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Purpose To investigate the association between the presence of a cilioretinal artery (CRA) and advanced age-related macular degeneration (AMD), including the prevalence of choroidal neovascularization (CNV) and geographic atrophy (GA). Design Retrospective cross-sectional study. Methods Setting: Single center Patient population: A total of 738 patients with AMD who underwent optical coherence tomography angiography (OCTA) were included in the study. Fundus photographs were reviewed to determine the presence of the CRA. Intervention/observation procedures: In patients with a unilateral CRA, paired tests were performed between eyes with and without the CRA to compare AMD severity and prevalence of CNV and GA. Main outcomes: AMD stage, and prevalence of CNV and GA. Macular vasculature, including vessel density, perfusion density, and foveal avascular zone, examined using OCTA. Results A total of 27.8% and 8.1% of patients had a CRA in one and both eyes, respectively. A total of 174 eyes from 87 patients with a unilateral CRA were examined. Eyes with a CRA showed lower AMD stage (4-step AREDS category; P = 0.037) and a lower prevalence of CNV (23.0% vs. 41.4%; P = 0.024) than those without a CRA. The prevalence of GA and macular vessel density, perfusion density, and foveal avascular zone measured by OCTA were similar in both groups. Conclusions In the eyes with a CRA, AMD stage and prevalence of CNV were lower than those in the eyes without a CRA. However, the effect of the CRA on the macular vascular system remains unclear.

Patients with retinitis pigmentosa have defects in visual function, including the visual field, color vision, contrast sensitivity, and impaired functional vision, such as reading and driving. An assessment of visual function is required when interpreting the outcome of clinical trials of retinitis pigmentosa. Various defects of functional vision should be considered when assessing visual impairment for patients with retinitis pigmentosa.

PURPOSE To evaluate microstructural changes in cystoid macular edema in retinitis pigmentosa after intravitreal dexamethasone implant injection. METHODS In an extended cohort of a randomized trial of intravitreal dexamethasone implant for the management of retinitis pigmentosa-associated cystoid macular edema, microstructural changes during six months after the treatment were evaluated using spectral-domain optical coherence tomography. RESULTS Forty-two eyes were included, and all had cystoid space in the inner nuclear layer (INL) at baseline. No eyes showed subretinal fluid, and 28.6% showed hyperreflective foci. Among 38 eyes with cystoid space both in the INL and outer nuclear layer/Henle's layer, 13 (34.2%) showed complete resolution and 12 (31.6%) showed cystoid space only in the INL at 2 months after injection, whereas others showed persistent cystoid space in both layers. After complete resolution, cystoid space recurrence was earlier in the INL than in the outer nuclear layer/Henle's layer. Multivariable analysis showed that greater cystoid space area in the INL and outer nuclear layer/Henle's layer, presence of macular leakage, and longer intact external limiting membrane at baseline were associated with greater cystoid space area decrease after the treatment. CONCLUSION Resolution and recurrence pattern of retinitis pigmentosa-associated cystoid macular edema after dexamethasone treatment showed that the INL is the primary layer of cystic change, and this suggests its pathogenesis is most likely caused by Muller cell dysfunction.

Purpose To describe the clinical characteristics and treatment outcomes of uveitis in patients with psoriasis in Korea. Methods The medical records of 20 patients (27 eyes) with psoriatic uveitis in two tertiary hospitals were retrospectively reviewed. We analyzed data about patient demographics, uveitis types, laterality, onset of disease, human leukocyte antigen (HLA) types, intraocular pressure, visual acuity, comorbidities, and medical treatments and outcomes for uveitis and psoriasis. Results The cohort comprised 11 males and nine females (age of onset, 50.1 ± 13.2 years) and the mean follow-up period was 3.9 ± 4.0 years. Types of uveitis included anterior (85%), intermediate (10%), and panuveitis (5%). A total of 13 (65%) cases presented with unilateral involvement and 12 out of 18 patients (66.7%) were positive for HLA-B27. The average intraocular pressure of affected eyes was 11.6 ± 3.6 at the first visit and 13.8 ± 3.6 mmHg at the final visit. The average logarithm of the minimum angle of resolution visual acuity of affected eyes at the initial examination was 0.16 ± 0.52 and 0.27 ± 0.71 at the last examination. Most common comorbidity (13 patients, 65%) was psoriatic arthritis (PsA). All cases underwent topical corticosteroid treatment; however, 11 (55%) required systemic corticosteroid and immunosuppressants for the treatment of uveitis. Notable deterioration in visual outcome was found in two cases (10%) due to severe intraocular inflammation and its complications (uveitic glaucoma and bullous keratopathy). Recurrent uveitis was observed in 57.9% of patients. Patients with PsA tended to have higher positive rate of HLA-B27 (83.3%). However, there was no significant correlation between visual prognosis and location of psoriatic uveitis, presence of PsA, and HLA-B27 positivity. Conclusions Psoriatic uveitis in Koreans usually presents with anterior uveitis with unilateral involvement. PsA was the most common comorbidity. In majority of patients, visual outcomes are satisfactory with appropriate topical or systemic immunosuppressive treatment.

Purpose To investigate the indications for scleral buckle removal and the risk factors for the recurrence of rhegmatogenous retinal detachment after scleral buckle removal. Methods In this retrospective study, the medical records of all patients who underwent scleral buckle removal for the treatment of rhegmatogenous retinal detachment were reviewed. Results Forty eyes (40 patients) were included in this study. The indications for scleral buckle removal included exposure without infection in 23 eyes (57.5%), exposure with infection in seven eyes (17.5%), elevated intraocular pressure in six eyes (15.0%), strabismus or diplopia in three eyes (7.5%), and migration of buckle material in one eye (2.5%). After the removal of the scleral buckle, the recurrence of rhegmatogenous retinal detachment was observed in four eyes (10.0%) during follow-up, and the retina was successfully reattached after pars plana vitrectomy in all the eyes. Most clinical and ocular factors of the eyes with and without the recurrence of retinal detachment during follow-up were not different, but the eyes that underwent encircling removal were more likely to have retinal detachment recurrence during follow-up than those that underwent segmental buckle removal (n = 4 / 16 [25.0%] vs. n = 0 / 24 [0.0%]; p = 0.020). Conclusions Scleral buckle removal can result in the recurrence of retinal detachment. The benefits and risks of scleral buckle removal should be carefully considered before surgery, and extensive monitoring during follow-up after scleral buckle removal is important, especially for patients who underwent encircling removal.

To evaluate the efficacy and safety of intravitreal dexamethasone (DEX) implant in retinitis pigmentosa patients with cystoid macular edema (CME).In this randomized, noncontrolled, paired-eye, single crossover clinical trial, one eye of retinitis pigmentosa patients with bilateral CME with central macular thickness of250 µm was randomized to intravitreal DEX implant while the fellow eye was observed. Both eyes were started on topical dorzolamide. At Month 6, DEX implant was eligible for both eyes when CME was250 µm. Patients were followed up until Month 12. Primary outcome measures were the central macular thickness and best-corrected visual acuity changes from baseline at Month 2.Fourteen patients with bilateral RP-CME were included. Study eyes showed significant central macular thickness decrease (median, -147.5 µm; P = 0.001) and best-corrected visual acuity improvement (median, +6 letters; P = 0.001) at Month 2, but not at Month 6. Intravitreal DEX implant at Month 6 produced comparable efficacy to baseline treatment in 11 fellow eyes and 12 study eyes. Topical dorzolamide did not show significant therapeutic efficacy. During 12 months, elevated intraocular pressure of21 mmHg and cataract progression were observed in 14.3% and 40.0% of study eyes.Intravitreal DEX implant can both reduce macular thickness and improve vision in RP-CME, while repeated injection is required.

Purpose: To compare clinical outcomes between a 4-point scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture or a 2-point scleral fixation using Prolene sutureMethods: In this multicenter, retrospective cohort study, patients were enrolled who had undergone a pars plana vitrectomy and either a 4-point scleral fixation using Gore-Tex suture or a 2-point scleral fixation using Prolene suture. Preoperative biometrics, postoperative refractive outcomes, and postoperative surgical complication rates were evaluated.Results: Thirty-seven eyes underwent scleral fixation with Gore-Tex suture, while 44 eyes underwent scleral fixation with Prolene suture. Postoperative best corrected visual acuity was 0.20 (± 0.34) in the Gore-Tex group and 0.21 (± 0.28) in the Prolene group (logMAR, 20/32 on the Snellen scale) (p = 0.691). No significant difference was found in the average prediction error between the Gore-Tex (-0.13 ± 0.68 D) and Prolene (-0.21 ± 1.27 D) groups (p = 0.077). The postoperative complication rate was lower in the Gore-Tex group (17%) than in the Prolene group (41%) (p = 0.023).Conclusion: A 4-point scleral fixation using Gore-Tex suture may be a good alternative to a conventional scleral fixation using Prolene suture for IOL implantations in eyes without capsular support, with a lower risk of postoperative complications.

Purpose: To evaluate subfoveal choroidal thickness (SCT) changes and ocular inflammation after pars plana vitrectomy (PPV) in Vogt-Koyanagi-Harada (VKH) disease.Methods: We analyzed best-corrected visual acuity (BCVA), ocular inflammation, complications, and SCT in 17 eyes of 14 patients with VKH disease who underwent PPV and had ≥12-month follow-up. Main surgical indications included vitreous opacity, epiretinal membrane, and macular hole.Results: Mean BCVA showed significant improvement at all time-points after PPV. Mean SCT significantly increased up until 3 months after PPV (P = .001), but returned to baseline at 12 months and was lower than baseline at the final visit (P = .025). Mean acute uveitis relapse rate decreased after PPV (P = .008). SCT increase was greater in the nine eyes with postoperative uveitis recurrence than in those without (P = .043).Conclusion: Vision improved after PPV in patients with VKH disease. SCT increase in the early postoperative period was associated with uveitis recurrence during follow-up, suggesting that vitrectomy may induce choroiditis after PPV in VKH.

To develop a new classification system for vitreomacular traction (VMT) syndrome according to spectral-domain optical coherence tomography (SD-OCT) imaging and to investigate the clinical course of VMT patients. This study included 68 eyes of 68 consecutive patients who were followed with observation or treated with vitrectomy for idiopathic VMT. Eyes were classified into one of three groups according to SD-OCT findings: group A (foveal pseudocyst, which was defined as the formation of cystoid cavity located in the inner part of the central fovea along with foveal thickening), group B (parafoveal retinoschisis, which was defined as intraretinal cysts or clefts along with no apparent foveal thickening), and group C (outer retinal dehiscence at the fovea, which is sometimes accompanied by foveal thinning). The minimum required follow-up period was 1 year. Clinical course and anatomical and functional outcomes were compared among the groups. Twenty-seven eyes (39.7%) were included in group A, 22 eyes (32.4%) were included in group B, and 19 eyes (27.9%) were included in group C. Among the 24 eyes that were managed by observation, a significantly larger percentage of patients in group A (6/10 [60%]) exhibited more spontaneous resolution of VMT compared with those in groups B (9.1%) or C (0%) (P = 0.010). In the 44 eyes that were managed with vitrectomy, a significantly larger percentage of patients in group C (4/16 [25%]) experienced subsequent full-thickness macular hole development following vitrectomy compared with those in groups B (0%) or C (0%) (P = 0.014). The percentage of patients with photoreceptor inner segment/outer segment disruption was significantly reduced in group A after vitrectomy, with group C exhibiting the lowest recovery rate. Postoperatively, group A experienced a significantly better visual outcome than group C (P = 0.021). A novel configuration system offering insight into the clinical course of VMT is proposed. According to this system, anatomical and functional outcomes were favorable in group A and worse in group C.

PURPOSE To evaluate the impact of posterior staphyloma identified using ultra-widefield fundus imaging on the long-term progression of myopic maculopathy in highly myopic patients. METHODS In this observational cohort study, highly myopic patients who were followed up for at least 5 years using ultra-widefield fundus imaging were analysed for fundus abnormalities and the progression of myopic maculopathy based on the International Meta-analysis of Pathologic Myopia classification. RESULTS This study included 390 eyes (210 patients) with the mean follow-up period of 69.2 ± 7.5 months (range, 60-88). Posterior staphyloma was identified in 198 eyes (50.8%) in the baseline ultra-widefield fundus images. The border of staphyloma was not identified within 50° view circle corresponding to conventional fundus photography in 42 eyes (21.2%) with staphyloma, most of that were wide macular type. Progression of myopic maculopathy during follow-up was observed in 202 eyes (51.8%), and eyes with staphyloma were more likely to show progression compared to those without (142/198 [71.7%] versus 60/192 [31.3%]; p

Background To evaluate whether subretinal or intravitreal injection of human CD34+ bone marrow-derived stem cells (BMSC) can have protective effects on retinal degeneration that may be enhanced by coadministration of exosomes harvested from human bone marrow mesenchymal stem cells (MSCs). Methods Human CD34+ cells were harvested from the mononuclear cell fraction of bone marrow using magnetic beads and labeled with EGFP. Exosomes were harvested from cultured human MSCs under hypoxic conditions. Royal College of Surgeons (RCS) 3-weeks-old rats, immunosuppressed with cyclosporine A, received subretinal or intravitreal injection of CD34+ cells (50,000 cells), CD34+ cells with exosomes (50,000 cells+10 µg), exosomes alone (10 µg), or PBS. Retinal function was examined using electroretinography (ERG), and the eyes were harvested for histologic and immunohistochemical analysis. Results The b-wave amplitude of ERG at 2 weeks after injection was significantly higher in eyes with subretinal or intravitreal CD34+ BMSC alone or in combination with exosomes when compared to PBS injected eyes or untreated contralateral eyes. At 4 weeks after injection, the ERG signal decreased in all groups but eyes with subretinal CD34+ BMSCs alone or combined with exosomes showed partially preserved ERG signal and preservation of the outer nuclear layer of the retina near the injection site on histology when compared to eyes with PBS injection. Immunohistochemical analysis identified the human cells in the outer retina. Subretinal or intravitreal exosome injection had no effect on retinal degeneration when administered alone or in combination with CD34+ cells. Conclusions Both subretinal and intravitreal injection of human CD34+ BMSCs can provide functional rescue of degenerating retina, although the effects were attenuated over time in this rat model. Regional preservation of the outer retina can occur near the subretinal injection site of CD34+ cells. These results suggest that CD34+ cells may have therapeutic potential in retinal degeneration.

Background To date, no genetic analysis of inherited retinal disease (IRD) using whole-exome sequencing (WES) has been conducted in a large-scale Korean cohort. The aim of this study was to characterise the genetic profile of IRD patients in Korea using WES. Methods We performed comprehensive molecular testing in 168 unrelated Korean IRD patients using WES. The potential pathogenicity of candidate variants was assessed using the American College of Medical Genetics and Genomics and the Association for Molecular Pathology variant interpretation guidelines, in silico prediction tools, published literature, and compatibility with known phenotypes or inheritance patterns. Results Causative variants were detected in 86/168 (51.2%) IRD patients, including 58/107 (54.2%) with retinitis pigmentosa, 7/15 (46.7%) with cone and cone-rod dystrophy, 2/3 (66.6%) with Usher syndrome, 1/2 (50.0%) with congenital stationary night blindness, 2/2 (100.0%) with Leber congenital amaurosis, 1/1 (100.0%) with Bietti crystalline dystrophy, 1/1 (100.0%) with Joubert syndrome, 9/10 (90.0%) with Stargardt macular dystrophy, 1/10 (10.0%) with vitelliform macular dystrophy, 1/11 (9.1%) with other forms of macular dystrophy, and 3/4 (75.0%) with choroideraemia. USH2A, ABCA4, and EYS were the most common causative genes associated with IRD. For retinitis pigmentosa, variants of USH2A and EYS were the most common causative gene mutations. Conclusions This study demonstrated the distribution of causative genetic mutations in Korean IRD patients. The data will serve as a reference for future genetic screening and development of treatment modalities for Korean IRD patients.

Purpose To investigate the clinical findings and natural course of patients with pigmented paravenous chorioretinal atrophy (PPCRA) using multimodal imaging. Design Retrospective, observational case series. Methods We reviewed the records of consecutive patients diagnosed with PPCRA at a single center and assessed serial fundus photographs, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography images. Electrophysiological findings and visual field analysis were also reviewed. Results The study included 50 eyes in 25 patients. The mean age of the population was 51.6 ± 14.6 years. Nine patients (36.0%) were asymptomatic and 9 (36.0%) complained of nyctalopia. We divided fundus appearance into one of 3 groups: paravenous (58.0%), focal (16.0%), and confluent (26.0%). Of the 50 eyes, macular involvement was present in 13 eyes (26.0%). Fifteen patients (60.0%) demonstrated a symmetric fundus appearance, whereas 10 (40.0%) had marked asymmetry. Eight eyes (16.0%) exhibited apparent changes in fundus findings, over a mean follow-up period of 8.8 years. FAF imaging was most sensitive to evaluate the extent of lesions. Sixteen eyes (44.4%) showed progressive visual field loss during the follow-up period. Most patients maintained stable vision, and 36 eyes (72.0%) had a final visual acuity of 20/50 or better. Nevertheless, some eyes with macular involvement experienced severe deterioration in vision. Electrophysiological data were variable, and interocular asymmetry was common (45.8%). Conclusions PPCRA can present with a more variable expressivity than previously described. Multimodal imaging can provide insights into its clinical characteristics to facilitate the diagnosis, classification, and follow-up of these patients.

Purpose We explored the protective effects of N-acetylcysteine (NAC) on chorioretinal damage induced by photodynamic therapy (PDT) in an experimental rat model of choroidal neovascularization (CNV). Methods Experimental CNV was induced by an argon laser in 24 Brown Norway rats 7 days prior to PDT. Commencing 1 day after CNV induction, 0.5 mL of NAC was orally administered daily to the NAC + group (12 rats), and 0.5 mL of normal saline to the NAC– group (12 rats). Diode laser treatment was delivered for 42 s (total energy, 25 J/cm2) to the left eye prior to verteporfin infusion (PDT–) and to the right eye 15–20 min after such infusion (PDT+). Fluorescein angiography was performed just prior to PDT and enucleation to evaluate fluorescein leakage and CNV closure. We compared the CNV thickness, PDT-induced apoptosis [evaluated via terminal dUTP nick-end labeling (TUNEL)], fluorescein angiographic data, and extents of immunohistofluorescent staining for cleaved caspase-3 and superoxide dismutase (SOD) between the two groups. Results Fourteen days after diode laser treatment, the CNV closure rate was significantly higher in the PDT-treated than the control group. However, the CNV closure rates did not differ significantly between the NAC– and NAC + groups. The TUNEL activity (a measure of PDT-induced apoptosis) of retinal cells was higher in the NAC–/PDT + than the NAC+/PDT + group at 1, 3, 7, and 14 days. The cleaved caspase-3 and SOD levels were higher in the NAC–/PDT + than the NAC+/PDT + group at 3 and 7 days. Conclusions PDT triggers oxygen radical-induced injury to, and apoptosis in, the retina. NAC may reduce PDT-induced damage to the retina without compromising the therapeutic efficacy of CNV.

Purpose To describe intravitreal ranibizumab treatment frequency, clinical monitoring, and visual outcomes (including mean central retinal thickness [CRT] and visual acuity [VA] changes from baseline) in neovascular age-related macular degeneration (nAMD) in real-world settings across three ranibizumab reimbursement scenarios in the Middle East, North Africa, and the Asia–Pacific region. Methods Non-interventional multicenter historical cohort study of intravitreal ranibizumab use for nAMD in routine clinical practice between April 2010 and April 2013. Eligible patients were diagnosed with nAMD, received at least one intravitreal ranibizumab injection during the study period, and had been observed for a minimum of 1 year (up to 3 years). Reimbursement scenarios were defined as self-paid, partially-reimbursed, and fully-reimbursed. Results More than three-fourths (n = 2521) of the analysis population was partially-reimbursed for ranibizumab, while 16.4% (n = 532) was fully-reimbursed, and 5.8% was self-paid (n = 188). The average annual ranibizumab injection frequency was 4.1 injections in the partially-reimbursed, 4.7 in the fully-reimbursed and 2.6 in the self-paid populations. The average clinical monitoring frequency was estimated to be 6.7 visits/year, with similar frequencies observed across reimbursement categories. On average, patients experienced VA reduction of −0.7 letters and a decrease in CRT of −44.4 μm. The greatest mean CRT change was observed in the self-paid group, with −92.6 μm. Conclusions UNCOVER included a large, heterogeneous ranibizumab-treated nAMD population in real-world settings. Patients in all reimbursement scenarios attained vision stability on average, indicating control of disease activity. Electronic supplementary material The online version of this article (10.1007/s00417-017-3890-8) contains supplementary material, which is available to authorized users.

Background To investigate whether genetic risk variants for age-related macular degeneration (AMD) are associated with response to intravitreal anti-vascular endothelial growth factor (VEGF) in polypoidal choroidal vasculopathy (PCV) patients. Methods This prospective cohort study included 95 treatment-naïve patients that underwent anti-VEGF treatment for PCV for 12 months. Patients were genotyped for 10 single nucleotide polymorphisms in eight AMD-relevant genes. Genotypic association with visual and anatomic outcome measures at 12 months after initial treatment, including mean change in best-corrected visual acuity (BCVA) and total foveal thickness, visual gain of ≥ 15 letters, dry status on optical coherence tomography (OCT), pigment epithelial detachment (PED) regression on OCT, polyp regression on indocyanine green angiography, and injection numbers, were investigated using regression models with adjustment for non-genetic covariates under additive genetic model. Results In 81 patients who completed 12-month anti-VEGF monotherapy without photodynamic therapy, significant pharmacogenetic association was found between ARMS2 rs10490924 and PED regression on OCT. Proportions of PED regression were 26.4% for TT, 45.7% for TG, and 63.6% for GG genotype, showing additive effect of G allele for higher chance of PED regression (OR, 2.96; 95% CI, 1.38–6.36; corrected P = 0.043). For entire 95 patients, no significant association was found between candidate polymorphisms and receiving photodynamic therapy within 12 months. Conclusions In PCV patients, ARMS2 rs10490924 showed association with anatomic therapeutic response to anti-VEGF, suggesting pharmacogenetic relationship. Electronic supplementary material The online version of this article (10.1186/s12886-017-0631-z) contains supplementary material, which is available to authorized users.

Punctate inner choroidopathy (PIC) is a relatively uncommon idiopathic inflammatory multifocal chorioretinopathy, which occurs at the level of the outer retina, retinal pigment epithelium (RPE), and inner choroid. PIC was first described in 1984 by Watzke and colleagues in a series of 10 young myopic women who presented with blurred central vision, photopsia, and paracentral scotomas (Watzke et al. 1984). PIC is considered one of the “white dot syndromes” and is reported as having a considerable overlap with acute zonal occult outer retinopathy (Gass 2003; Ahnood et al. 2017; Francis et al. 2005). The development of various imaging modalities has led to a better understanding of PIC, but whether PIC is truly a separate disease entity or simply a subset of the so-called PIC/MCP spectrum is still controversial (Jampol and Becker 2003; Spaide et al. 2013).

Importance Retinal biomarkers reflecting in vivo brain Alzheimer disease (AD) pathologic abnormalities could be a useful tool for screening cognitively normal (CN) individuals at the preclinical stage of AD. Objectives To investigate the association of both functional and structural alterations of the retina with in vivo AD pathologic abnormalities in CN older adults and model a screening tool for detection of preclinical AD. Design, Setting, and Participants This cross-sectional study included a total of 49 CN individuals, and all assessment was done at the Seoul National University Hospital, Seoul, South Korea. All participants underwent complete ophthalmic examination, including swept-source optical coherence tomography (SS-OCT) and multifocal electroretinogram as well as amyloid-β (Aβ) positron emission tomography and magnetic resonance imaging. Data were collected from January 1, 2016, through October 31, 2017, and analyzed from February 1, 2018, through June 30, 2020. Main Outcomes and Measures For structural parameters of the retina, the thickness of the macula and layer-specific thicknesses, including peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer measured by SS-OCT, were used for analysis. For functional parameters of the retina, implicit time and amplitude of rings 1 to 6 measured by multifocal electroretinogram were used. Results Of the 49 participants, 25 were women (51.0%); mean (SD) age was 70.6 (9.4) years. Compared with 33 CN individuals without Aβ deposition (Aβ−CN), the 16 participants with Aβ (Aβ+CN) showed reduced inner nasal macular thickness (mean [SD], 308.9 [18.4] vs 286.1 [22.5] μm;P = .007) and retinal nerve fiber layer thickness, particularly in the inferior quadrant (133.8 [17.9] vs 103.8 [43.5] μm;P = .003). In addition, the Aβ+CN group showed prolonged implicit time compared with the Aβ−CN group, particularly in ring 5 (41.3 [4.0] vs 38.2 [1.3] milliseconds;P = .002). AD-related neurodegeneration was correlated with the thickness of the ganglion cell-inner plexiform layer only (r = 0.41,P = .005). The model to differentiate the Aβ+CN vs Aβ−CN groups derived from the results showed 90% accuracy. Conclusions and Relevance The findings of this study showing both functional as well as structural changes of retina measured by multifocal electroretinogram and SS-OCT in preclinical AD suggest the potential use of retinal biomarkers as a tool for early detection of in vivo AD pathologic abnormalities in CN older adults.

To identify increased or decreased levels of carboxymethyl lysine (CML)-modified proteins in the plasma of age-related macular degeneration (AMD) patients and age-matched controls for the identification of possible plasma biomarkers of AMD and its progression. Plasma samples from patients with wet AMD with choroidal neovascularization (wAMD group) (n = 10), intermediate dry AMD (dAMD group) (n = 10), and age-matched controls (control group) (n = 10) were immunoprecipitated to select peptides with CML modification. LC-MS/MS was used to identify proteins in each group with CML modification. Among the identified CML enriched proteins, 6 commonly abundant proteins were identified in the plasma. There was no significant difference in amount of these proteins among the three groups, except CML-modified albumin, which was significantly decreased with progressed AMD (P = 0.0015). Five proteins were identified in the control group only, and 10 other proteins were identified in the dAMD group, and 4 other proteins in the wAMD group. Proteins involved in inflammatory responses and immunologic response were found to contain CML in the less advanced dAMD group. In the more advanced wAMD group, intracellular proteins associated with transcription or molecular activation associated with angiogenesis or blood vessel formation were found to be altered with CML. Proteins involved in inflammatory and immunologic response were CML-modified in earlier dry AMD while proteins associated with angiogenesis and blood vessel formation were CML-modified in advanced wet AMD, suggesting the possible role of oxidative change of proteins with different functions as the pathophysiology of the development and progression of AMD.

Purpose: To study the clinical features of endogenous endophthalmitis (EE) in sample patient populations from the USA and South Korea over an 8-year period.Methods: We reviewed data from 128 eyes of 60 American and 48 Korean patients diagnosed with EE and compared their clinical characteristics.Results: Fungemia and liver abscess were the most common extraocular infection sources among American (26.7%) and Korean patients (33.3%), respectively. Klebsiella pneumoniae and Candida species were the most common pathogens of EE in the Korean and the American patients, respectively. Endophthalmitis caused by fungi had a better visual prognosis than that caused by bacteria (p = 0.001). Vitrectomy was beneficial for eyes with EE due to virulent bacteria presenting with worse than counting finger vision.Conclusions: The predisposing conditions and responsible organisms for EE vary in different regions of the world. The visual prognosis was strongly influenced by the underlying pathogen.

Purpose: Smartphone use has dramatically increased in recent years. Smartphones may have adverse health effects, particularly on the eyes, because users stare at the screen for a much longer time than they do with ordinary mobile phones. The objective of this study was to elucidate the relationship between smartphone use and ocular symptoms among adolescents. Methods: Information on smartphone use and ocular symptoms (blurring, redness, visual disturbance, secretion, inflammation, lacrimation and dryness) related to eye fatigue and strain from 715 adolescent subjects from three cities in Korea was obtained using a structured questionnaire. Ocular health was scored using number of ocular symptoms. Odds ratios (ORs), 95% confidence intervals (95% CIs) and p-values for ocular symptoms were calculated with binomial and multinomial logistic regression models. Results: Higher prevalence rates for ocular symptoms were observed in groups with greater exposure to smartphones (p < 0.05). Longer daily smartphone use was associated with a higher likelihood of having multiple ocular symptoms (5–7 symptoms out of 7 symptoms; p = 0.005). Excessive/intermittent use (>2 hours daily and ≤2 hours continuously) and excessive/persistent use (>2 hours daily and >2 hours continuously) compared to shorter use (p = 0.001). Conclusion: Increasing exposure to smartphones can have a negative impact on ocular health in adolescents.

PurposeVitreous vitamin C, as an anti-oxidant, is responsible for regulating oxygen tension and oxidative stress in the eye. Oxidative stress and retinal ischemia are implicated in the development of proliferative diabetic retinopathy (PDR). In this study, we aimed to determine whether vitreous level of vitamin C is compromised in patients with PDR and to investigate the association of diabetic macular ischemia and vitamin C.MethodsThis prospective study enrolled forty patients who underwent pars plana vitrectomy for the treatment of PDR (PDR group, n = 20) and idiopathic epiretinal membrane (control group, n = 20). Serum, aqueous humor, and the vitreous were collected for the analysis of vitamin C level by HPLC. Diabetic macular ischemia (DMI) in PDR group was evaluated with fluorescein angiography (FA).ResultsPDR patients (60.4 ± 2.1 y) were younger than non-diabetic control patients (67.4 ± 1.2 y). Serum, aqueous, and vitreous levels of vitamin C in PDR were 38.7%, 22.5%, and 11.1% of non-diabetic control group, respectively. All PDR patients had DMI (grade 1: 25%, grade 2: 30%, grade 3: 30%, grade 4: 15%). DMI grade was inversely correlated with the level of vitreous vitamin C (r = -0.546, P = 0.019), not with HbA1C, serum, or aqueous vitamin C level. In addition, the level of vitreous vitamin C (4.5 ± 2.6 μg/ml) in high DMI group (Gr 3 &4) was lower than that (31.0 ± 9.1 μg/ml) in low DMI group (Gr 1&2) (P = 0.015).ConclusionsVitreous level of vitamin C in PDR patients showed a tenfold decrease, which was associated with the degree of macular ischemia. This suggests that vitreous vitamin C depletion may cause macula ischemia in PDR patients.

Purpose: To analyse the intraocular pressure rise after intravitreal dexamethasone implant (Ozurdex) amongst different geographic populations. Methods: The medical charts of 294 dexamethasone implants between February 2011 and 2017 were reviewed retrospectively. South Asian (India), White (Europe, US and Israel) Latino (Argentina and Brazil) patient data was included in the study. Ocular hypertension (OHT) was defined as intraocular pressure of >25 mmHg or an increase of at least 10 mmHg from baseline. The main indications for treatment were diabetic macular edema (ME) (65.6%), retinal vein occlusion (26.5%), uveitis (7.8%). Results: Amongst 294 intravitreal implants, ocular hypertension (>25 mmHg) was recorded in 0, 8 and 9.5% in White, Latino, and South Asian groups, respectively. However, IOP > 20 mmHg was recorded in 14%, 28% and 27% in White, Latino, and South Asian groups, respectively. Incidence of very high IOP (>35 mmHg) was lower in all geographical groups. It was 3% in Latino followed by 2% in South Asian group. Conclusion: Latino and South Asian groups have higher IOP rise compared to White population. Most patients with elevated IOP fluctuate between 20–25 mmHg.

Vitelliform macular dystrophy (VMD) is a group of macular dystrophy characterized by the subretinal accumulation of yellow yolk-like materials which predominantly affect the macula. Best vitelliform macular dystrophy is among the most common autosomal dominant (AD) retinal dystrophy, caused by mutations in the BEST1 gene. Since first identification of BEST1 gene in 1998, molecular biology and pathophysiology of BEST1 gene and vitelliform macular dystrophy were studied. Recent advances in genetic analysis have described over 200 different human BEST1 mutations to date, associated with a broad spectrum of ocular diseases, called bestrophinopathy. However, the genotype-phenotype correlation in VMD is largely unexplored. Genetic test is clinically important in the diagnosis of VMD because the clinical features of VMD are similar to those of exudative age-related macular degeneration (AMD), choroidal neovascularization (CNV), or central serous chorioretinopathy (CSC). Here, in addition to describing the clinical characteristics of VMD, this chapter focuses on the clinical genetics of BEST1 gene in VMD.

Purpose: To evaluate the effect of dexamethasone intravitreal implant for macular edema (ME) following branch retinal vein occlusion (BRVO) in Korean patients. Methods: We performed a prospective, open-label, multicenter study of 71 patients with ME for < 3 months. Retreatment was allowed ≥4 months from the last injection. Results: At 6 and 12 months, mean ± SD best-corrected visual acuity (BCVA) improvement was 18.6 ± 12.9 and 15.3 ± 15.0 letters, respectively. Approximately 70% of maximum treatment response was observed after 1 week. Over the 12-month period, 32 and 49% of patients received 1 and 3 injections, respectively, with a mean ± SD interval of 20.0 ± 5.0 weeks. Patients who required 3 injections had higher central retinal thickness (CRT) and larger macular nonperfusion at baseline compared to those requiring only 1 injection. Adverse events included increased intraocular pressure (35%) and newly diagnosed cataract (16%). Conclusions: Intravitreal dexamethasone treatment with an interval of ≥4 months provides rapid and significantly better improvement in BCVA and CRT in patients with BRVO-associated ME.

To investigate the choroidal thickness changes in eyes with retinal vein occlusion (RVO) and to determine the effect of an intravitreal dexamethasone implant (Ozurdex) on choroidal thickness.This study comprised 47 patients diagnosed with unilateral, RVO-associated macular oedema (MO) and treated with Ozurdex. Baseline subfoveal choroidal thickness (SFCT) and central macular thickness (CMT) of the RVO eyes were compared with those of the normal contralateral eyes; serial changes in this parameter were evaluated at 1, 3 and 5 months after Ozurdex injection. The correlation between SFCT and CMT and between visual acuity change and SFCT or CMT changes were also investigated.The mean SFCT was significantly higher in RVO eyes at baseline (260.3 ± 71.2 μm) than it was in contralateral eyes (217.6 ± 55.3 μm; p0.001). While the mean SFCT decreased at 1 and 3 months after Ozurdex injection, it slightly increased at month 5. The change in SFCT was significantly associated with the change in CMT at 3 months (r = 0.5073; p = 0.0006) and 5 months after Ozurdex injection (r = 0.3489; p = 0.0274). The improvement in visual acuity was significantly correlated with the decrease in SFCT (r = 0.3241; p = 0.0413).SFCT in eyes with RVO was significantly greater than it was in normal contralateral eyes. After Ozurdex injection, SFCT decreased significantly. Improvement in visual acuity was correlated with the decrease in SFCT after Ozurdex injection.

Background To evaluate the efficacy of intravitreal ranibizumab for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) with combined severe diabetic retinopathy (DR). Methods This retrospective, interventional case series included eleven patients (mean age, 70.09 years; range, 54 to 83 years) with at least severe non-proliferative DR and subfoveal CNV secondary to AMD. Each subject was treated with intravitreal injections of 0.5 mg ranibizumab. The primary outcomes included change in best-corrected visual acuity and central subfield thickness (CST) on optical coherence tomography (OCT). Results The mean follow-up time was 16.7±14 months (range, 6 to 31 months). Mean visual acuity improved from 1.21±0.80 logarithm of the minimum angle of resolution (logMAR) to 1.0±0.6 logMAR (P=0.107), 0.95±0.62 logMAR (P=0.044), 1.10±0.68 logMAR (P=0.296), and 1.13±0.66 logMAR (P=0.838) at 1, 3, 6, and 12 months after injection, respectively. Eight patients (72.7%) gained or maintained vision (mean 0.32 logMAR), whereas three patients (27.3%) lost more than one line of vision (mean 0.51 logMAR). The mean OCT CST was 343.9±134.6 µm at baseline, and the mean CST at 1, 3, 6, 12 months after the injection was 367.8±172.1 (P=0.864), 346.2±246.2 (P=0.857), 342±194.1 (P=0.551), and 294.2±108.3 µm (P=0.621), respectively. Conclusion Intravitreal ranibizumab injection can be considered to be a therapy for the stabilization of subfoveal CNV secondary to AMD with combined severe DR. However, these patients might exhibit limited visual improvement after treatment.

Retrospective review of 13 eyes that had undergone pars plana vitrectomy (PPV) for vitreomacular traction (VMT) syndrome in retinitis pigmentosa (RP) and had a postoperative follow-up period ≥9mo in order to evaluate whether it is necessary to treat VMT in RP by vitrectomy. The 13 RP eyes suffering from VMT were evaluated by means of best corrected visual acuity (BCVA), anterior and posterior binocular examination, spectral-domain optical coherence tomography (SD-OCT) before and after operation. We detected that although vitrectomy could improve the macular morphology in some RP patients with VMT, visual outcomes might be limited and unpredicted most likely because of the long-standing retinal dysfunction, but the vitrectomy is necessary in order to remain or improve the central vision in some cases.

PURPOSE To evaluate the rate of progressive macular ganglion cell-inner plexiform layer (GCIPL) thinning in patients with open-angle glaucoma (OAG) who had been treated with intravitreal antivascular endothelial growth factor (VEGF) injection for wet age-related macular degeneration (AMD). METHODS This study was a retrospective modified case control study with fellow eye comparison. We enrolled bilateral OAG patients who had been treated with repeated anti-VEGF injections for unilateral wet AMD and followed-up on for a minimum of 24 months by Cirrus high-definition optical coherence tomography. The rate of macular GCIPL thinning was determined by linear regression of serial optical coherence tomography GCIPL thickness measurements over time. We compared the rate of macular GCIPL thinning between anti-VEGF-treated eyes and fellow untreated dry AMD eyes. RESULTS This study involved 32 OAG eyes of 16 subjects. The total follow-up period was 58.4±25.5 (24 to 98) months, and the mean number of anti-VEGF injections was 10.6±10.4 (3 to 40). The eyes with repeated anti-VEGF treatment differed significantly from their fellow eyes in the rate of GCIPL thinning (-2.95±3.58 vs. -0.77±0.95 µm/y, P=0.015). Also, multivariable regression analyses showed that anti-VEGF injection was significantly associated with the rate of GCIPL thinning (P=0.025). CONCLUSIONS In subjects with bilateral OAG, the rate of GCIPL thinning is significantly faster in eyes treated with anti-VEGF injection for wet AMD than in untreated dry AMD fellow eyes. This finding suggests that in glaucomatous eyes, VEGF inhibition could play a role, at least in part, in progressive change of inner retinal layers.

Purpose To investigate the prevalence of vitreopapillary traction (VPT) and its effect on peripapillary structure and visual function in eyes with idiopathic epiretinal membrane (ERM). Design Observational, comparative study. Participants Patients with idiopathic ERM (n = 116 eyes) and controls with similar age (n = 62 eyes). Methods Spectral domain optical coherence tomography (SD-OCT) axial optic disc scans were evaluated to identify VPT in eyes with idiopathic ERM. Based on VPT presence/absence, eyes were categorized as ERM with VPT (ERM +VPT , n = 52 eyes) or ERM without VPT (ERM −VPT , n = 64 eyes). Optic nerve head (ONH) parameters, average and sectoral retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) were compared between groups. Best-corrected visual acuity (BCVA) and visual field (VF) (automated Humphrey central 30-2 perimetry) mean deviation (MD) and pattern standard deviation (PSD) were compared between groups. Main Outcome Measures The ONH parameters, peripapillary RNFL thickness, BCVA, VF MD, and PSD. Results Fifty-two of 116 eyes (44.8%) with idiopathic ERM had VPT. The ERM +VPT group had larger rim area, smaller average and vertical cup-to-disc ratios, and smaller cup volume than ERM −VPT and normal groups (all P P = 0.006). Average and temporal RNFL thickness was higher in ERM +VPT (98.64±9.33 μm and 93.90±23.42 μm) than in normal eyes (94.02±8.45 μm and 66.42±12.71 μm). No significant difference in BCVA was found between ERM −VPT and ERM +VPT eyes, but MD was lower in ERM +VPT than in ERM −VPT (−3.91±3.68 dB vs. −2.18±2.42 dB; P = 0.005). Additionally, PSD was greater in ERM +VPT . Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.190; P = 0.014) and increased CMT (OR, 1.013; P = 0.005) were associated with vision loss, whereas VPT presence was associated with VF defects (OR, 6.290; P = 0.024). Conclusions Vitreopapillary traction was observed in >40% of eyes with idiopathic ERM, as confirmed by SD-OCT imaging. Vitreopapillary traction with idiopathic ERM was associated with altered optic disc architecture, increased average and temporal RNFL thickness, and VF defects.

A 53-year-old woman presented with complaints of blurred vision in the left eye. She had been treated for recurrent non-functioning pituitary adenoma (NFPA). A vitreous biopsy followed by histopathologic examination showed the presence of Candida albicans. Meanwhile, Cushing׳s disease was diagnosed and gamma knife surgery was performed. Vitrectomy and antifungal treatment improved ocular infection and inflammation. Herein, we describe the first case of C. albicans endophthalmitis in a patient with NFPA evolving into Cushing׳s disease.

To determine the risk factors for intraocular involvement in patients with primary central nervous system lymphoma (PCNSL), a retrospective chart review was performed on 136 patients who were pathologically diagnosed with PCNSL. The patients were investigated for demographics, clinical manifestation, and the profile of immunohistochemical tumor biomarkers, as well as for the presence of intraocular involvement of lymphoma at diagnosis or during follow-up. The mean age of the entire cohort was 58.6 ± 12.4 years, and the mean follow-up period was 31.1 ± 30.8 months. Twenty-nine (21 %) patients had an intraocular involvement, among which 20 (69 %) patients presented with intraocular involvement at diagnosis of PCNSL and 9 (31 %) patients developed intraocular involvement after a mean period of 32.4 ± 33.6 months. Of the patients with intraocular involvement, 8 (28 %) had no visual symptom at the diagnosis of ocular invasion. Between those with and without intraocular involvement, no significant differences were found with respect to the age, sex, and follow-up period as well as cerebrospinal fluid spread and bone marrow involvement. Among the immunohistochemical biomarkers, the Ki-67 proliferation index was significantly higher in patients with intraocular involvement than in patients without (P = 0.021), but the other investigated biomarkers did not show a significant difference between the two groups. A Ki-67 level ≥80 % was a risk factor for the intraocular involvement in patients with PCNSL (odds ratio, 2.63). Median overall survival was 39.0 months in the entire cohort and was not significantly different between those with and without intraocular involvement (P = 0.959).

Purpose To investigate postoperative macular ganglion cell-inner plexiform layer (GCIPL) thickness, determine the factors related to GCIPL thickness, and evaluate the association of GCIPL thickness with postoperative visual outcomes in patients with idiopathic epiretinal membrane (ERM). Design Retrospective, cohort study. Participants Sixty-two patients with unilateral idiopathic ERM who were followed for ≥6 months after surgery. Methods Ophthalmologic evaluations included best-corrected visual acuity (BCVA) assessment, spectral-domain optical coherence tomography, and macular visual field (VF) mean sensitivity (MS) as measured by Humphrey VF test. Macular GCIPL thickness in eyes with ERM was compared with that of the normal contralateral eyes 6 months after surgery. The correlation between the interocular difference in GCIPL thickness and postoperative visual outcome was evaluated. Main Outcome Measures Postoperative macular GCIPL thickness, factors related to the interocular differences in GCIPL thickness, and correlations of GCIPL thickness with BCVA and macular VF MS 6 months after surgery. Results Macular GCIPL thickness was significantly lower in eyes with ERM 6 months after surgery (71.77±10.21 μm) than in the unaffected contralateral eyes (81.69±5.33 μm; P P = 0.179). Preoperative central foveal thickness was the only factor significantly correlated with interocular differences in macular GCIPL thickness ( r = 0.3677; P = 0.0033). Among patients with intact photoreceptor layers, a greater decrease in GCIPL thickness was correlated with a worse postoperative BCVA ( r = 0.5209; P r = −0.2845; P = 0.0390). Conclusions Macular GCIPL thickness decreased after vitrectomy to remove an idiopathic ERM. The decrease in GCIPL thickness was significantly correlated with postoperative visual outcomes in patients with intact photoreceptor layers.

Choroidal neovascularisation (CNV) is a common vision-threatening complication of myopia and pathological myopia. Despite significant advances in understanding the epidemiology, pathogenesis and natural history of myopic CNV, there is no standard definition of myopic CNV and its relationship to axial length and other myopic degenerative changes. Several treatments are available to ophthalmologists, but with the advent of new therapies there is a need for further consensus and clinical management recommendations. Verteporfin photodynamic therapy has been an established treatment for subfoveal myopic CNV for many years, but this treatment does not restore visual acuity and is associated with long-term chorioretinal atrophy. More recently, clinical trials investigating the efficacy and safety of anti-vascular endothelial growth factor agents in patients with myopic CNV have demonstrated substantial visual acuity gains and quality of life increases compared with photodynamic therapy. These enhanced outcomes provide updated evidence-based clinical management guidelines of myopic CNV, and increase the need for a generally accepted definition for myopic CNV. This review critically summarises the latest myopic CNV literature in the context of clinical experience and recommends a myopic CNV treatment algorithm.

Purpose: To evaluate the efficacy of combined trabeculectomy (TLE) and 25-gauge transconjunctival sutureless vitrectomy (TSV-25) for uveitis patients.Methods: Combined TSV-25/TLE was performed in 9 eyes of 6 patients with vitreoretinal complications and intractable glaucoma. Visual acuity, intraocular pressure (IOP), inflammatory control, and number of hypotensive medications were evaluated.Results: Visual acuity improved in 7 of 9 eyes and inflammation was controlled with a decreased oral anti-inflammatory agent dosage in all eyes. Mean IOP, which was 28.11 ± 4.83 mmHg preoperatively, was significantly reduced (15.77 ± 2.68 mmHg) 5 years after surgery (p = 0.008). The mean number of IOP-lowering medications was 3.33 ± 0.71 before surgery and 1.11 ± 0.92 5 years after surgery (p = 0.007). Two eyes required implant of an Ahmed drainage valve during the follow-up period.Conclusion: Combined TSV-25/TLE can be effective in managing vitreoretinal complications and elevated IOP in uveitis patients.

To investigate the association between genetic risk variants for age-related macular degeneration (AMD) and response to intravitreal ranibizumab in Korean patients with neovascular AMD.This prospective study included 273 treatment-naive patients (273 eyes) who underwent 5 monthly injections (Months 0, 1, 2, 3, and 4) of intravitreal ranibizumab for neovascular AMD. Patients were genotyped for 23 single-nucleotide polymorphisms within 12 AMD-relevant genes. For each polymorphism, genotypic association with good response at Month 5, predetermined as visual improvement of ≥ 8 Early Treatment Diabetic Retinopathy Study letters from baseline, was investigated with logistic regression analysis adjusted for age, gender, smoking, baseline Early Treatment Diabetic Retinopathy Study letter, central retinal thickness, lesion area, and type of choroidal neovascularization.At Month 5, visual acuity improved by 9.1 ± 17.6 letters from baseline, and 136 patients (49.8%) were classified as good responders. In logistic regression, no tested polymorphism showed statistically significant association with favorable visual outcome at Month 5. When unadjusted for multiple tests, AA genotype for VEGF rs699947 had an increased chance of good response compared with other genotypes (odds ratio, 3.61; 95% confidence interval, 1.42-9.18; P = 0.0071).In this Korean neovascular AMD cohort, there was no statistically significant effect of genotype on early visual outcome after ranibizumab treatment.

To examine the prognostic factors for visual outcome in Korean BD patients with uveitis.Seventy-seven Korean BD patients with uveitis were enrolled. HLA-B and HLA-A genotypes were determined by PCR-based method. Visual acuity was measured by Snellen chart. Vision loss was graded into visual impairment (VI) defined as VA20/40 for more than 6 months, loss of useful vision (LUV) as VA20/200, and near total blindness (NTB) as VA of light perception or worse.VI was associated with a longer duration of uveitis, posterior uveitis, and cataract, LUV with male gender, a longer duration of uveitis, posterior uveitis, and cataract, and NTB with a longer duration of uveitis, cataract, and glaucoma. HLA-B*51 and HLA-A*26:01 did not show any association with VI, LUV, or NTB. However, HLA-B*51 carriers had earlier onset of uveitis and HLA-A*26:01 was strongly associated with posterior uveitis. In patients with posterior uveitis, VI was associated with a longer duration of uveitis and cataract, LUV with a longer duration, and NTB with HLA-B*51.Longer duration of uveitis, posterior uveitis, male gender, cataract, and glaucoma were found to be associated with poor visual outcome in BD-related uveitis. HLA-B*51 was associated with NTB in patients with posterior uveitis. HLA-A*26:01 showed no association with VI, LUV, or NTB, however, was strongly associated with posterior uveitis.

To evaluate the long-term efficacy and safety of intravitreal triamcinolone acetonide (IVTA) injection for posterior segment inflammation in Behçet disease (BD) patients.The authors reviewed the medical records of BD patients who underwent IVTA injection (4 mg/0.1 mL) for posterior uveitis attack unresponsive to systemic immunosuppression and were followed up for more than 24 months.Forty-nine patients (49 eyes) were included. Mean best-corrected visual acuity improved from 0.89 logMAR units to 0.70, 0.64 at 12, 24 months, respectively. Complete inflammation control was achieved in 87.0% of patients, but 60.0% of them experienced relapse within 12 months. For phakic eyes, cumulative probabilities for cataract surgery were 13.8%, 48.9%, and 60.2% at 12, 24, and 36 months, respectively. Intraocular pressure elevation exceeding 21 mmHg was noted in 40.8%.In Behçet uveitis attack that is unresponsive or intolerant to systemic medications, IVTA injection is an effective therapeutic option, although ocular complications could limit its efficacy and repeatability.

To analyze the incidence of and risk factors for newly developed or increased macular hemorrhage after intravitreal ranibizumab injection (IVR) for neovascular age-related macular degeneration (AMD).We performed a retrospective chart review of 220 subjects (220 eyes) from 5 hospitals who received IVRs for neovascular AMD between 1 June 2009 and 30 June 2010. Systemic conditions (age, sex, presence of diabetes, hypertension, cardiovascular disease, smoking, and use of anticoagulation agent) and presence of hemorrhage at the initial exam were evaluated. The primary study outcome was the incidence of newly developed or increased macular hemorrhage during the 1-month postinjection period.The incidence of newly developed or increased macular hemorrhage including vitreous hemorrhage was 8% (18/220). Presence of diabetes was found to be a risk factor for macular hemorrhage [odds ratios (OR): 2.16, 95% confidence intervals (CI): 1.07-8.13]. When subjects had both diabetes and hypertension, the risk of macular hemorrhage after injection increased 4.8-fold (OR: 4.84, CI: 1.24-18.85).The systemic condition of subjects was found to be an important risk factor for newly developed or increased macular hemorrhage after IVR for neovascular AMD. More consideration should be given to the status of diabetes and hypertension in subjects who receive ranibizumab for neovascular AMD.

Purpose. To demonstrate the long-term effectiveness of vitrectomy for intermediate uveitis (IU) and to determine whether complete control of inflammation before vitrectomy is necessary.Methods. This retrospective study included 66 eyes of 66 patients with IU who underwent vitrectomy for vitreoretinal complications. Eyes were followed for at least 12 months after vitrectomy. The degree of inflammation control and visual acuity were compared before and after vitrectomy. These parameters were compared according to the presence of complete inflammation control before surgery.Results. The indications of vitrectomy included epiretinal membrane (26 eyes), vitreous opacity (21 eyes), and tractional retinal detachment (12 eyes), among others. Uveitic attacks did not occur in 44 of the 66 patients after vitrectomy. The numbers of uveitis attacks, local steroid injections, and systemic medications significantly decreased, and vision meaningfully improved after vitrectomy. These parameters did not differ significantly, regardless of the presence of preoperative inflammation.Conclusions. This study showed that vitrectomy is a good modality to manage vitreoretinal complications associated with IU, even if complete control of intraocular inflammation is not achieved before vitrectomy.

Retinitis pigmentosa (RP) is a serious disease characterized by progressive degeneration of the retina and usually ends up with bilateral blindness. RP is the most common inherited retinal disease. Recent advance in genetic research has greatly improved our knowledge about RP. Since the first identification of causal gene rhodopsin, more than 60 causal genes and 3000 disease-causing mutations have been reported [1]. And imaging technology such as a high-resolution spectral domain optical coherence tomography (OCT) revealed new aspects of RP [2]. In RP patients, the vision-specific quality of life cannot be explained only by visual acuity or field, and both of them are related to the visual function [3].

PURPOSE To evaluate clinical characteristics, assess surgical outcomes, and determine prognostic factors after vitrectomy for epiretinal membrane (ERM) associated with nonexudative age-related macular degeneration (AMD). METHODS This study comprised 171 consecutive patients with idiopathic ERM (n = 132) or nonexudative AMD-associated ERM (AMD-ERM, n = 39) undergoing vitrectomy. Preoperative morphologic characteristics on spectral-domain optical coherence tomography images and postoperative outcomes of the two groups were compared. Factors influencing postoperative best-corrected visual acuity in the AMD-ERM group were also analyzed. RESULTS The AMD-ERM group was more likely to have an ERM with a smooth appearance (P = 0.009), a less severe vessel traction score (P = 0.002), a thinner central foveal thickness (P = 0.016), and more photoreceptor disruption than idiopathic ERM group. Mean central foveal thickness improved from 404.92 ± 82.08 and 369.87 ± 68.17 μm at baseline to 339.77 ± 39.27 and 331.72 ± 45.76 μm 1 year after surgery in eyes with idiopathic ERM and AMD-ERM, respectively (all P < 0.001). Mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.30 (20/40) ± 0.21 and 0.32 (20/42) ± 0.18 at baseline to 0.02 (20/21) ± 0.09 and 0.13 (20/27) ± 0.17 1 year after surgery in the idiopathic ERM and AMD-ERM groups, respectively (all P < 0.001). Baseline integrity of the ellipsoid zone line (P = 0.009) and preoperative best-corrected visual acuity (P = 0.024) were significantly correlated with visual outcome in the AMD-ERM group. CONCLUSION Morphologic differences between AMD-ERM and idiopathic ERM were identified. Vitrectomy resulted in significant anatomical and visual improvements in eyes with AMD-ERM, but final visual outcome was worse in these eyes than in those with idiopathic ERM.

Purpose To investigate how macular ganglion cell-inner plexiform layer (GCIPL) and retinal nerve fibre layer (RNFL) thicknesses within the macula change with retinitis pigmentosa (RP) severity. Methods Spectral domain optical coherence tomography (SD-OCT) was used to examine 177 patients with RP and 177 normal controls. An optical coherence tomography (OCT) line scan was used to grade RP severity. Retinitis pigmentosa (RP) was categorized as more advanced if there was no identifiable inner segment ellipsoid (ISe) band (NISE) and as less advanced if an ISe band could be identified and peripheral loss of ISe was apparent (IISE). Ganglion cell-inner plexiform layer (GCIPL) and RNFL thicknesses were manually measured on OCT images and analysed. Pearson's correlation analyses were used to examine correlations between GCIPL thickness, RNFL thickness, visual acuity (VA) and visual field extent in patients and controls. Results Ganglion cell-inner plexiform layer (GCIPL) was significantly thicker in IISE than in control eyes (p

PURPOSE To document comparative analysis of macular microstructures before and after silicone oil (SO) removal via spectral-domain optical coherence tomography and to assess the retinal changes associated with visual outcome. METHODS Forty-six eyes that underwent vitrectomy with SO tamponade were included. Ophthalmic examinations were performed before SO removal and at Months 1, 3, and 6 postoperatively including best-corrected visual acuity and spectral-domain optical coherence tomography. The macular microstructures identified by spectral-domain optical coherence tomography were compared before and after SO removal, and tomographic parameters related to visual outcome were analyzed. RESULTS Under SO tamponade, spectral-domain optical coherence tomography demonstrated macular tomographic findings: epiretinal membrane in 12 eyes (26.1%), cystoid macular edema in 9 (19.6%), undulated inner retina in 8 (17.4%), and submacular fluid in 4 (8.7%). The mean duration of SO tamponade was significantly longer in eyes with macular changes (6.3 ± 4.6 months) than those without changes (5.2 ± 4.4 months) (P = 0.02). A total of 13 eyes had peeling of epiretinal membrane or internal limiting membrane combined with SO removal. After SO removal, most of microstructural changes were resolved. In the eyes with macular epiretinal membrane or cystoid macular edema, final best-corrected visual acuity was significantly improved compared with baseline (P = 0.017, 0.049), which paralleled the decrease of central foveal thickness. Restoration of photoreceptor layer and external limiting membrane was achieved in 2 (4.9%) and 5 eyes (12.5%), and those with continuous photoreceptor layer or external limiting membrane had the better final best-corrected visual acuity. CONCLUSION Under SO tamponade, macular microstructural changes were identified by spectral-domain optical coherence tomography and were associated with duration of SO tamponade. Most of the microstructural changes were recovered after SO removal, if needed, combined with macular surgery. Anatomic resolution was accompanied by postoperative visual improvement.

PURPOSE The purpose of the study to determine whether ciliary body thickness increased in the presence of diabetic macular edema (DME) and whether it changed after pars plana vitrectomy. METHODS A DME group consisted of 26 diabetic patients who underwent pars plana vitrectomy for diffuse DME. An epiretinal membrane group, a surgical control group, consisted of 23 nondiabetic patients with epiretinal membrane who underwent pars plana vitrectomy. A healthy control was also included for the comparison of preoperative ciliary body thickness. Ciliary body thickness was measured using ultrasound biomicroscopy, and central macular thickness was determined using optical coherence tomography. The visual acuity, ciliary body thickness, and central macular thickness were compared between groups before and 1, 2, and 4 months after pars plana vitrectomy, and the correlations between the central macular thickness and ciliary body thickness and best-corrected visual acuity were determined. RESULTS The preoperative ciliary body thickness was increased significantly in the DME group compared with the epiretinal membrane and healthy control groups (both P < 0.001). The ciliary body thickness decreased significantly 1 and 2 months after surgery in the DME group (both P < 0.001) but not in the epiretinal membrane group. In the DME group, the postvitrectomy changes in the ciliary body thickness and central macular thickness showed similar trends and persisted significantly, until 4 months postoperatively (P = 0.027 and P = 0.010, respectively). The correlations between the preoperative central macular thickness and ciliary body thickness and between changes in central macular thickness and ciliary body thickness before and 2 months after surgery were not significant. CONCLUSION Ciliary body thickness was increased in patients with DME, and vitrectomy was effective in decreasing ciliary body edema as well as macular edema in those patients during the 4-month follow-up period.

PURPOSE To identify spectral-domain optical coherence tomography findings related to visual outcome in myopic foveoschisis after 25-gauge transconjunctival sutureless vitrectomy. METHODS Thirty-eight eyes with myopic foveoschisis were prospectively followed-up to 6 months after vitrectomy. Best-corrected visual acuity (BCVA), axial length, and spectral-domain optical coherence tomography findings were analyzed for identification of factors affecting visual outcome. RESULTS Best-corrected visual acuity improved significantly (preoperative 0.841 ± 0.534 logarithm of minimal angle of resolution to postoperative 0.532 ± 0.536 logarithm of minimal angle of resolution, P = 0.001), and central retinal thickness showed significant reduction (preoperative 409 ± 143 μm to postoperative 259 ± 72 μm, P < 0.001) with surgery. Anatomical success was achieved in 34/38 eyes (89.5%). Photoreceptor layer disruption was found in 20 of 38 eyes (52.6%) preoperatively and persisted after surgery in 18 of 20 eyes (90.0%). Patients with preoperative photoreceptor layer defects had significantly more associated foveal detachments and irregular choroidal surfaces and worse preoperative and final best-corrected visual acuity. Preoperative best-corrected visual acuity showed significant correlation with final best-corrected visual acuity (Pearson correlation coefficient = 0.555, P = 0.001). Patients with irregular choroidal surfaces and photoreceptor layer disruption had significantly worse final best-corrected visual acuity (P = 0.035, 0.005). CONCLUSION Twenty-five-gauge transconjunctival sutureless vitrectomy showed favorable results for the management of myopic foveoschisis. Photoreceptor layer defects and irregular choroidal surfaces on spectral-domain optical coherence tomography persist despite surgery, limiting visual outcome.

Background/Aims: To investigate the effects of intravitreal ranibizumab treatment for macular edema (ME) secondary to retinal vein occlusion (RVO) and the relationship between spectral-domain optical coherence tomography (SD-OCT) findings and visual outcome after successful resolution of ME. Methods: Forty consecutive eyes with ME secondary to branch RVO (BRVO; 29 eyes of 29 patients) or central RVO (CRVO; 11 eyes of 11 patients) were included in a prospective study and treated with 3 initial intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Retreatment was based on visual acuity changes and OCT findings. Patients with complete resolution of ME were classified into two groups according to final best-corrected visual acuity (BCVA) of better than 0.30 logMAR (group 1) or poorer than 0.30 logMAR (group 2), and SD-OCT findings were analyzed at baseline and at 12 months. Results: In patients with BRVO, mean BCVA at 12 months (0.19 ± 0.18) was significantly better than that at baseline (0.76 ± 0.37; p = 0.000). The mean number of injections was 4.4 ± 1.2. In patients with CRVO, the mean BCVA at 12 months (0.39 ± 0.23) was slightly improved from that at baseline (0.84 ± 0.68), but the difference was not significant (p = 0.063). Patients with CRVO received a mean number of 6.1 ± 1.4 injections of ranibizumab. Baseline SD-OCT more frequently detected the foveal inner/outer segment (IS/OS) line and external limiting membrane (ELM) in group 1 (p = 0.003) than in group 2 (p = 0.012). Preservation of the foveal IS/OS line (odds ratio = 5.400; p = 0.036) and ELM (odds ratio = 7.312; p = 0.016) at baseline correlated with good final visual outcome. Conclusion: Intravitreal ranibizumab injections effectively treat ME secondary to RVO. Good visual outcome was associated with preservation of the foveal IS/OS line and ELM at baseline.

PURPOSE To characterize retinal changes in areas of commotio retinae using spectral-domain optical coherence tomography. METHODS In this retrospective observational case series, we included 14 eyes of 14 patients who had experienced blunt ocular trauma and underwent spectral-domain optical coherence tomography and fundus photography evaluation on the same day. The retinal thickness and volume of eyes with commotio retinae were compared with those of eyes without it. Normal untraumatized fellow eyes served as control. Fundus images obtained by spectral-domain optical coherence tomography were compared with fundus photographs. The retinal tissue reflectivities indicated by the images were compared across each lesion. RESULTS There were 7 eyes with commotio retinae involving the macula and 7 eyes without it. Macular thickness and volume were not different between eyes with and without commotio retinae involving the macula. Photoreceptor outer segment reflectivity corresponding to the area of retinal opacity was increased with characteristic features and recovered with the disappearance of retinal opacity over time. CONCLUSION Lesions exhibiting retinal opacity characteristic of commotio retinae corresponded to hyperreflective outer segment lesions without the increase in retinal thickness on spectral-domain optical coherence tomography.

PURPOSE To compare the efficacy of combined photodynamic therapy (PDT) and optical coherence tomography-guided intravitreal bevacizumab injection versus PDT alone for the treatment of polypoidal choroidal vasculopathy. METHODS The medical records of 39 patients with symptomatic polypoidal choroidal vasculopathy who received combination therapy with PDT and intravitreal bevacizumab injections or PDT monotherapy were retrospectively reviewed. Best-corrected visual acuity, number of treatments, and optical coherence tomography and angiographic findings were compared between the two patient groups. RESULTS In the PDT monotherapy group (n = 19), the mean number of PDTs was 1.89, whereas in the combined therapy group (n = 20), mean 1.30 times of PDT and 2.90 times of intravitreal bevacizumab injection were performed during the 12 months of follow-up. The number of PDTs was significantly different between the 2 groups (P = 0.032). At 12 months, the mean improvement in best-corrected visual acuity was 3.0 lines in the combined group and 1.6 lines in the PDT monotherapy group. At 12 months, improved vision by ≥ 3 lines was achieved in 55.0% in the combined therapy group and 36.8% in the PDT monotherapy group. CONCLUSION Combined PDT and bevacizumab therapy effectively treated polypoidal choroidal vasculopathy with fewer PDTs compared with PDT alone during the 1 year of follow-up. Combined treatment appeared to result in better visual acuity, but a larger scale study is required to draw a definite conclusion.

Purpose To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) treatment of eyes with foveal serous retinal detachment (SRD) associated with inferior staphyloma and to investigate choroidal thickness changes following anti-VEGF therapy. Methods In this observational case series, eyes with inferior staphyloma accompanied by foveal SRD were treated with a single intravitreal anti-VEGF injection, followed by further injections as needed. Changes in height and width of subretinal fluid (SRF) and visual acuity after treatment were assessed. Choroidal thickness was measured at the subfovea, 1.5 mm superior and inferior to the fovea using enhanced depth imaging optical coherence tomography at baseline and 1 month after initial anti-VEGF therapy. Results Six eyes from six patients were included. One month after the initial injection, the mean SRF height and width had decreased significantly from 112.5 ± 40.1 to 44.5 ± 48.7 μm (p = 0.046) and from 1,401.8 ± 627.3 to 690.7 ± 634.7 μm (p = 0.028), respectively. Mean choroidal thickness at the superior point decreased from 218.7 ± 59.3 to 200.5 ± 61.0 μm (p = 0.046). SRF resolved completely in three of the six eyes (50%) with a mean of 6.8 ± 5.9 injections (range, 1 to 15). All eyes experienced at least one recurrence of exudation, at a mean interval of 4.8 months. Mean visual acuity improvement was 0.17 logarithm of the minimum angle of resolution units at a mean of 28.7 months follow-up. Conclusions Anti-VEGF therapy resulted in an SRF decrease and modest visual improvement in eyes with foveal SRD associated with inferior staphyloma. Reduction in superior choroidal thickness appeared to contribute to the clinical improvements that were observed.