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Purpose: To evaluate retinal thickness changes of individual retinal layers using spectral-domain optical coherence tomography (SD-OCT) after uneventful cataract surgery over a 3-months period. Design: Prospective cohort study. Methods: 41 patients who underwent uneventful cataract surgery were included. Retinal SD-OCT images of both eyes were acquired preoperatively, 1 day after surgery as well as 1 month and 3 months postoperatively. Changes of retinal layer thickness were estimated after semi-automated segmentation for the following individual layers in the central subfield (CS, 1 mm) and inner ring (IR, 1–3 mm) of the early treatment diabetic retinopathy study (ETDRS) grid: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), RNFL-GCL-IPL complex, inner nuclear layer (INL), outer plexiform layer (OPL), INL-OPL complex, outer nuclear layer (ONL), inner retina layer (IRL) and the total retina (TR). Furthermore, a sub-analysis with exclusion of patients devoid CME and an analysis in regard of patient age, lens status of the fellow eye, best corrected visual acuity and duration of surgery was conducted. Results: This study found significant alterations in all analysed retinal layers except for the RNFL (p = 0.33) and the GCL (p = 0.06) in the central subfield and the INL-OPL complex (p = 0.07) in the inner ring over the 3-months period (all p

Purpose: The retina is supplied with blood through superficial and deep capillary systems. Paracentral acute middle maculopathy (PAMM) is a relatively new terminology based on pathognomonic findings in the spectral-domain optical coherence tomography (SD-OCT). A connection with various retinal vascular diseases has been described, which is indicative of an ischemic etiology. The objective of our study is to contribute to the understanding of PAMM as either an isolated phenomenon or one associated with underlying health issues. We hope to contribute to a better understanding of this medical condition for potential future clinical approaches. Methods: This is a retrospective chart review performed at the Department of Ophthalmology of the Medical University of Graz. We reviewed the medical charts of patients who presented at our ophthalmological emergency department between January and April 2023. Patients with a diagnosis of PAMM, verified by a retina specialist, were included in our analysis. Results: Overall, five eyes of five female patients were enrolled. The patients′ age averaged 28.6 ± 10.4 years (16–44), with a median visual acuity at the initial presentation of 0 logMAR (1.9-0). Multimodal imaging, including SD-OCT, OCT angiography, fluorescein angiography and fundus photography, was performed. A complete blood count and a comprehensive internal medicine examination were performed, yielding no underlying comorbidities. Discussion: Our study shows that isolated PAMM may occur as an idiopathic exclusion diagnosis in otherwise healthy adults after further investigation yielded no results. However, due to the potential vascular comorbidities shown in previous studies, a thorough investigation should still be carried out.

Objective: To elucidate the pathogenesis of dupilumab (Dupixent®)–associated ocular surface disease (DAOSD). Design: Prospective single-center cohort study. Subjects: Twenty patients with moderate-to-severe atopic dermatitis (AD) who received dupilumab and 10 age- and sex-matched healthy controls were enrolled in the study. Methods: The study cohort underwent a thorough slit-lamp and entire-body dermatologic examination. Conjunctival swabs and smears were collected at baseline, 4 and 16 weeks after treatment initiation, and during the conjunctivitis episode. To analyse the ocular surface microbiome, 16S ribosomal RNA sequencing was performed, smears were hematoxylin and eosin stained, and serum cytokines were measured by using a multiplex immunobead assay. Main Outcome Measures: Composition of ocular surface microbiome and cellular component as well as serum cytokine levels. Results: Six of the 20 patients with AD developed DAOSD after dupilumab initiation; these patients responded after a delay to treatment as quantified by Eczema Area and Severity Index and Investigator’s Global Assessment score. Conjunctival smears showed massive neutrophilic infiltration and serum analysis revealed increased systemic levels of neutrophil-priming proinflammatory cytokines, in particular interleukin-1β and tumor necrosis factor α, in patients with DAOSD compared with those without it. The ocular surface microbiome of patients with DAOSD was characterized by a diverse and persistent microbial colonization, particularly by Acetobacter aceti. In contrast, microbial diversity decreased in patients with AD without DAOSD after the initiation of dupilumab treatment, especially the abundance of Staphylococcus aureus. In vitro experiments substantiated the potential role of the microbiome, showing increased growth of A. aceti and decreased growth of S. aureus in presence of dupilumab. Conclusions: Persistent neutrophilic infiltration and a unique microbial landscape on the ocular surface associated with elevated levels of systemic proinflammatory cytokines typify DAOSD. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

PurposeThere exists remarkable variation in definitions for the location of the center of a keratoconus. The objective of this study was to analyze deviations between locations obtained by different tomographic maps for that purpose. Furthermore, it was investigated whether these deviations are influenced by disease severity.MethodsIn 162 eyes with keratoconus, corneal tomographic maps derived by Scheimpflug technology were retrospectively analyzed to determine the cone location with 5 different methods: maximum axial curvature of the front surface (Kmax), maximum tangential curvature of the front surface (tKmax), minimum pachymetry (Pachymin), maximum elevation of the front surface (ELEF), and maximum elevation of the back surface (ELEB). Distances between the locations were calculated and tested for a correlation with keratoconus severity and distance between cone and corneal vertex.ResultsCone locations derived from the curvature maps (Kmax, tKmax) showed the lowest agreement with the locations determined by pachymetry or elevation maps. The largest distances were found between Kmax and Pachymin [Median and Interquartile range: 1.19 mm (0.87, 1.60)], Kmax and ELEB [1.12 mm (0.79, 1.41)], and Kmax and ELEF [0.97 mm (0.64, 1.27)]. Low distances (

Abstract To report on Acanthamoeba keratitis cases in a tertiary university eye-hospital in Graz, Austria, over a 21-year period. Retrospective study. Parameters included demographics, diagnostics, clinical courses, medical therapies, surgical interventions, secondary complications, and best spectacle-corrected visual acuity (BSCVA). Patient records for 44 eyes of 42 patients were analysed; 2 bilateral infections. Mean age at presentation was 31 ± 13 (16–65) years; contact lenses were used in 41 of 44 eyes (93.2%). Symptoms at initial presentation were mainly pain (41/43, 95.3%) and photophobia (16/43, 37.2%). Most frequent morphological findings were stromal infiltrates (30/44, 68.2%). Diagnosis was mainly confirmed by smears (40/42, 95.2%) and polymerase chain reaction (8/42, 19%). Antiamoebic treatment comprised biguanides and diamidines. Penetrating keratoplasty was performed in 10/44 (22.7%) eyes. Median time from symptom onset to initial visit was 2 (0–26) weeks; median follow-up was 30 (2–1008) weeks. BSCVA improved in 23/36 (63.9%) eyes, remained unchanged in 6/36 (16.7%) eyes and deteriorated in 7/36 (19.4%) eyes. Acanthamoeba keratitis predominantly occurs in young contact lens wearers. Diagnosis should be considered in patients with pain and stromal infiltrates. In the majority of cases, BSCVA can be improved. Early diagnosis and adequate treatment should be implemented to prevent complications.

Purpose Accumulating evidence points towards a close relationship between cardiovascular, endocrine and metabolic diseases. The BioPersMed Study (Biomarkers of Personalised Medicine) is a single-centre prospective observational cohort study with repetitive examination of participants in 2-year intervals. The aim is to evaluate the predictive impact of various traditional and novel biomarkers of cardiovascular, endocrine and metabolic pathways in asymptomatic individuals at risk for cardiovascular and/or metabolic disease.Participants Between 2010 and 2016, we recruited 1022 regional individuals into the study. Subjects aged 45 years or older presenting with at least one traditional cardiovascular risk factor or manifest type 2 diabetes mellitus (T2DM) were enrolled. The mean age of the participants was 57±8 years, 55% were female, 18% had T2DM, 33% suffered from arterial hypertension, 15% were smokers, 42% had hyperlipidaemia, and only 26% were at low cardiovascular risk according to the Framingham ‘Systematic COronary Risk Evaluation’.Findings to date Study procedures during screening and follow-up visits included a physical examination and comprehensive cardiovascular, endocrine, metabolic, ocular and laboratory workup with biobanking of blood and urine samples. The variety of assessed biomarkers allows a full phenotyping of individuals at cardiovascular and metabolic risk. Preliminary data from the cohort and relevant biomarker analyses were already used as control population for genomic studies in local and international research cooperation.Future plans Participants will undergo comprehensive cardiovascular, endocrine and metabolic examinations for the next decades and clinical outcomes will be adjudicated prospectively.

PurposeTo assess the prevalence and causes of visual impairment and blindness in a Central European country. The findings may have implications for the planning of further research and development of therapies in order to prevent blindness.SettingDepartment of Ophthalmology, Medical University of Graz, Austria.DesignRetrospective, epidemiological study.MethodsThe database of the Main Confederation of Austrian Social Insurances was searched for patients with visual impairment, legal blindness or deaf-blindness. This database gathers data from patients of all insurance providers in the country who receive care due to visual impairment and blindness. To determine the prevalence of these conditions, the number of all entries recorded in February 2019 was evaluated. Additionally, all new entries between (January 1st,) 2017, and (December 31st,) 2018, were analysed for distinct characteristics, such as sex, the cause of blindness/visual impairment, and age. Since health care allowances can provide a considerable source of income (459.90€-936.90€ per month), good coverage of practically all patients who are blind and visually impaired in the country can be assumed.ResultsOn February 2nd, 2019, 17,730 patients with visual impairments, blindness or deaf-blindness were registered in Austria, resulting in a prevalence of these diagnoses of 0.2% in the country. During the observational period from 2017 to 2018, 4040 persons met the inclusion criteria. Of these, 2877 were female (65.3%), and 1527 were male (34.7%). The mean age was 75.7 ± 18.0 years (median 82). Most patients (n = 3675, 83.4%) were of retirement age, while 729 (16.6%) were working-age adults or minors. In total, an incidence of 25.0 (95% confidence limit (CL) 24.3-25.8) per 100,000 person-years was observed from 2017 to 2018. A higher incidence was observed for females (32.2, 95% CL 31.0-33.3) than for males (17.7, 95% CL 16.8-18.5). Incidences where higher for males in lower age groups (e.g. 10-14 years: rate ratio RR = 2.7, 95% CL 1.1-6.8), and higher for females in higher age groups (e.g. 70-74 years: RR = 0.6, 95% CL 0.5-0.8). In total, the most frequent diagnoses were macular degeneration (1075 persons, 24.4%), other retinal disorders (493 persons, 11.2%) and inherited retinal and choroidal diseases (IRDs) (186 persons, 4.2%). Persons with IRDs were significantly younger compared to persons with macular degeneration or retinal disorders (IRDs: median 57, range 2-96 vs 83, 5-98 and 82, 1-98 years, pConclusionThese data show that IRDs are the leading cause of blindness and visual impairment in working-aged persons and children in Austria. Thus, these findings suggest to draw attention to enhance further research in the fields of emerging therapies for IRDs.

An amendment to this paper has been published and can be accessed via the original article.

Abstract Although intraocular pressure is the main the risk factor for the development of glaucoma, other risk factors such as vascular dysfunction might play an additional pathogenic role. Hypertriglyceridemia, which may lead to vascular dysfunction, has been implicated in the development of glaucoma. The objective of this meta-analysis was to investigate the association of triglyceride levels with the risk of glaucoma in case-control studies. Seventeen case-control studies were included investigating the difference in triglyceride levels in patients with glaucoma (N = 1 391) compared to subjects without glaucoma (N = 25 575). In random effects meta-analysis, the pooled mean triglyceride level across all studies and patients with and without glaucoma was 132.9 mg/dL (95%CI: 124.0–141.7). Patients with glaucoma had significantly higher mean triglyceride levels than patients without glaucoma (absolute difference = 14.2 mg/dL, 95%CI: 5.8–22.5, p

This study compares the presence of vitreous hyper-reflective dots (VHDs) detected with optical coherence tomography (OCT) between eyes with pseudophakic cystoid macular edema (CME) and those with no CME after cataract surgery. In addition, we evaluated the impact of VHDs on the responsiveness of pseudophakic CME to cortisone treatment.Department of Ophthalmology, Medical University of Graz, Austria.Retrospective, monocenter case-controlled study.Inclusion criteria for the study group and the control group were CME and no CME within 12 weeks following uneventful phacoemulsification in otherwise healthy eyes, respectively. VHDs (number and size) and the macular thickness were assessed with OCT. Furthermore, the number of peribulbar or intravitreal steroid injections was assessed.A total of 284 eyes from 267 patients were analyzed, among which 119 met the inclusion criteria for the study (n = 63) and the control group (n = 56). VHDs were observed in 54 (85.7%) study eyes and 21 (37.5%, p = 0.013) control eyes. The number of VHDs was 3.9±3.4 in the study group and 0.7±1 in the control group (p

Laser photocoagulation is the current gold standard treatment for proliferative retinopathy of prematurity (ROP). However, it permanently reduces the visual field and might induce myopia. Vascular endothelial growth factor (VEGF) inhibitors for the treatment of ROP may enable continuing vascularization of the retina, potentially allowing the preservation of the visual field. However, for their use in infants concern remains. This meta-analysis explores the safety of VEGF inhibitors.The Ovid Interface was used to perform a systematic review of the literature in the databases PubMed, EMBASE and the Cochrane Library.This meta-analysis included 24 original reports (including 1.457 eyes) on VEGF inhibitor treatment for ROP. The trials were solely observational except for one randomized and two case-control studies. We estimated a 6-month risk of retreatment per eye of 2.8%, and a 6-month risk of ocular complication without the need of retreatment of 1.6% per eye. Systemic complications were only reported as isolated incidents.VEGF inhibitors seem to be associated with low recurrence rates and ocular complication rates. They may have the benefit of potentially allowing the preservation of visual field and lower rates of myopia. Due to the lack of data, the risk of systemic side effects cannot be assessed.

Purpose: To evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. Methods: Medical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent). Results: Ninety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 ± 0.28 and 0.52 ± 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 ± 209.1 μm preoperatively and 327 ± 66.1 μm postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 ± 0.14 vs. 0.7 ± 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 ± 54.6 μm; ELM disruption: 334 ± 75.2, p = 0.31). Conclusions: PPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact. [ABSTRACT FROM AUTHOR]

Purpose: To assess gains in quality of life (QOL) and visual acuity (VA), and to evaluate speed of visual and functional rehabilitation in diabetes patients with different stages of retinopathy (DR) after phacoemulsification in either one or both eyes. Methods: This prospective longitudinal study comprised 102 patients having either (1) first eye, or (2) first and subsequent second eye cataract surgery. One surgeon performed all surgeries. In both groups, the following subset of patients was compared: those with no apparent retinopathy (no DR), those with mild nonproliferative DR (NPDR), those with severe NPDR, and those with proliferative DR. VA and questionnaire (VF-14) responses were recorded prior to and 1, 3, 6, 8 and 12 months after surgery. Results: Patients with no DR and mild NPDR showed a significantly more rapid speed of visual and functional rehabilitation compared to patients with severe NPDR and proliferative DR. Maximum visual and functional results for these patients were observed 1 month after surgery, and values were significantly higher in comparison to other patients (p values <0.0001). Patients with no DR and mild NPDR who had second eye surgery demonstrated significant improvements (VA, QOL) and sustainment of the improved functional status achieved after first eye surgery (p < 0.001). Conclusions: Patients with no DR and mild NPDR show greater significant improvements in QOL and VA, and a more rapid speed of visual and functional rehabilitation in comparison to patients with more advanced DR. Functional gains are sustained at 1 year after surgery, if second eye surgery is performed. [ABSTRACT FROM AUTHOR]

AbstractPurpose:To assess psychological, visual and functional aspects associated with subretinal hemorrhages secondary to age-related macular degeneration (AMD). Method:In this prospective, comparative, longitudinal study, 90 eyes of 90 patients with a subretinal hemorrhage, secondary to AMD, of at least 1 disk diameter were treated with recombinant tissue plasminogen activator (rTPA) and gas, and compared to 25 eyes of 25 controls. Outcome measures were: (1) visual acuity, (2) self-reported vision-related quality of life (Visual Function 14-item questionnaire) and (3)Hospital Anxiety and Depression (HAD) scores. Visual acuity and questionnaire responses were recorded prior to as well as 2 weeks and 4 months after treatment. Results:Improvements across objective visual acuity and vision-related functional measures, assessed at 2 weeks and 4 months, were significantly higher in patients who had rTPA and gas injections than in controls (p < 0.01). Patients were significantly more distressed at their 2-week follow-up in comparison to controls (HAD scores p < 0.01). Comparisons to controls showed no significant difference in psychological scores at the 4-month follow-up (p > 0.32). Conclusions:Patients with subretinal hemorrhages secondary to AMD are psychologically distressed as a result of acute loss of vision. More attention should be given to strategies that teach patients to cope with acute vision loss and thereby psychological disorder.Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

AbstractBackground??To present a method for performing photodynamic therapy (PDT) with a constant predictable light fluence based on actual laser spot magnification.Methods??A calibrated Gullstrand-type model eye with a scale of half circles in the centre of the artificial fundus was used for this study. The axial length of the model eye was set to different values ranging from 20 to 31?mm, and the actual laser spot magnification of four indirect condensing laser lenses were determined using a PDT laser unit.Results??Equations for determining the actual laser spot magnification were calculated for each laser lens. The total change in laser spot magnification from hyperopia (axial length 20?mm) to myopia (axial length 31?mm) was ?20% to .8% for Mainster Standard lens (Ocular Instruments Inc, Bellevue, Washington, USA), ?15.7% to .7% for Mainster Wide Field lens (Ocular Instruments Inc), ?16.3% to .1% for Volk Transequator lens (Volk Optical Inc, Mentor, Ohio, USA), and ?19.2% to .4% for Volk PDT Laser lens (Volk Optical Inc).Conclusions??Axial length of the eye has a considerable effect on PDT laser spot magnification when an indirect laser lens is used. By calculating the actual laser spot magnification in conjunction with knowledge of the true greatest linear dimension of the neovascular lesion, the clinician may be able to deliver a constant predictable amount of light fluence to the fundus independent of the axial length of the PDT treating eye. [ABSTRACT FROM AUTHOR]

Abstract [ABSTRACT FROM AUTHOR]