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The purpose of this study was to investigate the predictors of retinal pigment epithelium (RPE) tear development after treatment for neovascular age-related macular degeneration using swept source optical coherence tomography angiography.This prospective study included 152 treatment-naïve eyes with neovascular age-related macular degeneration without high myopia that were followed up for 1 year after treatment. Eligible eyes were classified into eyes with or without RPE tear development. They were matched in a 1:2 ratio. The areas of choroidal neovascularization (CNV) and RPE detachment (pigment epithelial detachment [PED]) were measured from optical coherence tomography angiography and OCT en face images, respectively. The optical coherence tomography angiography-specific parameters representing CNV status were analyzed.Eight (5.3%) of the 152 eyes developed RPE tears (RPE tear group). After matching, 16 eyes without RPE tears were analyzed (non-RPE tear group). The ratio of the CNV/PED area was lower in the RPE tear group than that in the non-RPE tear group (P = 0.007). The PED area was broader (P = 0.008), and PED height was greater in the RPE tear group (P = 0.04). Optical coherence tomography angiography-specific parameters did not differ between the two groups.Neovascular age-related macular degeneration with pretreatment broad PED, high PED, and small CNV area relative to the PED area has a high risk of RPE tear development after therapy. However, CNV status may not have an association.

PURPOSE To evaluate fixation status of eyes with branch retinal vein occlusion (BRVO) and to investigate its association with other clinical parameters. METHODS This study included 57 consecutive eyes with BRVO after resolution of macular edema. Fixation status was determined by microperimetry. Defect length of the foveal ellipsoid zone band was measured by optical coherence tomography, and retinal perfusion status was assessed by optical coherence tomography angiography. RESULTS In microperimetry, the mean fixation rate around the gravitational center of all fixation points (defined as the fixation center) was found to be 79.8 ± 18.9%, which was significantly associated with defect length of the foveal ellipsoid zone band (P < 0.001) and distance between the foveal and fixation centers (P = 0.012). The integrity of the ellipsoid zone band at the fixation center was intact in 55 eyes (96.5%). Fixation centers were located within and outside the foveal avascular zone in 33 (57.9%) and 24 (42.1%) eyes, respectively; among the latter eyes, all fixation centers were perfused. Downward deviation of fixation points was rare, despite variations in the occluded area; there was a significant difference in distribution of deviation between eyes with superotemporal and inferotemporal BRVO (P < 0.001). CONCLUSION In eyes with BRVO, fixation status was strongly associated with visual acuity, morphologic damage, and retinal perfusion status both in the foveal area and at the fixation center after resolution of macular edema. This information regarding fixation status could facilitate vision management in patients with BRVO.

The area of choriocapillaris nonperfusion on optical coherence tomography angiography correlated with the area of macular atrophy on fundus autofluorescence in eyes with exudative age-related macular degeneration. Choroidal ischemia might be involved in macular atrophy in treated age-related macular degeneration., Purpose: To compare the areas of choriocapillaris (CC) nonperfusion and macular atrophy (MA) in treated exudative age-related macular degeneration. Methods: This was a prospective, observational, cross-sectional study. Forty-four eyes exhibiting MA (42 patients with age-related macular degeneration), with a dry macula, underwent fundus autofluorescence and optical coherence tomography angiography. The area of MA detected by fundus autofluorescence and CC nonperfusion detected by optical coherence tomography angiography was measured using image analysis software. The rates of concordance between the MA and CC nonperfusion areas were calculated. We qualitatively and quantitatively compared the areas of MA and CC nonperfusion in age-related macular degeneration eyes. Results: The mean areas of MA and CC nonperfusion were 5.95 ± 4.50 mm2 and 10.66 ± 7.05 mm2, respectively (paired t-test, P < 0.001). In 39 eyes (88.6%), the CC nonperfusion area was larger than the MA area, and the mean CC nonperfusion area was significantly larger than the mean MA area. Fundus autofluorescence matching optical coherence tomography angiography showed that the CC nonperfusion area was almost included in the MA area. The mean concordance rate for the MA area inside the CC nonperfusion area was 87.7 ± 13.9%. Conclusion: The MA and CC nonperfusion areas markedly overlapped. The area of CC nonperfusion correlated with the MA area. Choroidal ischemia might be involved in the pathogenesis of MA in treated age-related macular degeneration.

PURPOSE The purpose of this study was to investigate the lamina cribrosa (LC) microvasculature using swept-source optical coherence tomography angiography (OCTA) images that have been processed using multiple image averaging and a projection-resolved algorithm. OCTA has recently gained popularity for assessing retinal and choroidal microvasculature. However, it is not known if the LC microvasculature, which likely holds important information for further understanding of glaucoma, can be visualized with OCTA. METHODS One normal subject and 1 glaucomatous subject were enrolled and optic disc 3×3 mm swept-source OCTA cubic images were obtained for each subject. Anterior LC slab frames were developed, and the averaged images were created using 3 frames. Images were examined both with and without removal of projection artifacts. RESULTS The OCTA images of anterior LC slabs before projection artifact removal contained information on superficial and deep layer vessel blood flow. However, after projection artifact removal, fewer blood flow signals remained. These en face OCTA images showed flow signals on or immediately adjacent to lamina beams, but not inside lamina pores. The glaucomatous eye had a sectoral reduction in LC microvasculature blood flow that was not detected in normal eye. CONCLUSIONS This is the first demonstration of imaging of the inner LC microvasculature, which, in agreement with previous histologic reports, was arranged in a polygonal pattern. Furthermore, glaucomatous eye had decreased flow signals in comparison with normal eye. Therefore, future imaging studies with OCTA may be helpful for identifying and better understanding LC pathologic changes associated with glaucoma.

To investigate the incidence and predictors of macular atrophy during treatment with aflibercept for neovascular age-related macular degeneration in Japanese patients.This study included patients with treatment-naive subfoveal neovascular age-related macular degeneration treated from December 2012 through January 2015. Patients were treated with bi-monthly aflibercept injections after 3 monthly loading injections for the first year. Diagnosis of retinal pigment epithelial atrophy was made based on color fundus photography, spectral-domain optical coherence tomography, and fundus autofluorescence. Baseline characteristics and morphological features were analyzed for their association with the development of macular atrophy.This study included 123 eyes that had no baseline macular atrophy and treated with aflibercept injections for 12 months. Thirteen eyes (10.6%) developed new macular atrophy at 12 months. Logistic regression analysis showed that the presence of intraretinal fluid and thinner subfoveal choroidal thickness at baseline were associated with the development of macular atrophy after aflibercept treatment.Macular atrophy developed in about 10% of eyes with neovascular age-related macular degeneration during 12 months of treatment with a fixed regimen of aflibercept. Intraretinal fluid and subfoveal choroidal thickness seem to be predictors for development of macular atrophy after anti-vascular endothelial growth factor (VEGF) therapy.

PURPOSE To examine the recurrence rate of choroidal neovascularization (CNV) lesion activity in age-related macular degeneration (AMD) and associated factors after 1-year aflibercept treatment. METHODS Age-related macular degeneration eyes with 1-year aflibercept fixed-regimen treatment and a follow-up period of at least 18 months from the initial aflibercept injection for treatment-naive exudative AMD were retrospectively evaluated. The recurrence rate was examined. Age, gender, visual acuity, AMD subtype, greatest linear dimension, and retinal and choroidal thicknesses at the 12th month examination were compared between eyes with and without recurrence. Presence of remnant polyps and pigment epithelial detachment (PED) morphology were also compared in polypoidal choroidal vasculopathy (PCV) eyes. RESULTS Of the 98 eyes studied, 69 displayed a dry macula at the 12th month examination; 43.7% exhibited recurrence during the subsequent 12-month period in Kaplan-Meier analysis. Although no factors associated with recurrence were detected in AMD, remnant polyps and pigment epithelial detachment morphology at the 12th month examination were significantly associated with recurrence in polypoidal choroidal vasculopathy (P = 0.018 and 0.048, respectively). CONCLUSION Continuous, proactive treatment would be considered overtreatment for more than half of the AMD eyes that achieved a dry macula. Angiography and optical coherence tomography analyses may be useful for predicting recurrence in polypoidal choroidal vasculopathy eyes.

Rationale: Bilateral diffuse uveal melanocytic proliferation (BDUMP) is an extremely rare retinal exudative disease with physical disorders and no established treatment standard. We describe treatment courses in 3 cases of BDUMP. Patients concerns: Three male patients complained active vision loss. One male patient in his 70s (patient 1) was treated with prednisolone, mesalazine, and ciclosporin for hypoplastic anemia and ulcerous colitis. One male patient in his 60s (patient 2) was on prednisolone therapy for adult Still disease. Another male patient in his 70s (patient 3) was on prednisolone therapy for polymyalgia rheumatica, giant cell arteritis, and pancreatic body tumor. Diagnoses: Retinal specialists diagnosed these patients with BDUMP based on characteristic fundus findings of multiple red patches and retinal exudate. Interventions: Two patients (patients 1 and 2) with poor response to anti-vascular endothelial growth factor (VEGF) monotherapy and/or triamcinolone acetonide sub-Tenon injection were treated with combined anti-VEGF therapy and photodynamic therapy. One patient (patient 3) was treated with 3 rounds of monthly anti-VEGF monotherapy. Outcomes: Retinal exudates were resolved in all patients. No recurrence of retinal exudates was observed for at least 10 months, 2 years, or 4 months after the therapy in patients 1, 2, and 3, respectively. However, best-corrected visual acuity of the right eye was low (20/200) compared with that of the left eye (20/22) in patient 2 despite exudate resolution, due to permanent outer retinal damage secondary to long-term retinal exudate. Lessons subsections: Combined anti-VEGF therapy and photodynamic therapy may be a feasible therapeutic option for treatment-resistant exudate in patients with BDUMP. Early diagnosis of BDUMP and prompt administration of combination therapy are crucial.

PURPOSE To investigate associations between parafoveal microcirculatory status and foveal pathomorphology in eyes with macular edema (ME) secondary to retinal vein occlusion (RVO). METHODS Ten consecutive patients (10 eyes) with acute retinal vein occlusion were enrolled, 9 eyes of which received intravitreal ranibizumab (IVR) injections. Foveal morphologic changes were examined via optical coherence tomography (OCT), and parafoveal circulatory status was assessed via adaptive optics scanning laser ophthalmoscopy (AO-SLO). RESULTS The mean parafoveal aggregated erythrocyte velocity (AEV) measured by adaptive optics scanning laser ophthalmoscopy in eyes with retinal vein occlusion was 0.99 ± 0.43 mm/second at baseline, which was significantly lower than that of age-matched healthy subjects (1.41 ± 0.28 mm/second, P = 0.042). The longitudinal adaptive optics scanning laser ophthalmoscopy examinations of each patient showed that parafoveal AEV was strongly inversely correlated with optical coherence tomography-measured central foveal thickness (CFT) over the entire observation period. Using parafoveal AEV and central foveal thickness measurements obtained at the first and second examinations, we investigated associations between differences in parafoveal AEV and central foveal thickness, which were significantly and highly correlated (r = -0.84, P = 0.002). CONCLUSION Using adaptive optics scanning laser ophthalmoscopy in eyes with retinal vein occlusion macular edema, we could quantitatively evaluate the parafoveal AEV. A reduction or an increase in parafoveal AEV may be a clinical marker for the resolution or development/progression of macular edema respectively.

PURPOSE To investigate the parafoveal perfusion status of the superficial and deep capillary layer in eyes with resolved branch retinal vein occlusion, and to study its effects on retinal sensitivity. METHODS In 27 enrolled eyes (27 patients) with resolved branch retinal vein occlusion, superficial and deep capillaries in the macular area (3- × 3-mm, centered on the fovea) were examined with optical coherence tomography angiography. Retinal sensitivity was examined with fundus-monitored microperimetry. RESULTS Optical coherence tomography angiography clearly showed the parafoveal superficial and deep capillaries individually. On the affected side of retina, 25 eyes (92.6%) showed capillary nonperfusion; 23 (85.2%) in the superficial layer and 22 (81.5%) in the deep layer. Capillary nonperfusions of both layers frequently overlapped and appeared to be connected with each other. Mean (±SD) retinal sensitivity at the superficial capillary nonperfusion was 19.2 ± 6.3 dB, significantly lower than that at the superficial capillary perfusion (24.4 ± 2.8 dB, P < 0.001). Similarly, mean retinal sensitivity at the deep capillary nonperfusion was 20.8 ± 5.0 dB, significantly lower than that at deep capillary perfusion (24.3 ± 2.8 dB, P = 0.0016). Mean retinal sensitivity with superficial capillary nonperfusion was significantly lower than that with deep capillary nonperfusion (P = 0.0226). CONCLUSION Optical coherence tomography angiography visualized parafoveal capillary nonperfusion in superficial and deep layers individually in eyes with resolved branch retinal vein occlusion. Retinal sensitivity was significantly reduced at these capillary nonperfusions.

To evaluate peripheral retinal hemorrhagic patterns in eyes with acute central retinal vein occlusion, and to explore their clinical relevance in differentiating for the retinal perfusion status, through a prospective, and cross-sectional study.Fifty eyes with acute central retinal vein occlusion were included. Retinal hemorrhagic patterns at the equator and retinal perfusion status were evaluated by ultra-wide field fundus photography and fluorescein angiography.Retinal perfusion was categorized as nonischemic in 29 eyes, ischemic in 18 eyes, and undeterminable in 3 eyes. None of the examined eyes had flame-shaped retinal hemorrhages in the periphery. All hemorrhages were rounded-dot or blot and were variable in size. Particle analysis was performed to quantify hemorrhage size, and showed higher values in eyes having larger blot hemorrhages, and lower values in eyes having dot or smaller blot hemorrhages. Mean size of maximum peripheral dot or blot hemorrhage was larger in eyes classified as ischemic (10,763.0 ± 5,946.3 pixels) than as nonischemic (2,839.9 ± 1,153.6 pixels, P0.001). The authors calculated area under the curve to investigate the ability of continuous variables to discriminate retinal perfusion status, which was 0.963 (P0.001) for mean size of maximum peripheral blot hemorrhages.The authors objectively evaluated retinal hemorrhagic patterns at the equator in eyes with acute central retinal vein occlusion using particle analysis. The resulting hemorrhage size measurement was considered to be often useful in determining retinal perfusion status. Because they can be noninvasively evaluated with readily available equipment, peripheral hemorrhagic patterns might be good clinical markers of retinal perfusion.

Although central blood pressure (BP) is considered to be more closely associated with large arterial remodeling and cardiovascular outcomes than brachial BP, few studies have investigated these associations with changes in small arteries. As morphological changes in retinal vessels might be associated with cardiovascular outcomes, we conducted a cross-sectional study to investigate the association of central BP with retinal vessel caliber.The study included 8054 Japanese participants. Central BP was estimated by the radial arterial waveform by calibrating brachial BP. Central retinal arteriolar equivalent (CRAE) was computationally measured using fundus photography.CRAE was most strongly associated with central SBP (r = -0.324, P 0.001), followed by DBP (r = -0.292, P 0.001) and central pulse pressure (PP; r = -0.226, P 0.001). The correlation coefficient between SBP and CRAE was significantly greater in central SBP than in brachial SBP (r = -0.300, P 0.001). After adjustment for possible covariates, brachial SBP (β = -0.221, P 0.001) and central SBP (β = -0.239, P 0.001) were independently associated with CRAE. Further, higher brachial SBP (β = -0.226, P 0.001) and smaller PP amplification (β = 0.092, P 0.001) were identified as independent determinants of narrowing of CRAE in the same equation, which indicated the superiority of central BP. Central BP-determined hypertensive individuals had a significantly narrower CRAE independent of brachial BP (central/brachial: hypertension/hypertension 121.4 ± 11.5, hypertension/normotension 120.9 ± 11.2, normotension/hypertension 125.1 ± 11.9, normotension/normotension 128.1 ± 11.5 μm).Central BP was more closely associated with the narrowing of CRAE than brachial BP. Slight increases in central BP might be involved in the morphological changes in small retinal arteries, even in individuals with optimal brachial BP.

Purpose In this study, the authors aimed to investigate structural abnormalities in the retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) and study the surgical outcomes in eyes with such alterations by comparing ultrastructure findings of the surgically excised epiretinal membrane (ERM) and inner limiting membrane (ILM) in patients with idiopathic ERM. Methods and patients Vitreous surgery was performed on four eyes with idiopathic ERM, of which three had columnar alterations of the nerve fiber layer. The ERM and ILM were dissected and removed, and ultrathin sections were analyzed and imaged completely by using electron microscopy. All the patients underwent a comprehensive ophthalmologic examination, including SD-OCT, fundus-monitoring microperimetry, and red-free scanning laser ophthalmoscopic imaging. Results Preoperatively, SD-OCT revealed the presence of columnar structures only in the RNFL. Transmission electron microscopy showed that all samples contained retinal cell debris on the outer surface of the ILM. However, adhesion of retinal nerve fibers on the outer surface of the ILM was not observed in any specimen. The columnar alterations in the RNFL observed via SD-OCT resolved completely within 1 month in all eyes. At 6 months after surgery, no eyes showed scotoma on microperimetry. Further, no dissociated nerve fiber layer appearance was identified. Conclusion Vitrectomy with ILM peeling can be safely performed for ERMs with RNFL alterations, detected preoperatively by SD-OCT, without any structural or functional disturbances. The columnar alterations of the RNFL on SD-OCT may be inner retinoschisis.

Purpose: To investigate how combined cystoid spaces and serous retinal detachment affect photoreceptor status and visual acuity at final visit in macular edema associated with branch retinal vein occlusion. Methods: Forty-seven consecutive eyes from 47 patients with macular edema associated with branch retinal vein occlusion treated with intravitreal bevacizumab injection were retrospectively reviewed. Foveal pathomorphology on optical coherence tomography images were divided into two groups: those in which combined foveal cystoid spaces and serous retinal detachment were observed at least once (C+S(+)) and those in which they were not observed (C+S(−)). The relationship between foveal pathomorphology and photoreceptor status and logarithm of the minimum angle of resolution at final visit was investigated. Results: Sixteen eyes were categorized as C+S(+), and the final visual acuity of C+S(+) group was significantly worse than that of C+S(−) group compared with no difference at baseline. Intriguingly, combined foveal pathomorphologies during the course were significantly associated with the absence of external limiting membrane and the junction of inner and outer segments at last visit. Using multivariable analysis, final logarithm of the minimum angle of resolution was significantly related to baseline logarithm of the minimum angle of resolution, diabetes, and C+S(+). Conclusion: Combined foveal cystoid spaces and retinal detachment during follow-up predict the disrupted foveal photoreceptors and concomitant poor final visual acuity in branch retinal vein occlusion treated with intravitreal bevacizumab injection.

PURPOSE To evaluate the hyperreflective foci in branch retinal vein occlusion and central retinal vein occlusion depicted by spectral-domain optical coherence tomography (OCT). METHODS Consecutive series of 73 eyes of 73 patients with retinal vein occlusion (58 branch retinal vein occlusion and 15 central retinal vein occlusion) who had Spectralis OCT images obtained were retrospectively reviewed, comparing color fundus photographs and fluorescein angiography. RESULTS Hyperreflective foci were detected in 54 eyes (74.0%) by spectral-domain OCT, and hard exudates were detected in 17 eyes (23.3%) by color fundus photography. Hard exudates on the color photographs corresponded to the confluence of hyperreflective foci mainly around the outer plexiform layer in the unaffected areas on the spectral-domain OCT images, whereas fine hyperreflective foci were scattered in all retinal layers of the affected areas (P < 0.001). Most eyes with hyperreflective foci attached to the inner side of the external limiting membrane also had serous retinal detachment (P < 0.001). Compared with diabetic macular edema, we did not find subfoveal hard exudates in retinal vein occlusion. CONCLUSION Hyperreflective foci delineated on spectral-domain OCT suggest the pathogenesis regarding the flow of extravasated blood constituents in retinal vein occlusion.

Purpose To compare retinal morphologic alterations in eyes with polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC) using speckle noise-reduced spectral-domain optical coherence tomography. Methods We retrospectively reviewed 63 eyes of 62 patients with active PCV and 38 eyes of 38 patients with active CSC. Patients underwent fundus photography, angiography, and speckle noise-reduced spectral-domain optical coherence tomography examinations, and retinal morphologic alterations were evaluated. Results Cystoid macular edema, lipid deposits, subretinal hemorrhage, and hemorrhagic pigment epithelial detachment were not seen in any eye with CSC but were seen in eyes with PCV. In PCV, mean visual acuity was significantly poorer in eyes with fibrin infiltration (P = 0.027) or hemorrhagic infiltration (P = 0.002) in the fovea than in eyes without fibrin or hemorrhagic infiltration. Conclusion Differentiating factors between PCV and CSC noted on spectral-domain optical coherence tomography include a lack of cystoid macular edema, lipid deposition, subretinal hemorrhage, and hemorrhagic pigment epithelial detachment in eyes with CSC, which makes spectral-domain optical coherence tomography helpful in differentiating CSC from PCV. More severe retinal alterations were seen in PCV than in CSC because of infiltration of fibrin and hemorrhage in the outer retina, which also correlated with poorer vision.

The aim of this study was to investigate the efficacy of periodic intravitreal aflibercept (IVA) in exudative age-related macular degeneration, and to explore the predictive factors for visual outcome. This is a prospective interventional case series. Fifty-two eyes of 52 treatment-naive age-related-macula-degeneration patients were enrolled. All participants received IVA bimonthly following 3 monthly loading dose. The primary endpoint was change in best corrected visual acuity (BCVA) and central retinal thickness (CRT), and the secondary outcomes included changes in subfoveal choroidal thickness (SCT), macular atrophy (MA), and retinal average sensitivity (AS) determined by microperimetry at 12 months compared with baseline. The predictive factors for the change of BCVA were examined. Of 52 enrolled patients, 4 patients were drop out. Remaining 48 patients were examined. Mean logMAR BCVA significantly improved from 0.42 ± 0.37 at baseline to 0.29 ± 0.34 at 12 months (P = .008). Mean CRT and SCT significant reduced from 285.6 ± 135.2 μm, 247.9 ± 96.7 μm at baseline to 233.4 ± 98.0 μm, 208.1 ± 94.6 μm at 12 months, respectively (P

PURPOSE The purpose of this study was to examine indocyanine green angiography of eyes with central serous chorioretinopathy (CSC). METHODS We retrospectively studied the medical records of 39 patients (41 eyes) with active CSC who were

Purpose To study the retinal structural changes associated with a retinal arterial macroaneurysm and their association with visual prognosis. Methods We studied retrospectively the medical records of 44 eyes of 44 patients with a retinal arterial macroaneurysm; all eyes showed hemorrhagic and/or exudative changes of the fovea with a visual disturbance. The retinal structural changes were examined by optical coherence tomography (OCT). Results At the initial visit, 30 eyes (68%) showed severe hemorrhagic complications. In eyes with subretinal hemorrhage beneath the fovea, retinal structure was relatively preserved at the initial visit. At the final visit, however, foveal structure was often degenerated, especially in its outer aspect, with limited visual recovery. The 14 eyes (32%) with minimal hemorrhagic complications showed an extensive exudative change caused by the aneurysm. In 13 of these eyes, OCT examination revealed extensive retinal edema, predominantly in the outer retina. Retinal edema beneath the fovea caused a focal serous retinal detachment in 12 eyes. Eight eyes with extensive exudative change showed an accumulation of hard exudates in the macular area, and visual recovery of these eyes was often limited. Conclusion Subretinal hemorrhage or extensive exudative change from a retinal arterial macroaneurysm can cause destruction of the foveal outer photoreceptor layer, resulting in a poor visual outcome.

To report the tomographic features of vascular lesions beneath the retinal pigment epithelium in eyes with polypoidal choroidal vasculopathy by using spectral-domain optical coherence tomography (SD-OCT).Retrospective observational case series.Angiograms and images obtained using the prototype SD-OCT system were compared for 21 eyes of 21 patients with polypoidal choroidal vasculopathy to identify sub-retinal pigment epithelium abnormalities visible on three-dimensional and enhanced SD-OCT images.On angiography, a branching vascular network and at least 1 polypoidal lesion were visible in all 21 eyes; 10 eyes also had pigment epithelial detachment (PED). SD-OCT revealed a thin straight line of high reflectivity-Bruch's membrane-associated with the branching vascular network in all 21 eyes, polypoidal lesions, 19 (90%) of the 21 eyes; and PED, 9 (90%) of the 10 eyes with PED. The vascular abnormalities of polypoidal choroidal vasculopathy (polypoidal lesion and branching vascular network) identified with angiograms were visualized on SD-OCT images in 20 of the 21 eyes (95%) as areas of moderate reflectivity between the clearly delineated abnormal section of retinal pigment epithelium and Bruch's membrane.Enhanced SD-OCT imaging clearly depicted Bruch's membrane beneath areas of abnormal retinal pigment epithelium in the same locations where the vascular abnormalities of polypoidal choroidal vasculopathy were evident on angiography.

PURPOSE To study the correlation between final visual acuity and integrity of the foveal photoreceptor layer after resolution of macular edema (ME) associated with central retinal vein occlusion (CRVO). METHODS We studied retrospectively 27 eyes of 27 patients with resolved ME associated with central retinal vein occlusion. On optical coherence tomography, integrity of the foveal photoreceptor layer was studied using the junctions between inner and outer segments of the photoreceptor (IS/OS) line as a hallmark. RESULTS At the final visit, foveal thickness was decreased to a physiologic level in all eyes. On optical coherence tomography, 14 eyes showed the IS/OS line in the fovea, whereas 13 eyes showed no IS/OS line. In concordance with resolution of the ME, visual acuity had improved significantly by the final visit. However, final visual acuity in eyes without an IS/OS line was significantly poorer than that in eyes with an IS/OS line (P < 0.0001). In addition, integrity of the foveal photoreceptor layer after resolution of the ME had a significant correlation with the initial retinal perfusion status (P = 0.0156) and with initial visual acuity (P = 0.0050). CONCLUSIONS After resolution of the ME associated with central retinal vein occlusion, visual acuity is closely associated with integrity of the foveal photoreceptor layer.

PURPOSE To describe the clinical characteristics of macular complications on the border of an inferior staphyloma associated with tilted disk syndrome. METHODS We reviewed retrospectively the medical records of 32 consecutive eyes of 20 patients with tilted disk syndrome and an inferior staphyloma lying across the macula. RESULTS In 21 (66%) eyes, fluorescein angiography showed window defects on the border of the staphyloma, where the early phase of indocyanine green angiography showed hypofluorescence due to atrophy of the choriocapillaris. On the late phase of indocyanine green angiography, 19 eyes (59%) showed hyperfluorescence along the border of the staphyloma, which often extended beyond the area of the window defect. Of the 32 eyes, 25 (78%) had macular complications: polypoidal choroidal vasculopathy in 7 (22%), classic choroidal neovascularization in 1 (3%), focal serous retinal detachment without polypoidal choroidal vasculopathy or choroidal neovascularization in 13 (41%), and atrophy of the retinal pigment epithelium alone in 4 (13%). Visual acuity in eyes with polypoidal choroidal vasculopathy or choroidal neovascularization was significantly worse than that in eyes with other complications (P < 0.001). CONCLUSIONS Eyes with tilted disk syndrome often have macular complications on the border of the inferior staphyloma, which can cause severe visual loss.

PURPOSE To study the clinical characteristics of tears of the retinal pigment epithelium (RPE) in eyes with polypoidal choroidal vasculopathy (PCV). METHODS The authors report eight eyes of eight patients with PCV that had tears of the RPE. These were examined with angiography and tomography. RESULTS Eight eyes of eight patients (seven men and one woman) had RPE tears at the margin of a serosanguineous pigment epithelial detachment (PED) associated with PCV. Tears of the RPE were detected at the initial visit in one eye and during follow-up without any treatment in five eyes. In two eyes, the RPE tears were detected 3 months and 6 months, respectively, after photodynamic therapy. In all eyes, the RPE tears were detected at the side opposite to the polypoidal lesions of the PEDs, and the fovea was not involved in the RPE tear. Visual acuity in the seven eyes without RPE tears on presentation ranged from 20/100 to 20/16 (median, 20/32). During follow-up, three of these eyes lost three or more lines of vision. At the final examination, while three of these eyes had visual acuity of 20/25 or better, the other four had visual acuity of 20/200 or worse. CONCLUSION In eyes with PCV, RPE tears can occur at the margin of serosanguineous PEDs-either spontaneously or after photodynamic therapy.

Background and Purpose— Argatroban, a direct thrombin inhibitor, has been shown to reduce neural injury after transient cerebral ischemia. It has also been reported that this neuroprotective effect results from an anticoagulant function. This study was designed to evaluate quantitatively the inhibitory effects of argatroban on leukocyte– and platelet–endothelial cell interactions after transient retinal ischemia. Methods— Retinal ischemia was induced for 60 minutes in male Long-Evans rats by temporary ligation of the optic sheath (n=342). Argatroban was administered just after induction of ischemia. Leukocyte and platelet behavior in the retinal microcirculation was then evaluated in vivo with scanning laser ophthalmoscopy. The expression of P-selectin and intracellular adhesion molecule-1 (ICAM-1) was evaluated by reverse transcription–polymerase chain reaction. After 10 days of reperfusion, ischemia-induced retinal damage was evaluated histologically. Results— Treatment with argatroban suppressed leukocyte–endothelial cell interactions; the maximum numbers of rolling and accumulated leukocytes were reduced by 90.1% ( P P P P P P Conclusions— Argatroban treatment suppressed leukocyte– and platelet–endothelial cell interactions after transient retinal ischemia. This inhibitory effect on postischemic blood cell–endothelial cell interactions might partially contribute to its neuroprotective effects.

Background and Purpose —Tacrolimus, an immunosuppressant agent, has been shown to reduce tissue injury and leukocyte accumulation after transient ischemia. This study was designed to evaluate quantitatively the inhibitory effects of tacrolimus on leukocyte rolling and on subsequent leukocyte accumulation in vivo after transient retinal ischemia and the protective effects of tacrolimus on ischemia-induced neural damage. Methods —Retinal ischemia was induced for 60 minutes in anesthetized pigmented rats by temporary ligation of the optic sheath. Tacrolimus was administered at 10 minutes after ischemic induction. At 4, 12, 24, and 48 hours after reperfusion, leukocyte behavior in the retinal microcirculation was evaluated in vivo with acridine orange digital fluorography. After 7 days of reperfusion, ischemia-induced retinal damage was evaluated histologically. Results —Treatment with tacrolimus suppressed leukocyte rolling; the maximum number of rolling leukocytes was reduced by 60.1% at 12 hours after reperfusion ( P P P P Conclusions —The present study demonstrated the inhibitory effect of tacrolimus on leukocyte rolling and on subsequent leukocyte accumulation and the therapeutic potency to neural injury after transient retinal ischemia.

PURPOSE This study sought to measure foveal retinal thickness in patients with diabetic retinopathy and to investigate the relationship between foveal thickness and visual acuity, biomicroscopic findings, and angiographic features. METHODS A commercial scanning retinal thickness analyzer was used to measure retinal thickness. A laser slit was projected onto the retina and scanned in 400 milliseconds across the central area of the fundus. The image where the laser slit intersects with the retina was digitally recorded and analyzed. Retinal thickness was measured in 35 patients (35 eyes; patient age, 57 +/- 13 years) with diabetic retinopathy. Patients also were examined by fluorescein angiography and slit-lamp biomicroscopy to detect foveal thickening. RESULTS Linear regression analysis indicated a significant correlation between foveal thickness and visual acuity (adjusted R2 = 0.72, P < 0.001). Foveal thickness was abnormal in 6 (100%) of 6 eyes in which foveal thickening was detected with slit-lamp biomicroscopy. Foveal thickness also was abnormal in 9 (31%) of 29 eyes that appeared normal by biomicroscopic examination. Foveal thickness was 136 +/- 65 microns in 7 eyes without leakage, 175 +/- 35 microns in 13 eyes with questionable leakage, and 291 +/- 120 microns in 7 eyes with definite leakage (P = 0.0075). CONCLUSIONS Retinal thickness analysis is shown to be more sensitive than slit-lamp biomicroscopy for detecting small changes in retinal thickness. Retinal thickness analysis may prove to be a useful, noninvasive modality for the development or regression of macular edema.

This study aimed to evaluate the relationship between glaucoma progression and estimates of the retinal ganglion cells (RGCs) obtained by combining structural and functional measurements in patients with glaucoma.In the present observational cohort study, we examined 116 eyes of 62 glaucoma patients. Using Cirrus optical coherence tomography (OCT), a minimum of 5 serial retinal nerve fiber layer (RNFL) measurements were performed in all eyes. There was a 3-year separation between the first and last measurements. Visual field (VF) testing was performed on the same day as the RNFL imaging using the Swedish Interactive Threshold Algorithm Standard 30-2 program of the Humphrey Field Analyzer. Estimates of the RGC counts were obtained from standard automated perimetry (SAP) and OCT, with a weighted average then used to determine a final estimate of the number of RGCs for each eye. Linear regression was used to calculate the rate of the RGC loss, and trend analysis was used to evaluate both serial RNFL thicknesses and VF progression.Use of the average RNFL thickness parameter of OCT led to detection of progression in 14 of 116 eyes examined, whereas the mean deviation slope detected progression in 31 eyes. When the rates of RGC loss were used, progression was detected in 41 of the 116 eyes, with a mean rate of RGC loss of -28,260 ± 8110 cells/year.Estimation of the rate of RGC loss by combining structural and functional measurements resulted in better detection of glaucoma progression compared to either OCT or SAP.