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Purpose: To elucidate the clinical characteristics and progression rates of pachychoroid and conventional geographic atrophy (GA). Design: Retrospective, multicenter, observational study. Participants: A total of 173 eyes from 173 patients (38 eyes with pachychoroid GA and 135 with conventional GA) from 6 university hospitals in Japan were included. All patients were Japanese, aged ≥50 years and with fundus autofluorescence images having analyzable image quality. A total of 101 eyes (22 with pachychoroid GA and 79 with conventional GA) were included in the follow-up group. Methods: The studied eyes were classified as having pachychoroid or conventional GA; the former was diagnosed if the eye had features of pachychoroid and no drusen. The GA area was semiautomatically measured on fundus autofluorescence images, and the GA progression rate was calculated for the follow-up group. Multivariable linear regression analysis was used to determine whether the rate of GA progression was associated with GA subtype. Main Outcome Measures: Clinical characteristics and progression rates of pachychoroid and conventional GA. Results: The pachychoroid GA group was significantly younger (70.3 vs. 78.7 years; P < 0.001), more male-dominant (89.5 vs. 55.6%; P < 0.001), and had better best-corrected visual acuity (0.15 vs. 0.40 in logarithm of the minimum angle of resolution; P = 0.002), thicker choroid (312.4 vs. 161.6 μm; P < 0.001), higher rate of unifocal GA type (94.7 vs. 49.6%; P < 0.001), and smaller GA area (0.59 vs. 3.76 mm2; P < 0.001) than the conventional GA group. In the follow-up group, the mean GA progression rate (square-root transformation) was significantly lower in the pachychoroid GA group than in the conventional GA group (0.11 vs. 0.27 mm/year; P < 0.001). Conclusions: Demographic and ocular characteristics differed between GA subtypes. The progression rate of pachychoroid GA, adjusted for age and baseline GA area, was significantly lower than that of conventional GA. Japanese patients with conventional GA showed characteristics and progression rates similar to those in White populations. Some characteristics of GA in Japanese population differ from those in Waucasian populations, which may be due to the inclusion of pachychoroid GA. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Abstract This multicentre retrospective study evaluated the 1-year outcomes and safety profile of faricimab in treatment-naïve patients with neovascular age-related macular degeneration (nAMD). Fifty-five patients (57 eyes) underwent loading therapy comprising three monthly faricimab injections. If dryness was achieved by the third month, subsequent treat-and-extend (TAE) follow-up continued at a minimum 8-week interval thereafter. If wet macula persisted at the third month, a fourth dose was administered, followed by the TAE regimen. After 1 year, improvements in visual acuity (0.44 ± 0.46 [baseline] to 0.34 ± 0.48; p

Purpose: To report Vogt-Koyanagi-Harada (VKH) disease in a patient with extreme anisometropia. Observations: A 56-year-old woman was referred to our hospital. Her past medical history was significant for amblyopia in the right eye. At the initial visit, decimal best-corrected visual acuity (BCVA) was 0.03 (Snellen equivalent 5/160) in the right eye and 0.03 (Snellen equivalent 5/160) in the left eye, and axial length was 28.44 mm and 22.36 mm, respectively. Anterior chamber inflammation was seen predominantly in the right eye with fibrin exudates. Swept-source optical coherence tomography demonstrated choroidal thickening and folds predominantly in the left eye. Additionally, serous retinal detachment (SRD) was much more evident in the left eye than in the right eye. Subfoveal choroidal thickness (SCT) was 417 μm in the right and over 800 μm in the left eye. Cerebrospinal fluid examination revealed lymphocyte-dominant hypercellularity. Based on these findings, we diagnosed the patient with VKH disease and treated her with a high-dose systemic corticosteroid. One month after the initiation of treatment, SRD in both eyes fully resolved, and SCT decreased to 105 μm in the right and 311 μm in the left eye. Conclusions and Importance: The marked discrepancy in axial length between the right and left eyes might contribute to the different severity of inflammation in VKH disease.

Abstract This multicenter study aimed to assess the short-term effectiveness and safety of faricimab in treatment-naïve patients with wet age-related macular degeneration (wAMD) in Japan. We retrospectively reviewed 63 eyes of 61 patients with wAMD, including types 1, 2, and 3 macular neovascularization as well as polypoidal choroidal vasculopathy (PCV). Patients received three consecutive monthly intravitreal injections of faricimab as loading therapy. Over these 3 months, visual acuity improved gradually compared to baseline. Moreover, the central foveal thickness decreased significantly at 1, 2, and 3 months compared to baseline (p

Abstract The chronic eye disorder, neovascular age-related macular degeneration (nAMD), is a common cause of permanent vision impairment and blindness among the elderly in developed countries, including Japan. This study aimed to investigate the disease burden of nAMD patients under treatment, using data from the Japan National Health and Wellness surveys 2009–2014. Out of 147,272 respondents, 100 nAMD patients reported currently receiving treatment. Controls without nAMD were selected by 1:4 propensity score matching. Healthcare Resource Utilisation (HRU), Health-Related Quality of Life (HRQoL), and work productivity loss were compared between the groups. Regarding HRU, nAMD patients had significantly increased number of visits to any healthcare provider (HCP) (13.8 vs. 8.2), ophthalmologist (5.6 vs. 0.8), and other HCP (9.5 vs. 7.1) compared to controls after adjusting for confounding factors. Additionally, nAMD patients had reduced HRQoL and work productivity, i.e., reduced physical component summary (PCS) score (46.3 vs. 47.9), increased absenteeism (18.14% vs. 0.24%), presenteeism (23.89% vs. 12.44%), and total work productivity impairment (33.57% vs. 16.24%). The increased number of ophthalmologist visits were associated with decreased PCS score, increased presenteeism and total work productivity impairment. The current study highlighted substantial burden for nAMD patients, requiring further attention for future healthcare planning and treatment development.

Purpose: To evaluate and compare the scleral thickness of patients with idiopathic central serous chorioretinopathy (iCSC) and steroid-induced central serous chorioretinopathy (sCSC) using anterior-segment OCT. Design: Retrospective, comparative study. Participants: One hundred ten eyes of 110 patients with central serous chorioretinopathy. Methods: We classified the patients into iCSC and sCSC groups and compared age, sex, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness. We measured scleral thickness 6 mm posterior to the scleral spur in 4 directions. Main Outcome Measure: Scleral thickness in sCSC eyes. Results: We enrolled 96 and 14 eyes in the iCSC and sCSC groups, respectively. The sCSC group included a greater proportion of women than the iCSC group (42.9% and 13.5%, respectively; P = 0.020). We observed no between-group differences in age, spherical equivalent, axial length, or SCT. Univariate analysis revealed that the sCSC group had a significantly thinner sclera at the superior (423.4 μm vs. 346.6 μm; P < 0.001), temporal (440.1 μm vs. 399.4 μm; P = 0.020), inferior (450.1 μm vs. 395.3 μm; P = 0.001), and nasal (436.6 μm vs. 391.9 μm; P = 0.002) points than the iCSC group. Multivariate analyses revealed that female sex (odds ratio, 4.322; 95% confidence interval, 1.025–18.224; P = 0.046) and mean scleral thickness (odds ratio, 0.972; 95% confidence interval, 0.955–0.990; P = 0.002) were significantly associated with sCSC. Conclusions: The scleral thickness of eyes in the sCSC group was significantly thinner than that in the iCSC group. This suggests that the sclera has less involvement in the pathogenesis of sCSC than in that of iCSC.

Purpose: To investigate the clinical and morphologic factors related to asymmetric dilated vortex veins in central serous chorioretinopathy (CSC). Design: Retrospective, comparative study. Participants: One hundred fifty-eight eyes of 158 patients with CSC. Methods: All patients with CSC underwent ophthalmic examination and multimodal imaging, including measurements of axial length (AL), fluorescein angiography, indocyanine green angiography, swept-source OCT, and anterior segment OCT. Using en face OCT images at the level of the outer choroid, the eyes were divided into 2 groups: eyes with symmetric vortex veins (symmetry group) and those with asymmetric vortex veins (asymmetry group). Main Outcome Measures: Clinical and morphologic factors related to asymmetric vortex veins in CSC. Results: Of the 158 eyes, 120 eyes (75.9%) were classified into the asymmetry group and 38 eyes (24.1%) were classified into the symmetry group. The asymmetry group showed significantly greater spherical equivalent (–0.32 ± 1.78 diopters [D] vs. –1.35 ± 2.64 D; P = 0.033), shorter AL (23.52 ± 0.86 mm vs. 24.10 ± 1.06 mm; P = 0.005), and greater subfoveal choroidal thickness (414.6 ± 105.3 μm vs. 360.4 ± 91.8 μm; P = 0.005) than the symmetry group. No significant differences existed between the 2 groups regarding age, sex, or all scleral thicknesses at the superior, temporal, inferior, and nasal points. In the multivariate analyses, shorter AL (odds ratio, 0.56; 95% confidence interval, 0.36–0.88; P = 0.011) was found to be significantly associated with the presence of asymmetric vortex veins. Conclusions: The asymmetric dilated vortex vein is a common finding in patients with CSC. Our results suggest that certain biometric factors, such as short AL, may be associated with asymmetric dilated vortex veins developing in patients with CSC.

Purpose: To report a case of branch retinal vein occlusion (BRVO) in which rapid formation of macular pucker was observed after an intravitreal ranibizumab (IVR) injection. Observations: A 66-year-old patient was referred to our department for the treatment of macular edema (ME) secondary to BRVO in the left eye. On the initial visit, widespread retinal hemorrhage was observed around the superior temporal vascular arcade, and the decimal best-corrected visual acuity (BCVA) was 0.7 (Snellen equivalent 20/29) in the left eye. Optical coherence tomography demonstrated a thin epiretinal membrane (ERM) accompanied by diffuse retinal thickening. A 0.5 mg IVR injection was administered for the treatment of ME and prompt resolution of retinal hemorrhage. Fourteen days after IVR administration, the ERM had progressed remarkably into a macular pucker and had spread from the superior macula to the equator, accompanied by partial tractional retinal detachment. We performed pars plana vitrectomy combined with encircling scleral buckling. Three months after the surgery, the decimal BCVA was 0.4 (Snellen equivalent 20/50), the retina was attached, and no recurrence of ME or proliferation was observed. Conclusions and Importance: IVR for BRVO may cause rapid formation of macular pucker in the eye, especially in the presence of pre-existing ERM. Careful observation of patients with BRVO is essential after administration of anti-VEGF agents, especially in eyes with pre-existing ERM.

Abstract A paracentesis prior to an intravitreal injection is a very safe procedure and can prevent IOP-spikes after injections. As these spikes pose the risk of inducing glaucomatous changes particularly in patients with frequent injections and/or with a risk profile, a regular paracentesis prior to an injection may be considered and discussed with the patient.

Abstract This study investigated the pathophysiological features of pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) by analysing and comparing cytokine profiles in aqueous humour (AH) collected from 18 PNV, 18 nAMD and 11 control patients. Responses to intravitreal injection of aflibercept were also analysed in the PNV and nAMD groups. In the PNV group, vascular endothelial growth factor (VEGF)-A was significantly lower than in the nAMD group (p = 0.03) but was almost identical to that in the control group (p = 0.86). The nAMD group showed positive correlations between interleukin (IL)-6 and IL-8 (r = 0.78, p

Abstract Brown adipocytes function to maintain body temperature by heat production. However, direct measurement of heat production at a single cell level remains difficult. Here we developed a method to measure the temperature within primary cultured brown adipocytes using a cationic fluorescent polymeric thermometer. Placement of the thermometer within a matured brown adipocyte and a precursor cell enabled the detection of heat production following uncoupler treatment. The increase in the intracellular temperature due to stimulation with a mitochondrial uncoupler was higher in matured brown adipocytes than in precursor cells. Stimulation with a β-adrenergic receptor (β-AR) agonist, norepinephrine, raised the intracellular temperature of matured brown adipocytes to a level comparable to that observed after stimulation with a β3-AR-specific agonist, CL316.243. In contrast, neither β-AR agonist induced an intracellular temperature increase in precursor cells. Further, pretreatment of brown adipocytes with a β3-AR antagonist inhibited the norepinephrine-stimulated elevation of temperature. These results demonstrate that our novel method successfully determined the difference in intracellular temperature increase between matured brown adipocytes and precursor cells in response to stimulation by an uncoupler and β-AR agonists.

Abstract We conducted a genome-wide association study (GWAS) on the outcome of anti-VEGF treatment for exudative age-related macular degeneration (AMD) in a prospective cohort. Four hundred and sixty-one treatment-naïve AMD patients were recruited at 13 clinical centers and all patients were treated with 3 monthly injections of ranibizumab followed by pro re nata regimen treatment for one year. Genomic DNA was collected from all patients for a 2-stage GWAS on achieving dry macula after the initial treatment, the requirement for an additional treatment, and visual acuity changes during the 12-month observation period. In addition, we evaluated 9 single-nucleotide polymorphisms (SNPs) in 8 previously reported AMD-related genes for their associations with treatment outcome. The discovery stage with 256 patients evaluated 8,480,849 SNPs, but no SNPs showed genome-wide level significance in association with treatment outcomes. Although SNPs with P-values of

Purpose: To report the detection of retrobulbar blood vessel in the optical coherence tomography angiographic (OCTA) images of two eyes with pathologic myopia. Observations: Two eyes of 2 cases with pathologic myopia were examined by OCTA (RTVue XR Avanti, Optovue, and Cirrus 5000, Zeiss). Case 1 was a 64-year-old man, and Case 2 was a 65-year-old woman. In Case 1, the thickness of the subfoveal choroid was 38 μm and the sclera was 274 μm, and they were 17 μm and 214 μm, respectively, in Case 2. The axial length was 35.8 mm in Case 1 and 29.5 mm in Case 2. The choroidal vessels were clearly visible in the choriocapillary slab in both the RTVue and the Cirrus images. The vessels were visible in the area of the retinal pigment epithelial and choriocapillaris atrophy due to the pathologic myopia. The retrobulbar blood vessels temporal to fovea were seen in the OCTA images at the level of the outer aspect of the sclera in both cases. Cross sectional images of the retrobulbar blood vessel in both cases were observed under the sclera in serial scan images overlaid with blood flow. Conclusions: and Importance: These in situ images of the retrobulbar blood vessels that were obtained by OCTA was possible because of the thinness of the choroid and sclera and atrophy of the choriocapillaris in these eyes with pathologic myopia. We conclude that OCTA might have utility to study the retrobulbar vascular alterations in eyes with pathologic myopia.

To compare the efficacy of the subthreshold micropulse laser (SML) to conventional laser (CL) in treating focal leakages of the retinal pigment epithelium (RPE) in the eyes with central serous chorioretinopathy (CSC).Twenty-nine eyes of 28 patients with CSC and typical focal leakage were treated with CL or SML. Both treatments were made with a 577 nm yellow laser (CL: NIDEK MC-500, SML: IRIDEX IQ577). The percentage of eyes with a complete resolution, the distance of the laser burns from the fovea, and injury of the RPE after treatment were studied.A complete resolution was seen in 10 of 15 eyes (66.7%) after CL and 9 of 14 eyes (64.3%) after SML (P = 0.89). The average distance from the foveal center to the leakage point was 1282±596 μm for eyes treated with CL and 1271±993 μm for eyes treated with SML (P = 0.4). Only three eyes treated with SML had treatment sites within 500 μm of the fovea. RPE damage determined by fundus autofluorescence was found in all eyes treated with CL and only one eye treated with SML (P

To evaluate the age-dependent morphologic alterations in the outer retina and choroid at the macula using swept-source optical coherence tomography (OCT).Thirty eyes (30 normal subjects; average age, 49 years) were examined; five (age range, third-eighth decades of life) had refractive errors of ±2 diopters or less and no fundus abnormalities. An Early Treatment Diabetic Retinopathy Study (ETDRS) map of the outer retinal and choroidal thickness was constructed using swept-source OCT. The outer retinal and choroidal segmentation lines were drawn automatically, partially manually, within 6 millimeters of the macula.The mean outer retinal and choroidal thicknesses in the 6-millimeter-diameter circle were 145±13 and 236±68 microns, respectively. The choroidal thickness and age were negatively (r = -0.66, P