Subretinal Fluid Research Articles

Clinical Presentation and Treatment Outcomes of Adult-Onset Coats Disease

Purpose: To study the clinical profile, treatment, and outcomes of patients 35 years or older diagnosed with Coats disease. Methods: A cross-sectional observational hospital-based study was performed. Results: The study included 74 eyes diagnosed with adult-onset Coats disease. The mean age at presentation was 50 years (range, 35-75). Most patients were men (72.5%) and had a unilateral presentation (92.8%). The most common stage at presentation was 2A (extrafoveal exudation) (39.2%) followed by 2B (foveal exudation (33.7%). Optical coherence tomography was performed in 40 eyes; 32 eyes (80.0%) had intraretinal fluid (IRF), 31 eyes (77.5%) had hard exudates, and 22 eyes (55.0%) had a disorganized retinal inner layer. Fluorescein angiography was performed in 35 eyes and showed an irregular foveal avascular zone in 28 eyes (80.0%). Multiple leaking microaneurysms were seen in 32 eyes (91.4%), with extensive vascular abnormalities involving the macula (86%) and extramacular zones (91%). Treatment modalities comprised laser photoablation (43.4%), cryotherapy with or without laser application (5.7%), and intravitreal injections (49%), alone or in combination. At a mean follow-up of 28 months (range, 3-293), 23 eyes (39.6%) had anatomic resolution of subretinal fluid and/or IRF. No statistical improvement was found in the mean best-corrected visual acuity (VA) between preoperatively and postoperatively ( P > .05). Conclusions: Patients with adult-onset Coats disease have a unilateral presentation with a less severe stage than patients with childhood-onset disease. Despite the good anatomic responses after treatment, the final VA remained unchanged.

Choroidal macrovessel: literature review and analysis of clinical cases

Introduction. Choroidal macrovessel (CM) is a rare anatomical feature most often detected incidentally. Recent studies suggest an arterial origin of CM, with the majority of authors considering it to be an enlarged short posterior ciliary artery. The literature describes both variants of CM not associated with retinal changes and those complicated by exudative manifestations. Purpose. This study aims to describe two clinical cases of choroidal macrovessel and conduct a differential diagnosis based on literature data with clinically similar conditions. Material and methods. Patients underwent a standard ophthalmologic examination, as well as optical coherence tomography, optical coherence tomography angiography (protocols 10 and 20 degrees), and multispectral laser scanning. Results. We present descriptions of two clinical cases: CM in a patient with choroidal folds and a prominent CM with accompanying subretinal fluid. In both cases, CMs were incidental findings not associated with reduced visual acuity. In the second clinical example, we demonstrate the presence of subretinal fluid in a patient with CM, with no negative progression after one year of observation. For differential diagnosis, an analysis of conditions with similar clinical manifestations was conducted based on literature data. Conclusion. The presented clinical cases illustrate the diversity of CM manifestations. In most cases, the pathology is not associated with retinal structural abnormalities; however, it can cause retinal changes in some patients. Due to its rarity, CM can be considered a poorly studied anatomical feature, warranting dynamic observation upon detection.

Evaluation of the relationship between the real-time changes of macular structure and visual function in patients with rhegmatogenous retinal detachment after silicone oil tamponade

PurposeTo evaluate the relationship between the real-time changes of macular structure and visual function in rhegmatogenous retinal detachment (RRD) patients. MethodsForty-six patients were enrolled in this retrospective study. The best corrected visual acuity (BCVA) and macular structural changes were analyzed within 3 months after silicone oil tamponade. ResultsThe mean final BCVA was significantly better than the preoperative BCVA (P = 0.002). The parafoveal thickness became thinner, the proportion of subretinal fluid (SRF) decreased, and the proportion of intact external limiting membrane (ELM) increased within 3 months postoperatively. The recovery stage and the integrity of ELM in the SRF (-) group were significantly faster than that in the SRF (+) group (all P < 0.05). The central foveal thickness (CFT), the inferior and temporal thickness of the parafovea, and the integrity of the ELM were significantly correlated with BCVA at each time point (all P < 0.05). Long duration of preoperative RRD, thinner CFT at 1 month postoperatively, and without integrity of ELM at 3 months postoperatively were associated with poor final BCVA recovery (R2 = 0.462). ConclusionsThe macular microstructural tended to restore integrity within 3 months. The presence of SRF in macula delayed the recovery of RRD patients but did not affect the visual function.

Resolution of choroidal effusion and serous retinal detachment after PASCAL photocoagulation in a patient with diabetic retinopathy.

To present a rare case of PASCAL photocoagulation-induced choroidal effusion and serous retinal detachment in a patient with diabetic retinopathy. A case report. A 68-year-old man with type 2 diabetes mellitus presented with decreased vision in both eyes. His best corrected visual acuity (BCVA) was 0.39 logMAR units in both eyes. The patient underwent panretinal photocoagulation (PRP) in two quadrants of both eyes on the same day according to his fundus fluorescein angiography. Three days after the first session of PRP, the BCVA in his left eye deteriorated by 2.0 logMAR units. Fundoscopic examination detected a significant choroidal effusion in inferonasal quadrant of the left eye. A macular Spectral-Domain Optical Coherence Tomography (SD-OCT) scan showed a large macular serous retinal detachment in the left eye. Topical steroid, topical cycloplegic, and 64 mg oral methylprednisolone were initiated. Two weeks later, his BCVA returned to the level of the first visit with a completely resolved choroidal effusion and no subretinal fluid. Considering the inflammatory and destructive mechanism of PRP, the laser operator should use the minimum power necessary to avoid possible chorioretinal complications.

Successful treatments of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome-related macular edema and exudation by intravitreal aflibercept injection in a senile patient: A case report.

The prevalence of idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is <1/1,000,000, and it tends to occur in young women. Panretinal photocoagulation, focal laser photocoagulation, peripheral cryopexy, vitrectomy, and corticosteroid therapy are the traditional treatments. We reported a case of a senile patient with IRVAN syndrome who presented with severe exudation in both eyes and macular edema in the left eye, successfully treated by serial intravitreal aflibercept injections. A 77-year-old Taiwanese woman complained of progressive blurred vision in the left eye and ocular examinations revealed a visual acuity of 20/125 in the left eye. Indirect fundoscopy and fluorescein angiography showed bilateral multiple aneurysms, vasculitis, optic nerve staining, and neovascularizations. In addition, optical coherence tomography demonstrated macular edema with subretinal fluid and exudations in the left eye. Monthly intravitreal injections of antivascular endothelial growth factor with aflibercept 2.0 mg were administered in the left eye. The visual acuity in the left eye improved to 20/50 after 18 months of treatment. Macular edema and subretinal fluid regressed. Furthermore, vessel leakage and optic disc staining also improved. This case is the first to demonstrate successful treatment of IRVAN syndrome-related central macular edema and exudations, in the absence of neovascularization, using a series of intravitreal aflibercept injections as monotherapy.

Choroid Involvement Secondary to Optic Disc Pit Maculopathy: OCT Analysis And Evolution After Surgical Treatment: Choroidal Involvement In Optic Pit Maculopathy

PurposeTo assess choroidal changes associated to optic disc pit maculopathy (ODP-M) and their evolution after surgical treatment. DesignMulticentric retrospective case series. MethodsAnalysis of 42 patients affected by unilateral ODP-M undergoing surgical treatment between 2013 and 2023. Optical coherence tomography (OCT) were performed at baseline and postoperative months 1, 6, 12, 24 and most recent follow-up. Subfoveal choroidal thickness (SFCT) and peripapillary choroidal thickness (PPCT) were measured in ODP-M and fellow eyes. The presence of retinal pigmented epithelium (RPE) atrophy was used to distinguish between “early” and “advanced” disease, and data regarding fluid localization were collected. ResultsBaseline SFCT in ODP-M eyes was significantly higher than fellow eyes (386.8±88.9 vs. 334.4±72.2 μm, p=0.002), differently from PPCT (192.6±47.8 vs. 181.2±45.7 μm, p=0.46). SFCT significantly decreased 1 month post-operatively (mean reduction 36.5 μm, p=0.009) and remained below pre-operative values throughout the follow-up, showed a mean reduction of 79.4 μm at final follow-up (p<0.001). Conversely, PPCT showed no changes between pre-operative and post-operative values (all p>0.05). Nine eyes (21.4%) showed submacular dilated choroidal vessels, correlated with the presence of subretinal fluid (p=0.008) and reducing in caliber after surgical treatment. The 10 eyes (23.8%) with “advanced” disease had lower baseline SFCT and worse BCVA compared to the “early” subgroup, and showed a delayed reduction of choroidal swelling post-operatively. ConclusionSubfoveal choroid may thicken and remodel in response to ODP-M, eventually returning to physiological values after surgical treatment. Moreover, the presence of RPE atrophy may influence retino-choroidal balance. Conversely, PPCT didn't show comparable modifications.

Settings and Clinical Applications of Subthreshold Micropulse Laser Therapy: A Review.

Subthreshold lasers operate below the threshold of visible tissue damage, thereby preventing ophthalmoscopically visible thermal damage to the chorio-retinal layers. They could represent a safe and effective alternative and/or adjunctive procedure to conventional lasers in treating diabetic macula edema (DME), central serous chorioretinopathy (CSCR), and branch retina vein occlusion (BRVO). This review focuses on the use of subthreshold micropulse laser (SMPL), its settings, and clinical applications. Despite their widespread use, a standardized protocol for sub-threshold laser settings has not been established yet, and thus, there is uncertainty in selecting effective and safe parameters for any specific situation. We conducted a comprehensive overview of the existing indications for subthreshold laser therapy and their settings for different retinal diseases. The debate revolves around which parameters could guarantee the safety of the procedure for each case, depending on the duty cycle, the laser wavelength, the spot duration, and the power, with laser power titration on one side or choosing a fixed lowered power value on the other side. SMPL therapy for DME, CSCR, and BRVO-associated macular edema has shown significant effectiveness in reducing the macular thickness, facilitating subretinal fluid absorptions, increasing the best corrected visual acuity (BCVA) and reducing the number of intravitreal injections (IVI) required annually. We presented a broad list of the laser parameters reported in the literature, organized into different tables divided based on the specific pathology, with the aim of providing a useful tool for future studies.

Anterior Subtenon Triamcinolone Injection for Refractory Macular Edema: A Retrospective Case Series.

To evaluate the effectiveness of anterior subtenon triamcinolone (AST) injections in the management of refractory macular edema. This is a retrospective case series of consecutive eyes with refractory macular edema treated with AST at a single vitreoretinal surgeon's practice at Toronto Western Hospital, University of Toronto, Canada in 2018-2023. Refractory was defined as persistent macular edema with a central subfield thickness of 250μm or greater over a 24-week period, receiving at least four intravitreal anti-VEGF injections. Vision outcomes and optical coherence tomography features for all eyes were compared for three visits pre-AST treatment and two visits post-AST treatment. Ninety-three patients (119 eyes; diabetic macular edema (26%), and pseudophakic CME (74%), with a mean follow-up duration of 161 days were included. The presence of subretinal fluid (p=0.0013), central subfield macular thickness (p<0.0001), cube average thickness (p=0.0024) and macular cube volume (p= 0.0017) significantly improved from pre-AST to post-AST treatment. Visual acuity also significantly improved from pre-AST treatment to post-AST treatment (p<0.0001). There was no significant change in the intraocular pressures from pre-AST to post-AST (p=0.7920) and no complications were noted throughout the follow-up period. The findings from this study suggest that AST injections show modest improvement in anatomical and functional outcomes, and are safe for the treatment and management of refractory macular edema.

Association of Various Optical Coherence Tomographic Patterns of Diabetic Macular Edema With Central Subfield Thickness and Visual Acuity: A Cross-Sectional Observational Study.

Introduction Diabetic macular edema (DME) is the most common and vision-threatening complication in diabetic patients with diabetic retinopathy (DR), especially in those with Type 2 diabetes mellitus. Optical coherence tomography (OCT) is a reliable tool most commonly used for assessing macular morphology and provides quantitative information on the macula. OCT also examines the outer retinal layers, which can predict visual outcomes. Thus, our study aims to identify the association of various OCT-detected DME morphological patterns with central subfield thickness (CST) and visual acuity. Materials and methods This is a cross-sectional observational study of 50 patients with DME detected on OCT who visited the Ophthalmology Department of Saveetha Medical College and Hospitals for a period of six months, from November 2023 to April 2024. A complete ocular examination, including best corrected visual acuity, scored with the logMAR scale, anterior segment examination, and fundus biomicroscopy using 90D and 78D lenses, was performed. Early Treatment of Diabetic Retinopathy Study (ETDRS) grading of DR into mild to very severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) was noted. Spectral-domain OCT was used to diagnose DME. The CST was measured, and DME was classified into four patterns: sponge-like retinal swelling (SLRS), cystoid macular edema (CME), subretinal fluid (SRF), and posterior hyaloid traction (PHT). Results In the present study, males represented 60%, and females represented 40%. The mean age of the patients was 58.07 ± 6.80 years, with a mean duration of diabetes of 11.91 ± 5.14 years. Of the 50 patients with 100 eyes, only 60 eyes showed DME on OCT. CME was the most common morphological pattern (37%), while the least common pattern was PHT (10%). No significant association was found between a specific morphological pattern and control of diabetes. The most common pattern observed was SLRS in moderate NPDR, CME in severe NPDR, SRF in very severe NPDR, and PHT in PDR. Very severe NPDR patients showed all patterns of DME, and the PHT pattern was observed only in very severe NPDR and PDR. The highest mean CST was observed in the very severe NPDR stage, and the least was in the moderate NPDR stage. The mean CST was highest in SRF patterns and lowest in SLRS patterns. The best mean visual acuity was observed in the SLRS pattern, while the worst mean visual acuity was observed in the SRF pattern, followed by the PHT pattern. Conclusion Our study highlights the importance of OCT in patients with diabetes, as OCT patterns of DME are critical for predicting visual outcomes in DR. Severe grades of DR are usually associated with SRF and PHT patterns. Since patients with SRF and PHT patterns have the worst visual outcomes, these patients, upon identification, need to be counseled about their poor visual prognosis. Those with less severe DR should be closely monitored and advised on effective diabetes control to prevent progression and protect their vision.

Interpretation of SD-OCT imaging data in real-life conditions versus standardized reading centre analysis in eyes with diabetic macular oedema or macular oedema secondary to retinal vein occlusion: 24-month follow-up of the ORCA study.

As part of the prospective, non-interventional OCEAN study, the ORCA module evaluated physicians' spectral domain optical coherence tomography (SD-OCT) image interpretations in the treatment of diabetic macular oedema (DME) or macular oedema (ME) secondary to retinal vein occlusion (RVO). Presence of intraretinal fluid (IRF) and/or subretinal fluid (SRF) was evaluated independently by physicians and reading centres (RCs) on 1612 SD-OCT scans of 133 patients diagnosed with either DME or ME secondary to RVO. Agreement between physicians and RCs was calculated for both cohorts individually and as a combined ME cohort. Physicians' treatment decisions were analysed related to the results of the OCT-evaluations. For the combined ME cohort, presence of IRF/SRF was recorded by RCs in 792/1612 (49.1%) visits and by physicians in 852/1612 (52.9%) visits, with an agreement regarding presence or absence of foveal fluid in 70.4% of cases. In 64.4% (510/792) of visits with RC-detected foveal IRF and/or SRF no injection was given. In 30.3% of these visits with foveal fluid no reason was identified for a 'watch and wait' approach indicating possible undertreatment. BCVA deterioration was seen in a quarter of these eyes at the following visit. Despite good agreement between physicians and RCs to recognize SRF and IRF, our data indicate that omitting injections despite foveal involvement of fluid is frequent in routine clinical practice. This may put patients at risk of undertreatment, which may negatively impact real-life BCVA outcomes. www. gov , identifier NCT02194803.

Anatomic changes in asymptomatic pachychoroid spectrum diseases after cataract surgery

Pachychoroid spectrum disease (PSD) involves various chorioretinal pathologies associated with increased choroidal blood flow. Theoretically, PSD could worsen after cataract surgery since the choroidal thickness tends to increase after surgery. Therefore, we evaluated the prevalence of asymptomatic PSD in patients who underwent cataract surgery and compared the clinical characteristics according to the presence of PSD. The subretinal fluid (SRF) development risk was evaluated using the Cox proportional hazard model. Of 924 eyes, 184 (19.9%) showed asymptomatic PSD. Patients with asymptomatic PSD were older, predominantly male, hyperopic, and showed thicker choroid (P < 0.001, 0.001, < 0.001, and < 0.001). Seven (3.8%) of 184 eyes with asymptomatic PSD developed SRF. The Cox proportional hazard model showed that the flat, irregular pigment epithelial detect (FI-PED; HR 37.337, 95% CI 3.880–359.9300, P = 0.002) was the sole indicator for the SRF development after adjustment of age, sex, and axial length. The SRF-developed PSD group experienced a profound and prolonged increase in the choroidal thickness (P = 0.001, 0.002, and 0.002 at 1, 3, and 12 months). Meticulous preoperative evaluation for FI-PED and postoperative monitoring for choroidal thickness would predict SRF development after cataract surgery in eyes with asymptomatic PSD.

Brolucizumab in patients with neovascular age-related macular degeneration: Real-life outcomes from a tertiary care eye hospital.

To report real-world clinical evidence of brolucizumab in treating neovascular age-related macular degeneration (nAMD). This study included 37 eyes with nAMD treated with intravitreal injections of brolucizumab. The main outcomes were best corrected visual acuity (BCVA) changes, central retinal thickness (CRT), and serious ocular adverse events. Intraretinal fluid (IRF) and subretinal fluid (SRF), subretinal hyperreflective material (SHRM), pigment epithelial detachments (PEDs), hyperreflective foci, macular atrophy, and retinal pigment epithelial tears were evaluated. The mean BCVA of all patients showed a post-treatment value of 0.47 ± 0.33 log of minimum angle of resolution (LogMAR), compared to a baseline measure of 0.50 ± 0.28 LogMAR (P = 0.372). For treatment-naïve patients, a non-statistically significant improvement in BCVA was observed (P = 0.116). Both treatment-naive patients and the entire patient cohort exhibited a statistically significant improvement in the mean CRT after injections. Majority of patients exhibited improvements in optical coherence tomography findings, specifically in the resolution of IRF, SRF, SHRM, and PEDs. Four eyes experienced ocular adverse events in the form of intraocular inflammation. Brolucizumab did not yield a substantial improvement in BCVA, but it exhibited efficacy in reducing CRT in the entire study population and treatment-naive patients with nAMD. Our study identified intraocular inflammation as a significant adverse event with brolucizumab. Thus, precise patient selection, education, and vigilant inflammation monitoring are crucial for patients undergoing this treatment.

Safety and efficacy of subthreshold micropulse yellow laser for persistent subretinal fluid after scleral bucking a randomized clinical trial

Persistent subretinal fluid (PSF) after scleral bucking of rhegmatogenous retinal detachment may delay recovery and affect the final visual quality, but with no effective treatment. This study firstly investigated the safety and efficacy of 577 nm yellow subthreshold micropulse laser (SML) on PSF after scleral bucking surgery. This double-masked randomized clinical trial was conducted from December 2020 to October 2022 at Chongqing Aier Eye Hospital. Participants with PSF last for 1 month after scleral bucking surgery with break closed and retina reattachment were recruitment. These participants were treated by 577 nm yellow SML or sham treatment. Funduscopy, optical coherence tomography (OCT) volume change, best corrected vision acuity (BCVA) and visual field test were evaluated for six mouths follow-up. A total of 24 participants were randomized into SML group or Sham group equally. Compared with Sham group, the OCT volume within 6 mm of macular fovea was significantly less in SML group 6 months after therapy (P = 0.048). There were no statistically significant differences of OCT volume at 1, 2 and 3 months from baseline between groups. BCVA of ETDRS letters had no statistically significant difference. Pattern Standard Deviation amelioration (P = 0.039) had statistically significance in SML group compared with Sham group. There were no complications in the 2 groups. These preliminary findings suggest that 577 nm yellow SML therapy could accelerate PSF absorption after scleral bucking surgery.Trial registration: Chinese Clinical Trial Registry No. ChiCTR2000037838, 02/09/2020, https://www.chictr.org.cn/showproj.html?proj=51885.

Switch to faricimab after initial treatment with aflibercept in eyes with neovascular age-related macular degeneration

PurposeTo investigate the efficacy and outcomes of switching neovascular age-related macular degeneration (nAMD) patients from aflibercept to faricimab, focusing on visual acuity, retinal fluid management, and treatment intervals. The primary aim was to assess the early outcomes in nAMD patients refractory to aflibercept and explore faricimab’s potential as a longer-lasting therapeutic alternative.MethodsA single-center retrospective study was conducted on 50 refractory nAMD patients at Cleveland Clinic Abu Dhabi from September 2022–May 2023. Patients were switched from aflibercept to faricimab, having met specific criteria for refractory nAMD. The study analyzed best-corrected visual acuity (BCVA), central subfield thickness (CST), and fluid changes post-switch, using Optical Coherence Tomography (OCT).ResultsAfter three faricimab injections, significant reductions in CST were observed, with a notable decrease in retinal fluid. The mean BCVA remained stable throughout the study period. Although there was a decrease in the maximum pigment epithelial detachment (PED) height, it was not statistically significant. Treatment intervals post-switch showed that the majority of patients maintained or extended their treatment intervals, with a significant proportion achieving resolution of intraretinal fluid (IRF) and subretinal fluid (SRF).ConclusionsSwitching to faricimab from aflibercept in refractory nAMD patients led to significant improvements in retinal fluid management and CST, with stable BCVA outcomes. Faricimab presents a promising alternative for patients requiring frequent aflibercept injections, potentially offering a more manageable treatment regimen with extended dosing intervals. This study highlights the need for personalized therapeutic strategies in nAMD treatment, though further research is necessary to optimize treatment switches.

Efficacy and Durability of Faricimab in Naïve Eyes with Neovascular Age-Related Macular Degeneration

Introduction: The aim of the study was to evaluate functional and anatomical changes in patients with neovascular age-related macular degeneration (nAMD) treated with a loading dose of faricimab intravitreal injections (IVIs). Methods: Eighteen eyes of 18 patients with active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University G. D’Annunzio, Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI as per label. Enrolled patients underwent complete ophthalmic evaluation, including optical coherence tomography, fluorescein angiography, and indocyanine green angiography. All measurements were evaluated at baseline (T0) and then monthly up to week 20 (T4). Main outcome measures were changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), pigment epithelial detachments (PEDs) presence and maximum height (PED-MH), intraretinal fluid (IRF) presence, subfoveal subretinal fluid (SSRF) presence and thickness. Results: BCVA improved and CMT reduced significantly during follow-up (p < 0.001). In addition, SFCT decreased significantly (p = 0.031). Between T0 and T4, SSRF presence reduced from 55.6 to 16.7% (p = 0.045); IRF presence changed from 50 to 22.2%, respectively (p = 0.074). PED-MH was reduced in 58.8% of patients at T4. At week 20, 72.3% of patients were in the q12/q16 interval. Conclusion: Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of anatomical and functional parameters and a treatment interval after the loading phase equal or greater than 12 weeks in the majority of patients.

Use of a Fundus Image-Based Titration Strategy for Selective Retina Therapy for Central Serous Chorioretinopathy.

Background/Objectives: This study evaluated the clinical outcomes of selective retina therapy (SRT) for treating central serous chorioretinopathy. A fundus image-based titration method was used for laser irradiation. Methods: This retrospective cohort study included 29 eyes (29 patients) that underwent SRT for CSC. Both the pulse energy and number of micropulses were adjusted according to the fundus image. Mean best-corrected visual acuity (BCVA), central foveal thickness (CFT), and subretinal fluid (SRF) height were measured 1, 2, 3, 4, and 6 months after SRT. Mean deviation (MD) was measured using microperimetry at 3 and 6 months post-treatment. Results: At 6 months after SRT treatment, SRF was completely resolved in 89.7% of cases (26/29 eyes). The mean Snellen BCVA significantly improved from 0.34 ± 0.31 logMAR (logarithm of the minimum angle of resolution) (20/40) at baseline to 0.24 ± 0.24 logMAR (20/32) at 6 months (p = 0.009). The 0.1 improvement in mean BCVA is equivalent to a 5-letter gain on the ETDRS chart. The mean CFT decreased significantly from 309.31 ± 81.6 μm at baseline to 211.07 ± 50.21 μm at 6 months (p < 0.001). The mean SRF height also decreased significantly from 138.36 ± 56.78 μm at baseline to 23.75 ± 61.19 μm at 6 months (p < 0.001). The mean MD was improved from -1.56 ± 1.47 dB at baseline to -1.03 ± 2.43 dB at 6 months (p = 0.07) after treatment. Conclusions: SRT using fundus image-based titration can yield favorable functional and anatomical outcomes in the treatment of CSC.

MERLIN: Two-Year Results of Brolucizumab in Participants with Neovascular Age-Related Macular Degeneration and Persistent Retinal Fluid

PurposeTo report the safety and efficacy of brolucizumab (Beovu®) 6 mg vs. aflibercept (Eylea®) 2 mg administered every 4 weeks in participants with neovascular age-related macular degeneration (nAMD) and persistent retinal fluid after the Week 52 primary endpoint analysis (from Week 52 up to Week 104, post-study termination). DesignMulticenter, randomized, double-masked Phase 3a study. ParticipantsParticipants with recalcitrant nAMD (persistent residual retinal fluid despite previous frequent anti-vascular endothelial growth factor treatment). MethodsStudy eyes were randomized 2:1 to intravitreal brolucizumab 6 mg or aflibercept 2 mg every 4 weeks for 100 weeks, or until study termination. Main Outcome MeasuresAll available efficacy (analysis of noninferiority in mean best-corrected visual acuity [BCVA], central subfield thickness [CST], fluid-free status [no intraretinal fluid and no subretinal fluid]), and safety data up to study termination, including data up to Week 104 for those participants who completed the study prior to its termination. All P values after Week 52 were nominal and reflect observed data for the efficacy analyses. ResultsBrolucizumab 6 mg every 4 weeks was noninferior to aflibercept 2 mg in mean BCVA change from baseline to Week 104 (least squares mean difference, -0.4 Early Treatment Diabetic Retinopathy Study letters; 95% confidence interval [CI], -3.7 to 3.0; P = 0.0169). The proportion of eyes with ≥15-letter loss was 6.2% for brolucizumab and 4.7% for aflibercept. (P = 0.0014), and a greater proportion of eyes were fluid free at Week 104 (52.5% brolucizumab vs. 28.2% aflibercept; 95% CI, 11.9−37.3; P < 0.001) in eyes treated with brolucizumab vs. aflibercept. Incidence of intraocular inflammation (IOI), including retinal vasculitis and retinal vascular occlusion, was 11.5% (0.8% and 2.2%) for brolucizumab vs 6.1% (0% and 0.6%) for aflibercept, respectively. ConclusionsConsistent with 52-week results, brolucizumab 6 mg every 4 weeks was noninferior in mean BCVA change with anatomic outcomes superior to aflibercept 2 mg every 4 weeks from baseline to Week 104 or study termination. The incidence of IOI, including retinal vasculitis and retinal vascular occlusion, was higher with brolucizumab vs. aflibercept; therefore, brolucizumab should not be used more frequently than every 8 weeks following the loading regimen.

SUCCESSFUL TREATMENT OF VON HIPPEL-LINDAU DISEASE-ASSOCIATED RETINAL CAPILLARY HEMANGIOBLASTOMA WITH BELZUTIFAN IN A PEDIATRIC PATIENT.

The authors describe a case of a retinal capillary hemangioblastoma (RCH) in a pediatric patient with von Hippel-Lindau (VHL) syndrome that was successfully treated with systemic belzutifan. The clinical course was documented with serial fundus examinations and multimodal imaging, including Optos widefield fundus photography and optical coherence tomography. A literature review was conducted to look for similar cases and/or discussion. A left RCH was noted on a standard VHL surveillance retinal examination of a then 15-year-old male patient with VHL syndrome. Over the course of 17 months, this RCH was treated with focal laser therapy, photodynamic therapy, cryotherapy, bevacizumab injection, and endolaser ablation. Complications of these treatments included subretinal fluid and vitreomacular traction necessitating laser retinopexy, scleral buckle, and pars plana vitrectomy with membrane stripping. After a 6-month interval from the last local therapy (endolaser treatment), there was minimal regression of the lesion, and many concerning features persisted. At 22 months from presentation, the patient started belzutifan 120 mg PO daily with subsequent regression in size and less perfusion to the hemangioblastoma within 4 months. The patient is tolerating the systemic belzutifan with only the expected normocytic anemia and has not required transfusion therapy after 12 months of treatment. von Hippel-Lindau disease is a rare and serious condition associated with multiple types of benign and malignant tumors. Belzutifan is tolerated in the adolescent population and can provide a systemic treatment alternative for VHL-associated RCH.

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

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

Topographical Quantification of Retinal Fluid in Type 3 MNV and Associations With Short-Term Visual Outcomes

PurposeThis study aims to quantify the volume of intraretinal fluid (IRF), subretinal fluid (SRF), and sub-retinal pigment epithelium (sub-RPE) fluid in treatment-naïve Type 3 macular neovascularization (MNV) eyes with age-related macular degeneration (AMD) and to investigate the correlation of these fluid volumes with visual acuity (VA) outcomes at baseline and following anti-vascular endothelial growth factor (VEGF) treatment. DesignRetrospective, clinical cohort study. MethodsIn this study, we analyzed patients diagnosed with exudative AMD and treatment-naïve Type 3 MNV undergoing a loading dose of anti-VEGF therapy. Using a validated deep-learning segmentation strategy, we processed optical coherence tomography (OCT) B-scans to segment and quantify IRF (i.e., both in the inner and outer retina), SRF, and sub-RPE fluid volumes at baseline. The study correlated baseline fluid volumes with baseline and short-term VA outcomes post-loading dose of anti-VEGF injections. ResultsForty-six eyes from 46 patients were included in this study. Visual acuity was 0.51±0.30 LogMAR at baseline and 0.33±0.20 LogMAR after the loading dose of anti-VEGF (p=0.001). Visual acuity at the follow-up visit was 0.40±0.17 LogMAR in patients with no complete resolution of retinal fluid and 0.31±0.20 LogMAR in eyes without retinal fluid after treatment (P=0.225). In the multivariable analysis, the IRF volume in the inner retina (P=0.032) and the distance of the MNV from the fovea (P=0.037) were predictors of visual acuity at baseline. The baseline IRF volume in the inner retina also predicted the visual acuity at follow-up (p=0.023). ConclusionThe present study highlights the fluid volume in the inner retina as a crucial predictor of short-term visual outcomes in Type 3 MNV, underscoring the detrimental effect of IRF on neuroretinal structures.