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Purpose: To evaluate correlations between the burden of antivascular endothelial growth factor treatment and microperfusion status in superficial capillary plexus and deep capillary plexus (SCP and DCP) using wide-field optical coherence tomography angiography., Methods: A total 19 eyes with branch retinal vein occlusion were included in this retrospective study. Area of foveal avascular zone, capillary nonperfusion area, vascular density, and perfusion gap were compared between superficial capillary plexus and DCP. Internal areas of 3, 6, and 12 mm in diameter around the fovea were analyzed separately., Results: The mean number of injections per months was 0.20 ± 0.12. The number of antivascular endothelial growth factor injections per month showed a significant correlation with perfusion gap in 12 mm area (P = 0.010), but not with perfusion gap in 3-mm or 6-mm area. Correlations were also found between the final best-corrected visual acuity and vascular density in the 12 mm area of DCP (P = 0.031) and foveal avascular zone area (P = 0.033)., Conclusion: Wide-field optical coherence tomography angiography is very useful for assessing the microperfusion status in branch retinal vein occlusion. In extended field of view (12 mm × 12 mm), a larger perfusion gap was associated with frequent requirements of antivascular endothelial growth factor injections for macular edema. Reduction in vessel density was significantly correlated with poor visual outcome.

Purpose: To investigate the patterns of fundus autofluorescence (FAF) abnormalities in patients with central serous chorioretinopathy (CSC)., Methods: This cross-sectional observational study included 126 eyes of 118 patients who were diagnosed with central serous chorioretinopathy from December 2006 to April 2012 at Kyung Hee University Hospital, Seoul, Korea. Fundus autofluorescence patterns were analyzed with spectral domain optical coherence tomography and visual acuity., Results: Fundus autofluorescence patterns were grouped as blocked (38.9%), mottled (8.7%), hyper (31.0%), hyper/hypo (13.5%), or descending tract (8.0%). The duration of symptoms was 7.8 (±20.4), 28.3 (±31.8), 42.5 (±69.1), 163.8 (±183.5), and 174.5 (±162.3) days in the blocked, mottled, hyper, descending tract, and hyper/hypo groups, respectively (P < 0.001). The blocked FAF group had the best visual acuity (P = 0.011). The intact ellipsoid zone on the spectral domain optical coherence tomography was mostly found in the blocked FAF group (P < 0.001), and the disrupted ellipsoid zone was commonly exhibited in the hyper/hypo and descending tract groups. Disrupted external limiting membrane line on the spectral domain optical coherence tomography was seen in two patients of the descending tract group only., Conclusion: The FAF abnormalities in central serous chorioretinopathy show multiple patterns and are related with the chronicity and visual acuity. Fundus autofluorescence patterns in central serous chorioretinopathy are helpful when considering the timing of treatment and predicting the disease status.

Purpose: To investigate the outcomes of intravitreal aflibercept in refractory pigment epithelial detachment (PED) with or without subretinal fluid (SRF) in patients with neovascular age-related macular degeneration., Methods: A prospective, nonrandomized, interventional case series involved 40 patients with persistent vascularized PED previously treated with at least 3 injections of intravitreal bevacizumab or ranibizumab. Intravitreal aflibercept was administered as 3 initial loading doses every 4 weeks, followed by pro re nata retreatment every 8 weeks over 48 weeks. Pigment epithelial detachment was classified into solid-, hollow-, or mixed-type according to the reflective properties visualized using optical coherence tomography. The mean changes in best-corrected visual acuity, central subfield thickness, and the volumes of SRF and PED were analyzed., Results: The PED volume (baseline: 0.43 ± 0.55 mm) significantly reduced to 0.23 ± 0.32 mm at Week 8 (P = 0.003) and increased to 0.36 ± 0.41 mm at Week 48 (P = 0.345). The SRF volume (baseline: 0.52 ± 0.64 mm) significantly reduced to 0.24 ± 0.43 mm at Week 48 (P = 0.021). The mean baseline best-corrected visual acuity was 20/75 (47.5 letters); it showed no significant difference at Week 48 (+4.4 letters; P = 0.125). The baseline central subfield thickness was 323.2 ± 92.3 μm; it significantly reduced to 281.2 ± 90.7 μm at Week 48 (P = 0.001). In solid-type PEDs, there were poorer improvements in central subfield thickness, best-corrected visual acuity, and the volumes of the SRF and PED, with newly developed intraretinal cysts., Conclusion: Intravitreal aflibercept in treatment-resistant neovascular age-related macular degeneration led to significant reduction in PED and SRF volume, central subfield thickness, and best-corrected visual acuity preserved, over 12 months. However, solid-type PED showed less improvement than hollow- or mixed-type PED.

Purpose: To investigate the angiographic, tomographic, and clinical characteristics of idiopathic central serous chorioretinopathy (CSC) in elderly patients., Methods: The patients were divided into two groups according to a cutoff age of 60 years at baseline. Patients underwent spectral domain optical coherence tomography, fluorescein angiography, and indocyanine green angiography. Angiographic and tomographic features were compared between the two groups (young vs. elderly group)., Results: Of 176 patients, 26 patients (15.1%) were 60 years or older. Complete resolution of subretinal fluid after treatment was noted in 72.0% of the elderly group and 90.8% of the young group (P = 0.021). The elderly group showed worse baseline and final vision, more bilateral involvement, and lower male preponderance than the young group (P < 0.05, respectively). The elderly group was also associated with a higher frequency of retinal pigment epithelium depigmentation, foveal thinning, and double-layer sign compared with the young group (P < 0.05, respectively)., Conclusion: CSC in elderly patients was associated with a lower resolution of serous detachment, increased impairment of retinal pigment epithelial layers, foveal thinning, and worse visual outcome, suggesting a chronic insult to the choroidal vessels involving more severe damage to the outer retinal layers.

Purpose: To evaluate the efficacy and safety of full-fluence photodynamic therapy (PDT) and half-fluence PDT in chronic central serous chorioretinopathy (CSC)., Procedures: A retrospective review of CSC patients treated with full-fluence or half-fluence PDT for 12 months was performed. Best-corrected visual acuity (BCVA), central macular thickness (CMT), neural retinal thickness, subfoveal choroidal thickness (SFCT), resolution of subretinal fluid (SRF), and incidence of retinal pigment epithelium (RPE) atrophy at 12, 24, and 36 months were assessed., Results: Thirty-seven and 30 eyes received full-fluence and half-fluence PDT, respectively. The BCVA and CMT improved significantly in both the full-fluence and half-fluence groups at 36 months, without a significant difference between the groups. Both groups showed significant reductions in SFCT with full-fluence (416.8-316.8 µm) being better overall than half-fluence (409.7-349.1 µm, p = 0.002). All patients achieved complete resolution without recurrence after one PDT treatment per eye. A few cases of RPE atrophy occurred, which could be correlated to PDT in both groups during the follow-up., Conclusion: Both treatments were effective and safe in chronic CSC, with significant improvements in anatomic and visual parameters, without recurrence of SRF., (© 2018 S. Karger AG, Basel.)

Purpose: To investigate the correlation between preoperative en face spectral domain optical coherence tomography findings of the photoreceptor layer with restoration of foveal microstructure and visual acuity in repaired macular holes., Methods: Medical records of 106 patients with surgically closed macular holes were retrospectively reviewed. Preoperative OCT slabs of the external limiting membrane (ELM) and ellipsoid zone (EZ) were generated using embedded tools. All patients were classified into two groups according to the presence of preoperative retinal pigment epithelium protrusion seen as hyperreflective spots in EZ slab. Visual acuity, homogenous reflectivity, and glial proliferation in the ELM and EZ slabs were followed for 12 months., Results: Baseline hyperreflective spots in the EZ slab was observed in 51 (48.1%) eyes. Postoperative homogenous reflectivity and glial proliferation were related to the presence of baseline hyperreflective spots. Vision improvement was significantly greater in the absence of hyperreflective spots group from 9 months after the operation. In logistic regression analysis, the area of hyperreflective spots was significantly associated with foveal homogenous reflectivity at 12 months (P = 0.004)., Conclusion: Preoperative hyperreflective spots in en face EZ slab might be indicative of functional and anatomical restoration after macular hole surgery.

Purpose: To assess the effectiveness and safety of intravitreal ranibizumab compared with bevacizumab for the treatment of macular edema associated with branch retinal vein occlusion (BRVO)., Methods: This was a retrospective study of 80 eyes with macular edema associated with BRVO. Patients received either 0.5 mg of ranibizumab (n = 24) or 1.25 mg of bevacizumab (n = 56) intravitreally. Both groups received three initial monthly injections followed by as-needed injections. The best-corrected visual acuity, central subfield thickness, mean number of injections, and retreatment rate were evaluated monthly for 6 months after the initial injection., Results: The best-corrected visual acuity significantly improved from logarithm of the minimal angle of resolution (logMAR) 0.55 ± 0.26 at baseline to 0.24 ± 0.26 at 6 months in the ranibizumab group (p < 0.001) and from logMAR 0.58 ± 0.21 at baseline to 0.29 ± 0.25 at 6 months in the bevacizumab group (p < 0.001), which is not a statistically significant difference (p = 0.770). The mean reduction in central subfield thickness at 6 months was 236 ± 164 μm in the ranibizumab group (p < 0.001) and 219 ± 161 μm in the bevacizumab group (p < 0.001), which is not also a statistically significant difference (p = 0.698). The mean numbers of ranibizumab and bevacizumab injections were 3.25 ± 0.53 and 3.30 ± 0.53, respectively (p = 0.602). In addition, after the three initial monthly injections, the retreatment rates for ranibizumab and bevacizumab injections were 20.8% and 26.7%, respectively (p = 0.573)., Conclusions: Both ranibizumab and bevacizumab were effective for the treatment of BRVO and produced similar visual and anatomic outcomes. In addition, the mean number of injections and the retreatment rates were not significantly different between the groups., Competing Interests: No potential conflict of interest relevant to this article was reported., (© 2017 The Korean Ophthalmological Society)

Purpose: To investigate the association between fundus autofluorescence (FAF) and visual acuity, recovery of foveal microstructure, and FAF in surgically closed macular holes., Methods: Twenty-six eyes with surgically closed macular hole were classified into two groups based on foveal FAF: normal autofluorescence (NAF) or increased autofluorescence (IAF). The association between foveal FAF and visual acuity was analyzed. In addition, we examined the relationship between recovery of the foveal microstructure assessed by spectral domain optical coherence tomography and FAF after macular hole surgery., Results: At 1 month and 6 months after surgery, there were 9 NAF eyes and 17 IAF eyes. There were no differences between NAF and IAF eyes at 1 month and 6 months after surgery. Preoperative best-corrected visual acuity (logarithm of the minimum angle of resolution) did not differ between groups. Best-corrected visual acuity was significantly higher in the NAF group than in the IAF group at 1 month postoperatively (0.59 ± 0.34 vs. 0.91 ± 0.36, P = 0.044) and tended to be higher at 6 months (0.37 ± 0.38 vs. 0.69 ± 0.53, P = 0.126). Restoration of photoreceptor external limiting membrane differed significantly in 8 NAF eyes (89%) and 4 IAF eyes (24%) at postoperation 1 month (P = 0.001). After 6 months, external limiting membrane was restored in all 9 NAF eyes (100%) and in only 11 IAF eyes (65%) (P = 0.042)., Conclusion: Fundus autofluorescence findings observed in surgically closed macular holes correlated with visual improvement and photoreceptor status. Eyes with visual improvement had restoration of normal foveal autofluorescence and retinal microstructure, whereas eyes with persistent foveal hyperautofluorescence did not achieve complete restoration of the retinal microstructure, and visual improvement was not as significant.

Purpose: To evaluate the long-term prognosis of polypoidal choroidal vasculopathy (PCV) treated with anti-vascular endothelial growth factor (anti-VEGF) combined with verteporfin photodynamic therapy (PDT), according to polypoidal lesion regression. Methods: This study retrospectively reviewed the data of 33 naïve eyes with PCV treated with anti-VEGF combined with verteporfin PDT and followed-up for at least 7 years. The collected data included demographic profile, best-corrected visual acuity (BCVA), central foveal thickness (CFT), PED volume, and presence of submacular hemorrhage. Regression of polypoidal lesion was determined using indocyanine green angiography and optical coherence tomography. All eyes were divided into regression or persistent groups, based on the polypoidal lesion regression one year after the initial combined treatment. Results: BCVA improvement was maintained for 3 years in the regression (p = 0.001) and 1 year in the persistent (p = 0.006) groups, respectively. The mean BCVA of the regression group was better than that of the persistent group over 7 years, but the difference was significant only at 1 year (p = 0.037). The number of eyes which maintained BCVA less than or equal to 0.3 logMAR at 7 years was 11 eyes (64.7%) in regression group and 4 eyes (25.0%) in persistent group (p = 0.022). Conclusions: Regression of the polypoidal lesion at 1 year after the initial combination treatment was associated with favorable long-term visual prognosis, particularly in terms of maintaining good visual acuity. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to evaluate perifoveal microvasculature changes following pars plana vitrectomy with internal limiting membrane peeling for the epiretinal membrane (ERM) and macular hole (MH). Methods: This retrospective study included 59 eyes from 59 patients. Subjects were divided into two groups: an ERM group (n = 43) and an MH group (n = 16) based on the initial diagnosis. Swept-source optical coherence tomography angiography (SS-OCTA) was performed in the macular area, pre- and postoperatively. Perifoveal microvascular changes were calculated using MATLAB from the 6 × 6 mm SS-OCTA images, excluding the foveal avascular zone. Pre- and postoperative perifoveal vessel densities (pfVDs) were separately analyzed in six sectors (superior, superotemporal, inferotemporal, inferior, inferonasal, and superonasal) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). The baseline characteristics and other clinical factors were compared between the ERM and MH groups. Results: The postoperative best-corrected visual acuity significantly improved in both groups (p < 0.05). One year after surgery, the pfVD in the SCP of the ERM group significantly decreased in the inferotemporal sector (p = 0.049). The postoperative pfVD in the DCP of the MH group significantly decreased in temporal sectors (p < 0.05). The postoperative mean pfVD in the SCP in the MH group was significantly lower than that in the ERM group (p = 0.003). The presence of a dissociated optic nerve fiber layer (DONFL) was 75% in the MH group and 22% in the ERM group (p = 0.018). The correlation between the pfVD and DONFL was not statistically significant. Conclusion: Postoperative pfVD reduction in the temporal sector, a corresponding area in which DONFL is present after MH surgery, was significantly observed. After vitreoretinal surgery in MH patients, OCTA may serve as a useful tool for monitoring perifoveal microvascular changes, especially in temporal sectors. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of intravitreal dexamethasone (DEX) implantation for diabetic macular edema (DME) that proved unresponsive to previous anti-vascular endothelial growth factor (VEGF) treatment. This prospective interventional study recruited 91 patients with refractory DME after previous anti-VEGF treatments in one or both eyes. All patients were followed up for at least 12 months. Best-corrected visual acuity (BCVA), central subfield thickness (CST) and macular volume were measured. Over the 12 months, a mean of 2.1 ± 0.8 DEX implantations were administered per eye; 26 eyes (28.9%) received 1 implantation, 31 (34.4%) received 2, and 34 (36.7%) received 3. BCVA was significantly improved in the first 6 months, from 54.8 to 59.5 letters. Both CST and macular volume decreased significantly after DEX implantation and maintained these improvements for at least 12 months. Subjects who needed the second DEX implantation had a greater number of prior anti-VEGF injections than did those who needed only one implantation (6.0 vs 3.0). Two-thirds of refractory DME required less than two DEX implantations to maintain a dry macula for 12 months. Early switching to intravitreal DEX can be considered as the second-line therapeutic option, especially during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background/Aims: To investigate the effects of intravitreal ranibizumab treatment for macular edema (ME) secondary to retinal vein occlusion (RVO) and the relationship between spectral-domain optical coherence tomography (SD-OCT) findings and visual outcome after successful resolution of ME. Methods: Forty consecutive eyes with ME secondary to branch RVO (BRVO; 29 eyes of 29 patients) or central RVO (CRVO; 11 eyes of 11 patients) were included in a prospective study and treated with 3 initial intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Retreatment was based on visual acuity changes and OCT findings. Patients with complete resolution of ME were classified into two groups according to final best-corrected visual acuity (BCVA) of better than 0.30 logMAR (group 1) or poorer than 0.30 logMAR (group 2), and SD-OCT findings were analyzed at baseline and at 12 months. Results: In patients with BRVO, mean BCVA at 12 months (0.19 ± 0.18) was significantly better than that at baseline (0.76 ± 0.37; p = 0.000). The mean number of injections was 4.4 ± 1.2. In patients with CRVO, the mean BCVA at 12 months (0.39 ± 0.23) was slightly improved from that at baseline (0.84 ± 0.68), but the difference was not significant (p = 0.063). Patients with CRVO received a mean number of 6.1 ± 1.4 injections of ranibizumab. Baseline SD-OCT more frequently detected the foveal inner/outer segment (IS/OS) line and external limiting membrane (ELM) in group 1 (p = 0.003) than in group 2 (p = 0.012). Preservation of the foveal IS/OS line (odds ratio = 5.400; p = 0.036) and ELM (odds ratio = 7.312; p = 0.016) at baseline correlated with good final visual outcome. Conclusion: Intravitreal ranibizumab injections effectively treat ME secondary to RVO. Good visual outcome was associated with preservation of the foveal IS/OS line and ELM at baseline. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

AbstractAims:To report the beneficial effect of intravitreal bevacizumab (Avastin) injection in patients with acute central serous chorioretinopathy. Methods:Ten eyes of 10 patients with acute central serous chorioretinopathy received an intravitreal bevacizumab (1.25 mg/0.05 ml) injection. At baseline and follow-up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination and OCT imaging. Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity. Results:All patients showed resolution of neurosensory detachment promptly, and improvement in visual acuity and symptoms within 1 month. In 1 case, fluorescein leakage resolved and neurosensory detachment nearly resolved at 2 weeks after treatment. At 6 months the mean BCVA (LogMAR) had improved from 0.32 to 0.04, which was statistically significant (p = 0.007, Wilcoxon signed ranks test). No recurrence was observed during a 6-month follow-up. Conclusions:Intravitreal bevacizumab injection for acute central serous chorioretinopathy may result in prompt resolution of neurosensory detachment and reduction of angiographic leakage. These short-term results suggest that intravitreal bevacizumab injection may constitute a promising therapeutic option in acute central serous chorioretinopathy.Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]