22-4-216-223.