Elevated aqueous endothelin-1 concentrations in advanced diabetic retinopathy.

PURPOSE: Endothelin-1 (ET-1) is a potent vasoconstrictor which seems to be involved in the pathogenesis of diabetic retinopathy (DR). However, studies on intraocular ET-1 in DR have been limited. Thus, we investigated aqueous ET-1 levels in patients with DR. METHODS: A total 85 subjects were included in this prospective study. Those were classified into three groups: advanced DR group included those with severe nonproliferative DR or proliferative DR, whereas early DR group included those with mild nonproliferative DR or moderative nonproliferative DR. Those who underwent cataract surgery and had no concomitant ocular disease were included in the control group. Aqueous humor levels of ET-1 were obtained before intravitreal bevacizumab injection (IVB) and after 1 month for the DR patients, and at the time of cataract surgery for the control group. RESULTS: Advanced DR group included 40 eyes (47.1%), whereas early DR group did 19 eyes (22.4%), and control group (26 eyes, 30.5%). Mean aqueous ET-1 level was 10.1±4.1 pg/mL (6.0-21.0 pg/mL) in advanced DR group, 1.9±0.7 pg/mL (0.6-2.8 pg/mL) in early DR group, and 2.1±1.0 pg/mL (0.7-3.9 pg/mL) in control group (P < 0.001). Advanced DR group was further subdivided into severe nonproliferative DR (15 eyes, 12.8%) and proliferative DR (25 eyes, 34.3%). Mean aqueous ET-1 level was 10.1±4.3 pg/mL (6.0-20.1 pg/mL) in patients with severe nonproliferative DR, and 10.0±4.0 pg/mL (6.0-21.0 pg/mL) in those with proliferative DR (P = 0.928) at baseline. Mean ET-1 level at 1 month after intravitreal injection was 2.5±1.0 pg/mL (0.3-4.8 pg/mL) in patients with severe proliferative DR and 2.9±1.7 pg/mL (1.0-7.0 pg/mL) in those with proliferative DR (P = 0.443). Mean aqueous ET-1 level was significantly reduced in both groups (P < 0.001, respectively). CONCLUSION: The mean aqueous ET-1 level was significantly higher in the eyes with advanced DR than those with early DR and the control group. The mean aqueous ET-1 level was significantly reduced after intravitreal injections in the advanced DR group. Based on our results, future studies on the exact role of ET-1 in the pathogenesis of DR and future implication for intervention would be helpful for managing DR.

Prevalence of focal lamina cribrosa defects in eyes with pachychoroid disease spectrum.

AIM: To determine the prevalence of focal lamina cribrosa (LC) defect among patients with pachychoroid disease spectrum (PDS) in the absence of peripapillary retinoschisis. METHODS: This retrospective, cross-sectional study comprised of 180 patients with PDS, including polypoidal choroidal vasculopathy (PCV), central serous chorioretinopathy, and pachychoroidal neovasculopathy. Medical records and optic nerve head evaluations conducted using spectral-domain optical coherence tomography with enhanced depth imaging were reviewed. As a control group, 236 patients who underwent ophthalmologic evaluation for vitreous floaters, without obvious ocular disease, were also included. RESULTS: The mean age of the PDS group, which included 118 male patients (65.6%), was 57.4±11.1y. There was no significant difference between the two groups in age (P=0.710) or sex (P=0.248). Six patients (3.3%) in the PDS group and none in the control group showed focal LC defect (P=0.318). Among the six patients with focal LC defect in the PDS group, four eyes had PCV, one eye was the fellow eye of a PCV eye, and one eye had pachychoroidal neovasculopathy. CONCLUSION: Focal LC defect can be defected in patients with PDS in the absence of peripapillary retinoschisis. However, the prevalence of focal LC defect was not different significantly between PDS patients and those who did not have PDS.

Changes in peripapillary and subfoveal choroidal thickness in patients with central retinal vein occlusion.

PURPOSE: We sought to evaluate changes of mean peripapillary choroidal thickness (PCT) and subfoveal choroidal thickness (SFCT) over 12 months in patients with unilateral central retinal vein occlusion (CRVO). METHODS: Our retrospective, observational study included 19 patients with treatment-naïve, unilateral CRVO who completed at least 12 months of follow-up period. Mean PCT and mean SFCT in CRVO-affected eyes and unaffected contralateral eyes were measured at each follow-up visit, and then compared. Differences between baseline and 12 months (ΔSFCT and ΔPCT) and percentage changes (ΔSFCT or ΔPCT/baseline×100%) were determined. We also investigated the predictive factors for visual outcome in the CRVO-affected eyes. RESULTS: In the CRVO-affected eyes, mean PCT was 146.7±41.9 µm at baseline, and 106.5±24.2 µm at 12 months (P < 0.001). Mean PCT of the contralateral eyes was 129.8±42.6 µm at baseline and 124.6±39.7 µm at 12 months (P = 0.089). Mean SFCT of CRVO-affected eyes was 225.8±77.9 µm at baseline, and 199.4±66.6 µm at 12 months (P = 0.009). Mean SFCT of the contralateral eyes was 218.4±83.0 µm at baseline, and 208.4±78.1 µm at 12 months (P = 0.089). Δ PCT was -41.6±25.3 µm in the CRVO-affected eyes, and -5.2±5.8 µm in the contralateral eyes (P<0.001). % PCT was -24.9±14.0% in the CRVO-affected eyes, and -4.0±0.4% in the contralateral eyes (P = 0.001). Δ SFCT was -26.4±24.6 µm in the CRVO-affected eyes, and -9.5±16.7µm in the contralateral eyes (P = 0.016). % SFCT was -10.4±9.8% in the CRVO-affected eyes, and -3.4±6.4% in the contralateral eyes (P = 0.015). Among the various factors, BCVA at baseline (ß = 0.797, P = 0.001) and % SFCT (ß = 0.712, P = 0.001) were significantly associated with visual outcome at 12 months in the CRVO-affected eyes. CONCLUSION: Both peripapillary and subfoveal choroidal thickness reduced significantly over 12 months in the CRVO-affected eyes, but not in the contralateral eyes. In addition, the absolute reduction amount and reduction ratio of PCT and SFCT were significantly greater in the CRVO-affected eyes than the contralateral eyes.

Significant elevation of aqueous endothelin-1 in central retinal vein occlusion.

PURPOSE: To investigate aqueous humor concentrations of endothelin-1 (ET-1) in patients with central retinal vein occlusion (CRVO) compared with patients with branch retinal vein occlusion (BRVO) and a normal control group. METHODS: A total 80 subjects were included in this prospective study, including 15 patients with CRVO, 20 patients with BRVO, and 45 patients who underwent cataract surgery and had no concomitant ocular disease. Aqueous humor levels of ET-1 were obtained before intravitreal bevacizumab injection (IVB) and after 1 month. RESULTS: At baseline, the mean aqueous ET-1 level was 12.7±3.6 pg/mL in the CRVO group, 8.0±2.3 pg/mL in the BRVO group, and 2.0±0.9 pg/mL in the control group (P<0.001). After IVB, the mean aqueous level of ET-1 was 3.4±1.9 pg/mL (0.5-6.9 pg/mL) in the CRVO group and 1.8±1.0 pg/mL (0.3-3.2 pg/mL) in the BRVO group (P = 0.008). The mean aqueous ET-1 level was significantly reduced in both the patients with CRVO and those with BRVO (P<0.001). CONCLUSION: The mean aqueous humor ET-1 level was significant higher in the patients with CRVO than those with BRVO and in the control group. After IVB, the mean level was significantly reduced in both the patients with CRVO and those with BRVO.

Early detection of diabetic retinopathy based on deep learning and ultra-wide-field fundus images.

Visually impaired and blind people due to diabetic retinopathy were 2.6 million in 2015 and estimated to be 3.2 million in 2020 globally. Though the incidence of diabetic retinopathy is expected to decrease for high-income countries, detection and treatment of it in the early stages are crucial for low-income and middle-income countries. Due to the recent advancement of deep learning technologies, researchers showed that automated screening and grading of diabetic retinopathy are efficient in saving time and workforce. However, most automatic systems utilize conventional fundus photography, despite ultra-wide-field fundus photography provides up to 82% of the retinal surface. In this study, we present a diabetic retinopathy detection system based on ultra-wide-field fundus photography and deep learning. In experiments, we show that the use of early treatment diabetic retinopathy study 7-standard field image extracted from ultra-wide-field fundus photography outperforms that of the optic disc and macula centered image in a statistical sense.

Clinical characteristics of super stable polypoidal choroidal vasculopathy after initial remission with anti-VEGF monotherapy.

PURPOSE: To define a "super stable" subset of polypoidal choroidal vasculopathy (PCV) patients that have a long period of remission following anti-vascular endothelial growth factor (VEGF) therapy. METHODS: Twenty-one eyes that showed no recurrence for over 18 months following anti-VEGF monotherapy were included in the "super stable PCV group" and compared with 37 eyes with recurring disease. Patient demographics, visual acuity, and imaging data from optical coherence tomography (OCT) and fluorescein angiography/indocyanine green angiography were compared between the two groups at baseline and at 3 months after treatment initiation. RESULTS: The super stable group maintained remission for a mean duration of 31.0 months following a mean of 4.1 anti-VEGF injections. The super stable group was younger at baseline (64.6 ± 8.8 vs. 71.4 ± 7.9 years, P < 0.05) with a higher ratio of females (52.4% vs. 24.3%, P < 0.05) compared with the control group. The super stable group had a higher percentage of eyes with a single polyp, as opposed to multiple polyps (66.7% vs. 32.4%, P < 0.05), and the diameter of the largest polyp was smaller (328.4 ± 98.2 vs. 398.3 ± 112.2 µm, P < 0.05). Baseline choroidal thickness was greater in the super stable group (357 ± 102.7 vs. 293.2 ± 94.6 µm, P < 0.05). At 3 months after treatment, OCT features including central retinal thickness, pigment epithelial detachment (PED) size, and presence of subretinal fluid showed superior response in the super stable group. The reduction in PED height was almost 3 times as large in the super stable group (- 250.1 ± 228.5 µm vs. - 84.4 ± 221.1 µm, P < 0.05). Binary logistic regression further showed that factors such as age, polyp configuration, PED diameter at 3 months, and change in PED height at 3 months were associated with super stable remission. CONCLUSION: Identifying super stable PCV patients can prevent overtreatment and lessen treatment burden.

Long-term treatment response after intravitreal bevacizumab injections for patients with central serous chorioretinopathy.

PURPOSE: To investigate long-term treatment response after intravitreal bevacizumab injections (IVBIs) for central serous chorioretinopathy (CSC). METHODS: This retrospective, interventional study investigated the medical records of 45 eyes of 44 patients with CSC who underwent IBVIs and completed at least 2-year follow-up period. Complete resolution (CR) was defined as complete resolution of subretinal fluid at least 3 months after the last IVBI. Thick-choroid CSC was defined as mean subfoveal choroidal thickness more than 300.0 µm. The main outcome measure was long-term treatment outcome after IVBIs in patients with CSC. RESULTS: Thirty-five patients (79.5%) were male, and their mean age was 45.5 ± 9.6 years. The mean follow-up period was 35.1 ± 11.5 months. Twenty-two eyes (48.9%) had acute CSC, and 40 eyes (88.9%) achieved CR. Twenty eyes (50.0%) developed recurrence, the mean number of IVBIs to achieve the first CR was not significantly different between eyes with and without recurrences (2.6 ± 1.6 vs. 2.9 ± 1.9; P = 0.658). Thick-choroid CSC was significantly difference between the eyes with and without recurrence (17 eyes, 85.0% vs. eyes, 50.0%; P = 0.020). Among the baseline characteristics, serous pigment epithelial detachment (B = - 2.580, P = 0.032) and thick-choroid (B = 1.980, P = 0.019) were significantly associated with recurrence. CONCLUSION: Eyes with CSC treated with IVBI and achieving complete resolution of subretinal fluid have 50% chance of recurrence in the long term. Thinner choroid and serous pigment epithelial detachment appear protective for recurrences.

Focal lamina cribrosa defects and significant peripapillary choroidal thinning in patients with unilateral branch retinal vein occlusion.

PURPOSE: To investigate the prevalence of focal lamina cribrosa (LC) defects in patients with unilateral branch retinal vein occlusion (BRVO) and to compare ocular characteristics between eyes with and without focal LC defect and those eyes with normal-tension glaucoma (NTG). METHODS: This retrospective, cross-sectional study included 121 patients. Thirty-nine patients had unilateral BRVO (BRVO group), 36 patients had NTG (NTG group), and 36 patients had vitreous floaters, but no other ocular diseases (control group). In addition to baseline characteristics such as age, sex, refractive errors, the ocular characteristics such as peripapillary choroidal thickness (PCT), retinal nerve fiber layer thickness, and subfoveal choroidal thickness were retrospectively analyzed. RESULTS: Focal LC defects were detected in 20 eyes of 14 patients (38.9%) in the BRVO group, 24 eyes of 15 patients (41.7%) in the NTG group, and none in the control group (P<0.001). In the BRVO-affected eyes, the mean PCT was 102.7±31.1 µm in the eyes with focal LC defects, and 163.1±70.1 µm in the eyes without LC defects (P = 0.009). In the BRVO-affected eyes, the mean PCT was 102.7±31.1 µm in the eyes with focal LC defects, and 163.1±70.1 µm in the eyes without LC defects (P = 0.009). In the NTG group, the mean PCT was 133.1±48.9 µm in the eyes with focal LC defects and 170.8±81.9 µm in those without (P = 0.042). The other baseline and ocular characteristics were not significantly different between the eyes with and without focal LC defects in both the BRVO group and the NTG group. CONCLUSIONS: About 40% of the patients with unilateral BRVO had focal LC defect in the BRVO-affected eyes and unaffected fellow eyes, similar prevalence to the patients with NTG. The mean PCT was significantly thinner in the eyes with focal LC defect than those without in the patients with BRVO and those with NTG, suggesting possible pathophysiologic correlation between these two diseases.

Clinical characteristics of asymptomatic Terson syndrome in the patients with aneurysmal subarachnoid hemorrhage.

AIM: To investigate clinical characteristics of asymptomatic Terson syndrome and its clinical impact in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: This retrospective, interventional study included 31 patients with aneurysmal SAH, and the medical records were reviewed. In addition to baseline characteristics of the study population such as age, sex, and underlying medical history, multi-modal imaging analysis, including fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), were also reviewed. Glasgow Coma Scale (GCS), Hunt-Hess (HH) grade, and Fisher scale at the time of admission, and functional outcome by using modified Rankin Scale (mRS) at 6mo were compared. RESULTS: Of the 31 patients, 10 patients (32.3%) were diagnosed with Terson syndrome. All the patients with Terson syndrome did not report visual symptoms at the time of ophthalmologic screening. FA showed microvascular changes of retinal capillaries and varying degrees of disc leakage. SD-OCT allowed intuitive anatomical localization of multi-layered retinal hemorrhages and assessment of ellipsoid zone integrity. The patients with Terson syndrome showed significantly worse GCS (P=0.047) and HH grade (P=0.025) than those without, except Ficher scale (P=0.385). There was no significant difference in the mRS (P=0.250) at 6mo. Among baseline factors, the HH grade was the only significant factor associated with Terson syndrome (B=1.079, P=0.016). CONCLUSION: In our study, 32.3% of the patients have Terson syndrome without visual symptoms. The baseline HH grade is significantly correlated with Terson syndrome, and there is no significant difference in the functional outcome between the patients with and without Terson syndrome. Terson syndrome may develop without any visual symptoms as shown in our study, and ophthalmologic screening may be recommended to prevent further visual deterioration especially in the patients with poor HH grade at the time of aneurysmal SAH.

Significant changes of the choroid in patients with ocular ischemic syndrome and symptomatic carotid artery stenosis.

PURPOSE: To evaluated the changes in choroidal vasculature in patients with ocular ischemic syndrome (OIS) and in the ipsilateral eyes of patients with symptomatic carotid artery stenosis (CAS). METHOD: A total of 50 patients (15 patients with OIS, 10 patients with symptomatic CAS, 25 patients of age-and sex-matched control group) were included, and the medical records were retrospectively reviewed. The mean subfoveal choroidal thickness (SFCT) of each eye was measured, and binary images of the choroid were evaluated to compare the mean choroidal area and the luminal area. RESULTS: The mean SFCT was 170.5±75.3 µm in the eyes with OIS, 154.8±62.9 µm in the ipsilateral eyes with symptomatic CAS, and 277.5±73.2 µm in the right eyes of the control group patients (P<0.001). The mean choroidal area was 494,478.6±181,846.2 µm2 in the eyes with OIS, 453,750.0±196,725.8 µm2 in the ipsilateral eyes with symptomatic CAS, and 720,520±281,319.5 µm2 in the control group eyes (P = 0.036). The mean luminal area was 333,185.7±112,665.9 µm2 in the eyes with OIS, 313,983.3±132,032.1 µm2 in the ipsilateral eyes with symptomatic CAS, and 480,325.0±185,112.6 µm2 in the control group eyes (P = 0.046). The mean SFCT, mean choroidal area, and mean luminal area were significantly smaller in the eyes with OIS (P = 0.017, P = 0.005, and P = 0.004, respectively), and those with symptomatic CAS (P = 0.020, P = 0.016, and P = 0.021, respectively) than in the unaffected contralateral eyes. There were no significant differences between the eyes in the control group (P = 0.984, P = 284, and P = 0.413, respectively). CONCLUSION: The mean SFCT, mean choroidal area, and mean luminal area were significantly thinner in the eyes with OIS and the ipsilateral eyes with symptomatic CAS, compared with the control group eyes. The eyes with OIS and those with symptomatic CAS had significantly thinner SFCT, and smaller choroidal area and luminal area than the unaffected contralateral eyes. Choroid may reflect the vascular status of the carotid artery, indicated by choroidal thinning and decreasing choroidal area, especially luminal area.

Sectoral changes of the peripapillary choroidal thickness in patients with unilateral branch retinal vein occlusion.

AIM: To investigate sectoral changes in the mean peripapillary choroidal thickness (PCT) in patients with unilateral branch retinal vein occlusion (BRVO). METHODS: This retrospective, interventional study included 41 patients with acute, unilateral BRVO without macular edema. All patients completed at least a 6-month follow-up period. The PCT was measured at eight locations (temporal, superotemporal, superior, superonasal, nasal, inferonasal, inferior, and inferotemporal). In addition to calculating the average of all locations, the peripapillary choroidal area was divided into four sectors: superior (average of superotemporal PCT, superior PCT, and superonasal PCT), temporal, inferior (average of inferotemporal PCT, inferior PCT, and inferonasal PCT), and nasal. RESULTS: In the BRVO-affected eyes, the mean PCT was 177.7±69.8 µm (range, 70.1-396.0 µm) at baseline and 127.8±54.8 µm (range, 56.4-312.1 µm) at 6mo (P<0.001). In the non-affected contralateral eyes, the mean PCT was 192.5±60.6 µm (range, 61.4-365.0 µm) at baseline and 165.9±61.1 µm (range, 56.8-326.8 µm) at 6mo (P<0.001). In sectoral analysis, the mean PCT in each sector was significantly reduced in over 6mo in the BRVO-affected eyes (all P<0.001). In the non-affected contralateral eyes, the mean PCT was not significantly changed in any sector over the 6-month follow-up period (superior sector, P=0.143; temporal sector, P=0.825; inferior sector, P=0.192; and nasal sector, P=0.599). CONCLUSION: Sectoral analysis shows that the mean PCTs in all sectors are reduced significantly over 6mo in the BRVO-affected eyes, but not in the non-affected contralateral eyes.

Spectral domain optical coherence tomography as an adjunctive tool for screening Behçet uveitis.

BACKGROUND: This study investigated the association of central macular thickness (CMT) and macular volume (MV) with severity of Behçet uveitis in the absence of macular edema (ME). METHODS: This retrospective, interventional study included a total 131 treatment-naïve Behçet patients with varying degree of uveitis in the absence of ME. The mean CMT and MV were obtained by spectral domain optical coherence tomography (SD ODT). The patients were classified according to the anatomical classification of Behçet uveitis. The main outcome measure was comparison of mean CMT and MV with the types of Behçet uveitis. RESULTS: Sixty patients (45.8%) with no uveitis, 41 patients (31.3%) with anterior uveitis, 18 patients (13.7%) with posterior uveitis, and 12 patients (9.2%) with panuveitis. The mean CMT were 261.6±22.2 µm in no uveitis, 268.1±17.8 µm in anterior uveitis, 306.4±32.9 µm in posterior uveitis, and 300.4±44.0 µm in panuveitis (P < 0.001). The mean MV was 8.7±0.3 mm3 in those without uveitis, 8.8±0.3 mm3 in anterior uveitis, 9.9±1.1 mm3 in those with posterior uveitis, and 9.7±0.4 mm3 in panuveitis (P < 0.001). Types of Behçet uveitis was the only significant factor correlated with the mean CMT (B = 18.170, ß = 0.408, P < 0.001) and the mean MV (B = 0.328, ß = 0.652, P < 0.001). CONCLUSIONS: The mean CMT and MV were significantly thicker in the Behçet uveitis with posterior involvement. SD OCT can be used for an adjunctive tool for screening Behçet uveitis, especially for the presence of posterior involvement.

SIGNIFICANT REDUCTION OF PERIPAPILLARY CHOROIDAL THICKNESS IN PATIENTS WITH UNILATERAL BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To evaluate changes in peripapillary choroidal thickness in patients with branch retinal vein occlusion (BRVO) over 12 months, using spectral-domain optical coherence tomography with enhanced depth imaging. METHODS: This retrospective, interventional case series included 20 treatment-naive patients with unilateral BRVO with at least 12 months follow-up. The peripapillary choroidal thickness was measured over 12 months. RESULTS: In BRVO-affected eyes, the mean peripapillary choroidal thickness was 213.5 ± 51.7 µm (126.1[FIGURE DASH]326.9 µm) at baseline and 129.6 ± 39.3 µm (65.9[FIGURE DASH]197.1 µm) at 12 months. In nonaffected contralateral eyes, the mean peripapillary choroidal thickness was 194.1 ± 39.8 µm (158.5[FIGURE DASH]238.3 µm) at baseline and 156.6 ± 56.2 µm (125.9[FIGURE DASH]213.9 µm) at 12 months. The mean peripapillary choroidal thickness decreased significantly over 12 months in both BRVO-affected and nonaffected eyes (P < 0.001, both eyes). Although the mean peripapillary choroidal thickness was not significantly different between groups at baseline (P = 0.472), it was significantly lower in BRVO-affected eyes than in nonaffected eyes at 12 months (P = 0.036). CONCLUSION: Peripapillary choroidal thickness decreased significantly over 12 months in BRVO-affected eyes and nonaffected eyes in patients with unilateral BRVO.

SIGNIFICANT REDUCTION OF BOTH PERIPAPILLARY AND SUBFOVEAL CHOROIDAL THICKNESS AFTER PANRETINAL PHOTOCOAGULATION IN PATIENTS WITH TYPE 2 DIABETES.

PURPOSE: To evaluate changes in peripapillary choroidal thickness (PCT) and subfoveal choroidal thickness (SFCT) after panretinal photocoagulation (PRP) for diabetic retinopathy. METHODS: This retrospective interventional study included 59 treatment-naive eyes of 33 patients who underwent PRP and completed ≥12 months of follow-up. Peripapillary choroidal thickness and SFCT were measured at baseline and 1, 3, 6, and 12 months post-PRP. Differences between baseline and 12 months (ΔSFCT and ΔPCT) and percentage changes (ΔSFCT or ΔPCT/baseline × 100%) were determined. RESULTS: Mean SFCT was 287.7 ± 76.7 µm (139.0-469.0 µm) at baseline and 225.8 ± 62.0 µm (102.5-379.5 µm) 12 months post-PRP (P < 0.001). Mean PCT was 161.2 ± 16.5 µm (75.3-308.1 µm) at baseline and 128.4 ± 41.8 µm (73.0-212.9 µm) 12 months post-PRP (P < 0.001). ΔSFCT was -61.3 ± 28.7 µm (-139.5 to -17.0 µm), and %SFCT was 21.2 ± 7.2% (6.8% to 36.1%). ΔPCT was -36.4 ± 23.2 µm (-149.1 to 5.4 µm), and %PCT was 22.4 ± 12.0% (2.5% to 62.6%). Diabetic retinopathy severity was the only factor significantly correlated with %SFCT (ß = 0.500, P = 0.004) and %PCT (ß = 0.152, P = 0.024). CONCLUSION: Both PCT and SFCT reduced significantly after PRP. Diabetic retinopathy severity was significantly correlated with post-PRP changes of peripapillary and SFCT.

Gas-mediated vitreomacular adhesion release with intravitral ranibizumab injections for exudative age-related macular degeneration.

PURPOSE: To evaluate the efficiency of gas-assisted vitreomacular adhesion (VMA) release combined with intravitreal ranibizumab injections for exudative age-related macular degeneration (AMD) patients. MATERIALS AND METHODS: This prospective, interventional case series included a total of 23 eyes of 22 patients. The eyes were treated with intravitreal injection of 0.3 mL of perfluoropropane (C3F8) gas and concomitant intravitreal ranibizumab injection to stimulate VMA release. After three initial loading injections, additional intravitreal ranibizumab injections were performed pro re nata. Over a 12-month period, monthly examinations were performed for best-corrected visual acuity (BCVA, logMAR; logarithm of the minimum angle resolution), optical coherence tomography, and dilated fundus examinations. RESULTS: After gas injection, 22 eyes (95.7 %) showed complete VMA release at 1 week. Complete VMA was achieved in all eyes at 2 months after VMA release, without serious ocular adverse events except one patient who developed a retinal tear. Mean BCVA was 0.61 ± 0.37 logMAR (20/81 Snellen equivalents) at baseline and 0.46 ± 0.30 logMAR (20/57 Snellen equivalents) at 12 months (P = 0.135). Mean central macular thickness was 357.9 ± 128.6 µm at baseline and 245.6 ± 60.0 µm at 12 months (P = 0.188). Mean numbers of intravitreal ranibizumab injections were 4.8 ± 2.4 times during 12 months (4 to 8 injections). CONCLUSION: Gas-assisted VMA release can be used as an efficient alternative for exudative AMD patients with obvious VMA.

Baseline polyp size as a potential predictive factor for recurrence of polypoidal choroidal vasculopathy.

PURPOSE: To investigate the predictive factors for recurrence of polypoidal choroidal vasculopathy (PCV). METHODS: The medical records of 78 consecutive patients (78 eyes) with treatment-naïve PCV who responded to first-line treatment and completed at least a 3-year follow-up after the first remission were retrospectively analyzed. In this comparative cohort study, baseline characteristics were compared between the patients who had at least one recurrence (the recurrence group) and those without recurrence (the non-recurrence group) during at least 3-year follow-up periods. In addition, possible predictive factors for recurrence of PCV were investigated by using Cox regression analysis. RESULTS: Within 3 years of the first remission, 50 eyes (64 %) showed at least one recurrence (mean 1.5; 1 to ∼2 times). There were no significant differences in the baseline characteristics between the recurrence group and the non-recurrence group. However, the largest polyp diameter was significantly different: the mean largest polyp diameter (524 ± 340 µm) was significantly larger in the recurrence group compared to that of the non-recurrence group (352 ± 173 µm; P = 0.038). Cox regression analysis showed that the largest polyp diameter at baseline significantly correlated with recurrence of PCV (B = 1.470, P = 0.015). CONCLUSIONS: The largest polyp diameter at baseline may be predictive for PCV recurrence, as it was significantly larger in patients who had at least one recurrence.

The effect of consumption of ethanol on subfoveal choroidal thickness in acute phase.

BACKGROUND/AIMS: To investigate the acute effect of ethanol consumption on subfoveal choroidal thickness. METHODS: This prospective interventional study included the right eyes of 30 healthy subjects (30 eyes). Ethanol (1.0 g/kg) was administered orally on the first visit. A matching volume of water was administered orally on the second visit. Oral administration of ethanol and water was performed at 14:00, and choroidal thickness was measured every 30 min until 16:00. Change of choroidal thickness after oral administration of ethanol and water was the main outcome measure. RESULTS: At baseline, choroidal mean subfoveal thickness was 299.0±73.4 µm (range, 186.5-472.5 µm) before ethanol consumption and 297.1±71.1 µm (range, 187.0-470.5 µm) before water consumption. After consumption of ethanol, mean subfoveal choroidal thickness increased during the first 60 min and then decreased during the next 60 min, which was a significant change over time (p<0.001). After consumption of water, there was no significant change in mean subfoveal choroidal thickness over time (p=0.310). Comparison of changes in the mean subfoveal choroidal thickness during 120 min showed significant difference between ethanol and water consumption (p<0.001). CONCLUSIONS: The results of current study show that consumption of ethanol significantly affected the choroidal thickness. Mean subfoveal choroidal thickness increased during the first 60 min and then decreased during the next 120 min after ethanol consumption.

Ramipril inhibits high glucose-stimulated up-regulation of adhesion molecules via the ERK1/2 MAPK signaling pathway in human umbilical vein endothelial cells.

Ramipril has recently been shown to have anti-atherogenic properties. However, the specific mechanisms underlying these effects remain unclear. The purpose of this study was to determine the effects of ramipril on induction of adhesion molecules in human umbilical vein endothelial cells (HUVECs) using high-glucose (HG) conditions and to investigate possible underlying molecular mechanisms. The effects of ramipril on expression of intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 production, and ERK phosphorylation were examined in HG-induced HUVECs with inhibitors targeting the mitogen-activated protein kinase (MAPK) signaling pathway. HG induced the expression of the adhesion molecules ICAM-1 and VCAM-1. Pretreatment with ramipril drastically inhibited ICAM-1 and VCAM-1 production in a time- and dose-dependent manner. Moreover, upon investigating the effects of ramipril on the MAPK/extracellular signal-regulated kinase (ERK) signaling pathway, we found that ramipril completely inhibited HG-induced phosphorylation of ERK1/2. ERK inhibitors completely prevented the inhibitory effect of HG. This study demonstrated that ramipril reduces HG-stimulated induction of ICAM-1 and VCAM-1 expression via MAPK signaling, which may be useful for inhibition of atherosclerosis.

Association of Spectral-Domain Optical Coherence Tomography Findings with Visual Outcome of Macula-Off Rhegmatogenous Retinal Detachment Surgery.

PURPOSE: To identify prognostic factors for the visual outcome for patients with macula-off rhegmatogenous retinal detachment (RRD). METHODS: The medical records of 27 patients (27 eyes) with macula-off RRD were retrospectively investigated. In addition to clinical characteristics, spectral-domain optical coherence tomography (SD OCT) images were analyzed. RESULTS: The central foveal thickness at baseline was 923 ± 499.5 µm, and the mean height of the subretinal fluid was 697.8 ± 463.6 µm. Dropout of backreflection at the fovea was detected on preoperative SD OCT in 8 patients (29.6%). The external limiting membrane was disrupted in 5 patients (18.5%) as was the photoreceptor integrity in 9 patients (33.3%) at 12 months. On multiple regression analysis, backreflection integrity was the only predictive factor for postoperative visual outcome (B = 0.179, p = 0.020). CONCLUSIONS: Backreflection integrity on preoperative SD OCT seems to be helpful in predicting the postoperative visual outcome in macula-off RRD patients.