Change of retinal pigment epithelial atrophy after anti‑vascular endothelial growth factor treatment in exudative age‑related macular degeneration.

Purpose: The study aimed to investigate the quantitative changes of retinal pigment epithelial (RPE) atrophy during a 24‑month follow‑up period of anti‑vascular endothelial growth factor (VEGF) for exudative age‑related macular degeneration (AMD). Materials and Methods: This is a retrospective study. Sixty‑five eyes of 62 consecutive patients with naïve exudative AMD who had received treatment with anti‑VEGF therapy and followed for more 24 months were enrolled. All patients received three initial monthly injections of anti‑VEGF (ranibizumab or bevacizumab), followed by pro re nata or treat‑and‑extend protocol. Color fundus image, optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy. Multiple regression analysis was performed to investigate the predictive factors found during univariate analysis to identify an association with increased RPE atrophic areas. Results: The mean number of anti‑VEGF treatments was 9.18. RPE atrophic area was 1.293 ± 1.298 mm2 at baseline and enlarged to 2.394 ± 1.940 mm2 after 24 months, which differed significantly (P = 0.001). Multiple regression analysis revealed that larger areas of RPE atrophy at month 4 and larger numbers of anti‑VEGF treatments were associated with increased RPE atrophic areas. Conclusions: RPE atrophy progresses in eyes with exudative AMD during anti‑VEGF treatment. Larger areas of RPE atrophy at month 4 and larger numbers of anti‑VEGF injections were associated with an increased risk of progression of RPE atrophy the following treatment. These findings may be useful to clinicians using intravitreal anti‑VEGF for the treatment of exudative AMD, both for selecting an appropriate treatment plan and for predicting the progression of RPE atrophy.

Learning curves for strabismus surgery in two ophthalmologists.

Purpose: To identify the average turning point by comparing the learning curves of two surgeons learning to perform strabismus surgery. Materials and Methods: Patients who underwent procedures to correct exotropia between January 2010 and December 2014 followed for at least 3 months were retrospectively assessed. The first 70 patients on whom each of two ophthalmologists (A and B) performed surgery to treat strabismus were divided into 7 cohorts comprising 10 patients each based on the chronological order of the surgery. Factors, including patient age, preoperative angle of deviation, operative time, and success or failure of the operation, were compared between the two surgeons. Learning curves were calculated based on changes in operative time and operation success rate. Operation success was determined by measuring the angle of deviation at a distance of 5 m 3 months after the operation. Results: A turning point was observed after 40 cases for Surgeon A and 50 cases for Surgeon B based on the operative time learning curve. No turning point was observed in the operation success rate learning curve based on the absence of a specific trend. Success rate by cohort was not significantly different between the two surgeons (P > 0.05). Surgeon B had a significantly longer mean operative time than Surgeon A (P = 0.045). Conclusions: Approximately 50 cases are required for an ophthalmologist to reach a turning point in strabismus surgery. This outcome can be used as a guideline when training surgeons to perform strabismus surgery.

Comparison of aqueous concentrations of angiogenic and inflammatory cytokines based on optical coherence tomography patterns of diabetic macular edema.

Purpose: The purpose was to compare aqueous inflammatory and angiogenic cytokine levels in diabetic macular edema (DME). Materials and Methods: Aqueous samples were obtained from 50 eyes with DME and 12 normal eyes (control group). DME was classified according to the morphologic pattern based on optical coherence tomography: Diffuse retinal thickening (DRT; n = 19), cystoid macular edema (CME; n = 17), or serous retinal detachment (SRD; n = 14). Aqueous samples were collected just before intravitreal injection and at the beginning of cataract surgery in the control group. Interleukin (IL)‑6, IL‑8, interferon‑induced protein (IP)‑10, monocyte chemotactic protein (MCP)‑1, platelet‑derived growth factor (PDGF)‑AA, and vascular endothelial growth factor (VEGF) levels were measured by multiplex bead assay. Results: The IL‑6, IL‑8, IP‑10, and PDGF‑AA levels differed significantly among the three groups of DME (P = 0.014, P = 0.038, P = 0.021, and P = 0.041, respectively). However, there were no differences between groups in aqueous concentration levels of MCP‑1 and VEGF (P = 0.205 and P = 0.062, respectively). IL‑6 (P = 0.026) and IL‑8 (P = 0.023) correlated positively with central foveal thickness (CFT) in the CME group. None of the cytokine levels correlated significantly with CFT in any of the DRT and SRD groups. Conclusions: Aqueous concentrations of cytokines varied according to the morphologic pattern of DME, which might explain the variable response to treatments such as intravitreal bevacizumab or triamcinolone injection.

Association between hyperacuity defects and retinal microstructure in polypoidal choroidal vasculopathy.

Purpose: To improve our understanding of hyperacuity defects measured with preferential hyperacuity perimetry (PHP) by correlating PHP findings with the retinal microstructural changes visible on spectral‑domain optical coherence tomography (OCT) in patients with polypoidal choroidal vasculopathy (PCV). Materials and Methods: Twenty‑eight eyes of 28 patients with PCV were retrospectively reviewed. All patients underwent a complete ophthalmologic examination, including best‑corrected visual acuity (logMAR) testing, PHP, and OCT. The functional ‘PHP test score’ and ‘total volume of hyperacuity defect zone’ were also analyzed. Results: Patients were classified based on the hyperacuity defect by PHP, as follows: Hyperacuity defect (n = 17 eyes) group and hyperacuity intact (n = 11 eyes) group. The mean best‑corrected visual acuity in the hyperacuity intact group (0.46 ± 0.39) was better than that in the hyperacuity defect group (0.82 ± 0.37) (P = 0.014). The presence of serous retinal detachment and retinal pigment epithelial detachment did not differ significantly between groups (P = 0.120 and P = 0.689, respectively). A disrupted photoreceptor layer was more common in the hyperacuity defect group compared with the hyperacuity intact group (P = 0.0001). Among 17 eyes with a hyperacuity defect, 9 eyes showing intra‑retinal pathology (intra‑retinal cyst or hard exudates) and had a significantly higher PHP test score and larger total volume of the hyperacuity defect zone than 8 eyes without intra‑retinal pathology (P = 0.006 and P = 0.021, respectively). Conclusion: A hyperacuity defect in PCV was associated with photoreceptor disarrangement. Furthermore, PCV lesions on the inner retina that invaded the photoreceptor layer were associated with a more severe hyperacuity defect.

Segmentation error and macular thickness measurements obtained with spectral-domain optical coherence tomography devices in neovascular age-related macular degeneration.

Purpose: To evaluate frequency and severity of segmentation errors of two spectral-domain optical coherence tomography (SD-OCT) devices and error effect on central macular thickness (CMT) measurements. Materials and Methods: Twenty-seven eyes of 25 patients with neovascular age-related macular degeneration, examined using the Cirrus HD-OCT and Spectralis HRA + OCT, were retrospectively reviewed. Macular cube 512 × 128 and 5-line raster scans were performed with the Cirrus and 512 × 25 volume scans with the Spectralis. Frequency and severity of segmentation errors were compared between scans. Results: Segmentation error frequency was 47.4% (baseline), 40.7% (1 month), 40.7% (2 months), and 48.1% (6 months) for the Cirrus, and 59.3%, 62.2%, 57.8%, and 63.7%, respectively, for the Spectralis, differing significantly between devices at all examinations (P < 0.05), except at baseline. Average error score was 1.21 ± 1.65 (baseline), 0.79 ± 1.18 (1 month), 0.74 ± 1.12 (2 months), and 0.96 ± 1.11 (6 months) for the Cirrus, and 1.73 ± 1.50, 1.54 ± 1.35, 1.38 ± 1.40, and 1.49 ± 1.30, respectively, for the Spectralis, differing significantly at 1 month and 2 months (P < 0.02). Automated and manual CMT measurements by the Spectralis were larger than those by the Cirrus. Conclusions: The Cirrus HD-OCT had a lower frequency and severity of segmentation error than the Spectralis HRA + OCT. SD-OCT error should be considered when evaluating retinal thickness.

Traumatic chorioretinal folds treated with intra-vitreal triamcinolone injection.

A 34-year-old male visited the hospital due to decreased visual acuity in the left eye following an injury from a car accident. In the left eye, best-corrected visual acuity (BCVA) was hand motion and intraocular pressure (IOP) was 8 mmHg. Choroidal vasodilation and chorioretinal folds were observed by spectral domain-optical coherence tomography (SD-OCT). Topical and systemic steroid treatments did not improve the chorioretinal folds. Twelve months after the injury, intra-vitreal triamcinolone (4 mg/0.1 ml) was injected. Six months after intra-vitreal triamcinolone injection, BCVA in the left eye had improved to 20/100. Fundus examination showed improvement in retinal vascular tortuosity and SD-OCT revealed improvements in choroidal vasodilation and chorioretinal folds. Intra-vitreal triamcinolone injection (IVTI) was effective against traumatic chorioretinal folds with no recurrence based on objective observation by fundus photography and SD-OCT.