Current intravitreal therapy and ocular hypertension: A review.

To determine the effect of commonly used intravitreal agents on immediate and long-term IOP elevations and their association, if any, with glaucoma. Literature searches in PubMed and the Cochrane databased in January 2020 yielded 407 individual articles. Of these, 87 were selected for review based on our inclusion criteria. Based on the evidence provided, 20 were assigned level I, 27 level II, and 22 level III. Eight articles were rejected because of poor quality, insufficient clarity, or irrelevance based on standardized protocols set out by the American Academy of Ophthalmology. The studies that reported on short-term IOP elevation (i.e., between 0 and 60 min) showed that an immediate increase in IOP is seen in all patients who receive anti-VEGF agents or triamcinolone acetonide when measured between 0 and 30 min of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection of anti-VEGF agents, while the position of the implant vis-à-vis, the anterior chamber was important for steroid therapy. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. However, some studies demonstrated RNFL thinning in patients receiving chronic anti-VEGF therapy. Most, if not all, intravitreal agents cause ocular hypertension, both in the short term and long term. The functional consequences of these observations are not very clear.

Correlation in acute CSCR between hyperreflectivity on the infrared image in optical coherence tomography and fluorescein angiography.

BACKGROUND: To determine the association between hyperreflective area identified on the reference image (en-face image) in spectral domain optical coherence tomography (SD-OCT) scan and the leak on fluorescein angiography in patients with acute treatment naive central serous chorioretinopathy (CSCR). METHODS: Retrospective, observational chart review. The reference image (en-face) image on SD OCT raster scan was examined for the presence of a hyperreflective spot and an attempt was made to correlate its location on the actual leak seen on FFA using anatomical landmarks as reference. Follow up was 6 months after CSCR resolution. Appropriate statistical analysis was made. RESULTS: Sixty-two patients (65 eyes; 49 males) with CSCR were identified of which 62/65 eyes (95.38%) showed the said correlation. The mean age was 31.24 years. The mean follow-up was 17.25 months. The mean BCVA at baseline was 0.28 logMAR. The mean final BCVA was 0.08. The hyperreflective spot noted on the infrared (reference) image correlated the most with the classic ink-blot leakage as well as the minimally enhancing/ill-defined leakage pattern. In 37/41 eyes, the area of hyperreflectivitiy correlated with the pigment epithelial detachment. The hyperreflective spot resolved in most patients who received photodynamic therapy but persisted in most patients who received eplerenone therapy. Persistent hyperreflectivity after subretinal fluid resolution appeared to correlate with persistent metamorphopsia and reduced contrast sensitivity in eyes with no subretinal fluid. CONCLUSION: We demonstrate an interesting correlation between the area of leak and the OCT reference image (en face) used to determine the level of the scan. SYNOPSIS: The study looks at the potential applicability of a correlation between leaking areas on fundus fluorescein angiography and a hyperreflective area on the infrared image in optical coherence tomography (OCT) in patients with central serous chorioretinopathy (CSCR).