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The article presents the case of a 57-year-old male who has developed choroidal neovascularization (CNV) in both eyes six years following an initial diagnosis of acute disseminated encephalomyelitis-related choroiditis. On examination, old choroidal lesions, as well as subretinal hemorrhage were seen in both eyes. It recommends the use of systemic therapy in conjunction with antiangiogenic therapy.

Purpose: To assess the relationship between baseline age-related macular degeneration (AMD) and disease stage, as well as optical coherence tomography features seen in AMD, with 3-year changes in dark adaptation (DA)., Methods: Prospective longitudinal study including patients with AMD and a comparison group (n = 42 eyes, 27 patients). At baseline and 3 years, we obtained color fundus photographs, spectral-domain optical coherence tomography, and rod-mediated DA (20 minutes protocol). Multilevel mixed-effect models were used for analyses, with changes in rod intercept time at 3 years as the primary outcome. As some eyes (n = 11) reached the DA testing ceiling value at baseline, we used 3-year changes in area under the DA curve as an additional outcome., Results: Baseline AMD, AMD stage, and hyperreflective foci on optical coherence tomography were associated with larger changes in rod intercept time at 3 years. When change in area under the DA curve was used as an outcome, in addition to these features, the presence of retinal atrophy and drusenoid pigment epithelial detachment had significant associations. New subretinal drusenoid deposits at 3 years were also associated with more pronounced changes in rod intercept time and area under the DA curve., Conclusion: Specific optical coherence tomography features are associated with DA impairments over time, which supports that structural changes predict functional loss over 3 years.

Purpose: To determine the association between dark adaption (DA) and different health conditions linked with age-related macular degeneration (AMD)., Methods: Cross-sectional study, including patients with AMD and a control group. Age-related macular degeneration was graded according to the Age-Related Eye Disease Study (AREDS) classification. We obtained data on medical history, medications, and lifestyle. Dark adaption was assessed with the extended protocol (20 minutes) of AdaptDx (MacuLogix). For analyses, the right eye or the eye with more advanced AMD was selected. Multivariate linear and logistic regressions were performed, accounting for age and AMD stage., Results: Seventy-eight subjects (75.6% AMD; 24.4% controls) were included. Multivariate assessments revealed that body mass index (BMI; β = 0.30, P = 0.045), taking AREDS vitamins (β = 5.51, P < 0.001), and family history of AMD (β = 2.68, P = 0.039) were significantly associated with worse rod intercept times. Abnormal DA (rod intercept time ≥ 6.5 minutes) was significantly associated with family history of AMD (β = 1.84, P = 0.006), taking AREDS supplements (β = 1.67, P = 0.021) and alcohol intake (β = 0.07, P = 0.017)., Conclusion: Besides age and AMD stage, a higher body mass index, higher alcohol intake, and a family history of AMD seem to impair DA. In this cohort, the use of AREDS vitamins was also statistically linked with impaired DA, most likely because of an increased severity of disease in subjects taking them.

Purpose: To compare the choroidal thickness (CT) of diabetic eyes (different stages of disease) with controls, using swept-source optical coherence tomography., Methods: A multicenter, prospective, cross-sectional study of diabetic and nondiabetic subjects using swept-source optical coherence tomography imaging. Choroidal thickness maps, according to the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields, were obtained using automated software. Mean CT was calculated as the mean value within the ETDRS grid, and central CT as the mean in the central 1 mm. Diabetic eyes were divided into four groups: no diabetic retinopathy (No DR), nonproliferative DR (NPDR), NPDR with diabetic macular edema (NPDR + DME), and proliferative DR (PDR). Multilevel mixed linear models were performed for analyses., Results: The authors included 50 control and 160 diabetic eyes (n = 27 No DR, n = 51 NPDR, n = 61 NPDR + DME, and n = 21 PDR). Mean CT (ß = -42.9, P = 0.022) and central CT (ß = -50.2, P = 0.013) were statistically significantly thinner in PDR eyes compared with controls, even after adjusting for confounding factors. Controlling for age, DR eyes presented a significantly decreased central CT than diabetic eyes without retinopathy (β = -36.2, P = 0.009)., Conclusion: Swept-source optical coherence tomography demonstrates a significant reduction of CT in PDR compared with controls. In the foveal region, the choroid appears to be thinner in DR eyes than in diabetic eyes without retinopathy.

Purpose of Review: Pseudophakic cystoid macular edema (PCME) is a common cause of visual impairment after cataract surgery. This article systematically reviews and discusses the epidemiology, risk factors, diagnosis, and treatment of PCME, with a focus on advances in the past 1-2 years., Recent Findings: The incidence of PCME has declined with the advent of modern surgical techniques. Optical coherence tomography (OCT) has become an important adjunct to biomicroscopy and fluorescein angiography. PCME prophylaxis with topical nonsteroidal anti-inflammatory drugs remains unproven because long-term visual outcomes and comparative effectiveness studies are lacking. Chronic, refractory CME remains a therapeutic challenge, but investigational therapies with potential include corticosteroid intravitreal injections and implants, and intravitreal anti-vascular endothelial growth factor treatments. Few studies have assessed surgical options., Summary: There is currently a lack of well designed randomized clinical trials to guide the treatment of PCME.

Purpose: To compare the visual outcomes and retreatment rates of monotherapy with intravitreal bevacizumab versus combination with photodynamic therapy for choroidal neovascularization secondary to causes other than age-related macular degeneration., Methods: Seventeen patients received intravitreal bevacizumab, and 6 patients underwent intravitreal bevacizumab combined with verteporfin photodynamic therapy within 3 days. Additional bevacizumab was administrated if there was persistent fluorescein leakage or subretinal fluid on optical coherence tomography., Results: The mean change in visual acuity was vision gain of 1.7 lines in the monotherapy group compared with 2.8 lines in the combination therapy group at 12-month follow-up (P = 0.45). At 12 months, 93% in the monotherapy group and 100% in the combination group lost <2 lines of vision (P = 1.0); 36% gained >3 lines of vision in the monotherapy compared with 60% in the combination therapy group (P = 0.60). The monotherapy group received a mean of 4.8 reinjections, while the combination group received 2.6 reinjections over 12 months (P = 0.11). Subgroup analysis of cases of choroidal neovascularization caused by pathologic myopia demonstrated a mean change in visual acuity of vision gain of +2.0 lines in the monotherapy group versus +2.3 lines in the combination therapy group (P = 0.82) and a mean of 7.2 reinjections versus 2 in monotherapy and combination group, respectively (P = 0.0498) at 12 months., Conclusion: The majority of patients had stabilization or improvement in vision in both treatment groups. Combination therapy with bevacizumab plus photodynamic therapy showed lower retreatment rates in patients with myopia. Randomized clinical trials are necessary to confirm these findings.

Purpose: The purpose of the study was to compare the efficacy and safety of a transconjunctival sutureless technique for pars plana vitrectomy using conventional 20-gauge instruments versus the conventional technique., Methods: Clinical data were reviewed retrospectively for a consecutive series of patients who underwent transconjunctival sutureless vitrectomy (TSV; 38 eyes of 37 patients) and a control group who underwent vitrectomy using the conventional technique (38 eyes of 38 patients)., Results: Eighty-nine of 107 sclerotomies (83.2%) in the TSV group self-sealed without the need for sutures. The TSV group showed earlier visual improvement from baseline, as early as 7 postoperative days, compared with 60 days in the conventional group. This was attributed to less surgically induced astigmatism in the TSV group; mean astigmatism at baseline and postoperative days 7, 30, and 90 was -1.05 diopter (D), -2.53 D, -1.32 D, and -1.09 D, respectively, in the TSV group and -1.09 D, -3.91 D (P = 0.0285), -2.57 D (P = 0.0203), and -1.18 D, respectively, in the conventional group. No serious complications were observed in either group, including postoperative hypotony, wound leakage, or endophthalmitis., Conclusion: The 20-gauge TSV technique is as effective as the conventional technique and offers earlier postoperative recovery.