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In this retrospective, multicenter study of 261 eyes (259 patients), patients who underwent rhegmatogenous retinal detachment repair during the coronavirus disease 2019 (COVID-19) post-lockdown period experienced an additional 22-day delay, leading to significantly more epiretinal membrane and proliferative vitreoretinopathy and lower single-surgery anatomic success rates. During lockdown, perfluoropropane gas was used more commonly, and pneumatic retinopexy was used more commonly in COVID-19–positive patients.

Photodynamic therapy has been reported as a successful approach in inducing choroidal osteoma decalcification and stabilization. Although, photodynamic therapy may be an effective treatment to prevent tumor growth toward the foveola in extrafoveal osteomas, decalcification may be complicated by secondary choroidal neovascularization, necessitating close monitoring in these patients.

BackgroundTo demonstrate a technique for using optical coherence tomography angiography (OCTA) to simulate leakage in eyes with diabetic macular oedema and determine the sensitivity and positive predictive value of detecting leaking microvasculature on OCTA using fluorescein angiography (FA) as the comparative norm.Methods6×6 mm OCT angiograms were overlaid with the corresponding OCT thickness maps. Microvascular abnormalities on the OCT angiogram underlying areas of thickening on the OCT thickness map were assumed to be leaking. Two independent readers blindly read the OCTA overlay images then the FA images cropped to the same approximate region to delineate areas of leaking microvasculature. The results were compared to determine the sensitivity and positive predictive value of OCTA for detection of leaking vessels.Results28 eyes of 19 diabetic patients were included. Each eye demonstrated an average of seven leaking microvascular abnormalities on the OCTA images and 22 leaking abnormalities on the FA images. Sensitivity of leaking microvasculature detection by OCTA was 26.1% and positive predictive value was 68.4%. The correlation coefficient of the two readers’ detection of leaking microvasculature was 0.605 for OCTA reads compared with 0.916 for FA.ConclusionOCTA as a whole can be used to simulate leakage, but currently, sensitivity of the technique is low. Further understanding of the OCTA technology may yield novel means of detecting retinal pathology.

BACKGROUND AND OBJECTIVE:Aggressive posterior vitreoretinopathy (APVR) manifests with a broad area of retinal avascularity, progressive neovascularization, and/or tractional retinal detachment during the neonatal period.PATIENTS AND METHODS:A multicenter, retrospective, observational, consecutive case series study was performed to evaluate the retinal findings and structural retinal outcomes in patients treated for APVR within the first 3 months of life.RESULTS:Three premature neonates with a non-retinopathy of prematurity (ROP) APVR identified during routine ROP screening exams exhibited relatively severe, rapidly progressive retinal vascular abnormalities. Immediate laser photocoagulation of the avascular retina and vitrectomy for traction retinal detachment within several days to weeks improved or stabilized the retinal anatomy in all cases.CONCLUSIONS:This series describes clinical features in APVR in premature infants and suggests that early diagnosis and intervention may mitigate the typical aggressive course and poor prognosis of this condition.[[Ophthalmic Surg Lasers Imaging Retina.2019;50:201–207.]

This study uses fractal dimension analysis to study optical coherence tomography angiography images of patients with various stages of diabetic retinopathy. The results are compared with control patients to understand how fractal dimension changes as the stage of diabetic retinopathy changes.

AbstractThe objective of this research was to forecast the tax revenue of Pakistan for the fiscal year 2016–17 using three different time series techniques and also to analyse the impact of indirect taxes on the working class. The study further analysed the efficiency of three different time series models such as the Autoregressive model (A.R. with seasonal dummies), Autoregressive Integrated Moving Average model (A.R.I.M.A.), and the Vector Autoregression (V.A.R.) model. In any economy, tax analysis and forecasting of revenues is of paramount importance to ensure the economic and fiscal policies. This study is important to identify significant variables affecting tax revenue specifically in Pakistan. The data used for this paper was from July 1985 to December 2016 (monthly) and focused on forecasting for 2017. For the forecasting of total tax revenue, we used components of tax revenues such as direct tax, sales tax, federal excise duty and customs duties. The results of this study revealed that among these models the A.R.I.M.A. model gives better-forecasted values for the total tax revenues of Pakistan. The results further demonstrated that major tax revenue is generated by indirect taxes, which cause more inflation that directly hits the working class of Pakistan.

Supplemental Digital Content is Available in the Text.Optical coherence tomography angiography detected neovascular flow in 83% of the chorioretinal lesions occurring in eyes with idiopathic multifocal choroiditis but not in lesions confined to the subretinal pigment epithelium space.

The authors describe the first report in the literature of central retinal artery occlusion as the presenting manifestation of sarcoidosis. A 33-year-old man with asthma, headache, and 6 days of intermittent, transient vision loss in the OS presented with persistent vision loss in the OS. Ophthalmic examination was consistent with diagnosis of central retinal artery occlusion in the OS. Vascular imaging with CT angiography revealed an incidental finding of an intraconal mass surrounding the left optic nerve and hilar lymphadenopathy. Broncho scopic lymph node biopsy demonstrated noncaseating granulomas consistent with sarcoidosis. This case proffers a unique mechanism of vision loss in sarcoidosis and highlights that atypical causes of central retinal artery occlusion must be considered in patients without typical risk factors.

IMPORTANCE For patients with X-linked retinitis pigmentosa and clinicians alike, phenotypic variability can be challenging because it complicates counseling regarding patients’ likely visual prognosis. OBJECTIVE To evaluate the clinical findings from patients with X-linked retinitis pigmentosa with 13 distinct RPGR mutations and assess for phenotypic concordance or variability. DESIGN Retrospective medical record review of data collected from 1985 to 2011. SETTING Kellogg Eye Center, University of Michigan. PATIENTS A total of 42 patients with X-linked retinitis pigmentosa with mutations in RPGR. Age at first visit ranged from 4 to 53 years, with follow-up ranging from 1 to 11 visits (median follow-up time, 5.5 years; range, 1.4-32.7 years, for 23 patients with >1 visit). MAIN OUTCOMES AND MEASURES Clinical data assessed for concordance included visual acuity (VA), Goldmann visual fields (GVFs), and full-field electroretinography (ERG). Electroretinography phenotype (cone-rod vs rod-cone dysfunction) was defined by the extent of photopic vs scotopic abnormality. Qualitative GVF phenotype was determined by the GVF pattern, where central or peripheral loss suggested cone or rod dysfunction, respectively. Goldmann visual fields were also quantified and compared among patients. RESULTS Each mutation was detected in 2 or more related or unrelated patients. Five mutations in 11 patients displayed strong concordance of VA, while 4 mutations in 16 patients revealed moderate concordance of VA. A definitive cone-rod or rod-cone ERG pattern consistent among patients was found in 6 of 13 mutations (46.2%); the remaining mutations were characterized by patients demonstrating both phenotypes or who had limited data or nonrecordable ERG values. Concordant GVF phenotypes (7 rod-cone pattern vs 4 cone-rod pattern) were seen in 11 of 13 mutations (84.6%). All 6 mutations displaying a constant ERG pattern within the mutation group revealed a GVF phenotype consistent with the ERG findings. CONCLUSIONS AND RELEVANCE While VA and ERG phenotypes are concordant in only some patients carrying identical mutations, assessment of GVF phenotypes revealed stronger phenotypic conservation. Phenotypic concordance is important for establishing proper counseling of patients diagnosed as having X-linked retinitis pigmentosa, as well as for establishing accurate patient selection and efficacy monitoring in therapeutic trials.

IMPORTANCE Accurate diagnosis of choroidal melanoma is challenging and has important implications for both physicians and patients. We assessed the utility of quantification of fundus autofluorescence in the evaluation and follow-up of choroidal nevomelanocytic tumors. OBJECTIVE To assess the utility of autofluorescence quantification in distinguishing clinically diagnosed choroidal nevi, melanoma, and indeterminate nevomelanocytic lesions. DESIGN, SETTING, AND PARTICIPANTS A retrospective observational study from 2006 to 2012 of patients with choroidal nevomelanocytic lesions who had digital autofluorescence and color fundus imaging performed at the University of Michigan Kellogg Eye Center. INTERVENTION ImageJ software was used to output autofluorescence gray-scale values for each pixel of a 500 × 50-pixel region within each lesion and a corresponding adjacent control region. MAIN OUTCOME AND MEASURE A single value was generated, termed the Index of Retinal Autofluorescence (IRA), to represent the total difference in gray-scale values between the 2 regions in each affected eye. RESULTS Thirteen of the 14 clinically diagnosed nevi exhibited an IRA less than 150 gray-scale intensity squared (gsi2). Eight of 9 clinically diagnosed melanomas exhibited an IRA more than 150 gsi2. An IRA of 150 gsi2 distinguished nevi from melanomas with a sensitivity of 0.89 and specificity of 0.93. Fifteen of 19 patients with indeterminate nevomelanocytic lesions underwent clinical assessment and initial imaging with clinical follow-up at a median of 10 months. All 3 patients with an IRA less than 150 gsi2 showed no evidence of clinical progression and 6 of 12 lesions with an IRA more than 150 gsi2 showed clinical progression to melanoma. An IRA of 150 gsi2 identifies indeterminate lesions that progressed to melanoma with a sensitivity of 1.00 and specificity of 0.33. CONCLUSIONS AND RELEVANCE Quantification of digital autofluorescence images can differentiate between clinically benign and malignant choroidal nevomelanocytic lesions and may be predictive for clinical progression of indeterminate lesions.

IMPORTANCE Accurate assessment of disease burden and determination of disease progression are challenging in dry age-related macular degeneration (AMD). We assessed the utility of quantified fundus autofluorescence in (FAF) the evaluation and follow-up of dry AMD. OBJECTIVE To develop a method for quantitative FAF image analysis that is capable of stratifying severity of nonexudative AMD. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis from 2008 to 2012 at a university eye center of FAF images taken of normal and nonexudative AMD eyes compared the Index of Retinal Autofluorescence (IRA) with retinal specialists’ clinical rankings of FAF images and the Age-Related Eye Disease Study (AREDS) grading scheme of corresponding color fundus photographs. INTERVENTION Digital files of Heidelberg Spectralis FAF images taken of normal and nonexudative AMD eyes were analyzed. For each image, a unique horizontally oriented FAF signature composed of vertically averaged gray-scale values was generated through the fovea. A pairwise comparison of 2 signatures was performed using a modified difference of squares method, which generated a single quantitative value, the IRA. MAIN OUTCOMES AND MEASURES The effects of intersession testing, cataract extraction, pupillary dilation, focal plane, and gain settings on the IRA were assessed. RESULTS The FAF images taken of the same subjects at different times demonstrated low intersession variability of the IRA (intraclass coefficient = 0.75; 95% CI, 0.45-0.92). The IRA was affected by cataract severity, cataract extraction, small pupillary diameters (<5.5 mm), defocusing, and excessive high or low camera gain. The IRA values correlated with both subjective clinical rankings by retinal specialists (rs = 0.77). The IRA was positively correlated with AREDS score (rs = 0.73) and could statistically distinguish AREDS grades 3 and 4 (P < .001). Serial imaging demonstrated the utility of the method for identifying clinically meaningful disease progression. CONCLUSIONS AND RELEVANCE The IRA method applied to FAF digital files can quantify AMD disease severity and may be helpful in identifying AMD progression.

Suprachoroidal hemorrhage is typically observed in patients with hypotony in the context of intraocular surgery and trauma. We report a rare presentation of suprachoroidal hemorrhage associated with emesis (Valsalva maneuver) in a myopic patient with few other identifiable risk factors. This diagnosis was confirmed with wide-field fundus photography and B-scan ultrasound and was localized to the suprachoroidal space using both enhanced depth and swept-source optical coherence tomography imaging. This case is unique in its presentation and demonstrates the utility of newer imaging techniques to localize hemorrhages using a multimodal approach.[[Ophthalmic Surg Lasers Imaging Retina. 2016;47:674–676.]