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Abstract We sought to investigate changes in choroidal hemodynamics in preeclampsia according to presence of retinal change by quantitatively assessing choroidal vessels using optical coherence tomography (OCT). This retrospective study included 106 eyes (of 53 patients) with preeclampsia, including 70 eyes without retinal change in patients with preeclampsia (Group A), 22 eyes with retinal change in patients with preeclampsia (Group B), and 14 eyes of normal pregnant women (controls). Subfoveal choroidal thickness (SFCT) was measured on OCT B-scan images, and choroidal vessel densities (CVDs) were calculated using binarized OCT B-scan and en face images. Their values were then correlated with clinical parameters associated with preeclampsia. SFCT was greater in Group B compared to Group A or controls (354.32 ± 65.13 vs. 288 ± 55.68 or 277.21 ± 50.08, both P

To obtain a quantitative parameter for the measurement of choroidal vascular hyperpermeability (CVH) on ultra-widefield indocyanine green angiography (UWICGA) using an objective analysis method in macular choroidal neovascularization (CNV). A total of 113 UWICGA images from 113 subjects were obtained, including with 25 neovascular age-related macular degeneration (nAMD), 37 with polypoidal choroidal vasculopathy (PCV) (19 with thin-choroid and 18 with thick-choroid), 33 with pachychoroid neovasculopathy (PNV), and 18 age-matched controls. CVH was quantified on a gray image by the subtraction of 2 synchronized UWICGA images of early and late phases. The measured CVH parameter was compared with human graders and among CNV subtypes and correlated with choroidal vascular density (CVD) and subfoveal choroidal thickness (SFCT). The mean CVH values were 28.58 ± 4.97, 33.36 ± 8.40, 33.61 ± 11.50, 42.19 ± 13.25, and 43.59 ± 7.86 in controls and patients with nAMD, thin-choroid PCV, thick-choroid PCV, and PNV, respectively (p < 0.001). CVH was higher in thick-choroid PCV and PNV compared to the other groups (all p ≤ 0.006). The measured CVH value positively correlated with those reported by human graders (p < 0.001), CVD, and SFCT (p = 0.001 and p < 0.001, respectively). CVH can be measured objectively using quantitative UWICGA analysis. The CVH parameter differs among macular CNV subtypes and correlates with CVD and SFCT.

Abstract We sought to predict whether central serous chorioretinopathy (CSC) will persist after 6 months using multiple optical coherence tomography (OCT) images by deep convolutional neural network (CNN). This was a multicenter, retrospective, cohort study. Multiple OCT images, including B-scan and en face images of retinal thickness (RT), mid-retina, ellipsoid zone (EZ) layer, and choroidal layer, were collected from 832 eyes of 832 CSC patients (593 self-resolving and 239 persistent). Each image set and concatenated set were divided into training (70%), validation (15%), and test (15%) sets. Training and validation were performed using ResNet50 CNN architecture for predicting CSC requiring treatment. Model performance was analyzed using the test set. The accuracy of prediction was 0.8072, 0.9200, 0.6480, and 0.9200 for B-scan, RT, mid-retina, EZ, and choroid modalities, respectively. When image sets with high accuracy were concatenated, the accuracy was 0.9520, 0.8800, and 0.9280 for B-scan + RT, B-scan + EZ, and EZ + RT, respectively. OCT B-scan, RT, and EZ en face images demonstrated good performances for predicting the prognosis of CSC using CNN. The performance improved when these sets were concatenated. The results of this study can serve as a reference for choosing an optimal treatment for CSC patients.

Purpose: To quantitatively assess the angiographic features of uveitis associated with sarcoidosis on ultra-widefield fluorescein angiography (UWFA) and determine their correlations with clinical features. Design: A retrospective cohort study. Methods: Sixty-four eyes (64 patients) with sarcoidosis uveitis were included. On UWFA, presence of vasculitis, macular leakage, and optic disc leakage were assessed and features including peripheral ischemic area, vascular leakage area, and punched out lesions were quantitatively analyzed using FIJI (ImageJ2) and correlated with clinical features. Results: The mean peripheral ischemic area and leakage area were 0.0419 ± 0.113% and 0.0333 ± 0.0287% of the total retinal area, respectively. Macular and optic disc leakage were present in 18.8% and 59.4% of eyes, respectively. The average number of punched out lesions was 10.02 ± 21.95. Those changes were most abundant in the inferotemporal area. The presence of disc leakage correlated with all the other UWFA parameters (all r ≥ 0.260; all P ≤ 0.038). The leakage area correlated with vitreous cells, baseline and 6-month logMAR visual acuity, steroid dose and duration, erythrocyte sedimentation rate, and C-reactive protein (r = 0.472, 0.288, 0.321, 0.374, 0.250, 0.251, and 0.277; all P ≤ 0.46). Conclusions: This study quantitatively analyzed UWFA data in sarcoidosis uveitis. Angiographic changes were most frequent in the inferotemporal area. UWFA parameters correlated with one another and clinical variables. These quantitative imaging results warrant a subjective analysis of sarcoidosis uveitis.

AIM: To analyze the effect of systemic high-dose corticosteroid on the choroid in patients with unilateral optic neuritis. METHODS: A retrospective comparative cohort study. Seventy-six eyes of 38 patients with unilateral optic neuritis that received systemic high-dose corticosteroid treatment were enrolled. Choroidal thickness (CT) and choroidal vascularity index (CVI) were measured in both affected and the fellow eyes at baseline, 1wk, 1 and 3mo. Changes in CT and CVI were analyzed in both eyes and compared between eyes. RESULTS: The mean CT and CVI were 349 μm and 0.70 in the affected eyes and 340 μm and 0.69 in the fellow eyes at baseline (P=0.503 and 0.440, respectively). Decrement of CT and CVI at month 3 were significant in affected eyes (P=0.017 and P

Abstract Background To evaluate the effect of toric intraocular lens implantation in cataract patient with corneal opacity and high astigmatism. Methods Thirty-one eyes of 31 patients who underwent cataract surgery with toric intraocular lens implantation were included. All patients had corneal opacity with astigmatism. Preoperative total corneal astigmatism was determined considering posterior astigmatism using a rotating Scheimpflug camera (Pentacam®: Oculus, Wetzlar, Germany). At 2 months after toric intraocular lens implantation, we evaluated residual astigmatism, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). Results Postoperative UCVA and BCVA (0.30 ± 0.17, 0.22 ± 0.16LogMAR) were statistically improved compared to preoperative UCVA and BCVA (1.2 ± 0.34, 1.1 ± 0.30LogMAR, respectively) (P

Purpose: This study assessed the relationship between the choroidal morphology and short-term response to aflibercept treatment in pachychoroid neovasculopathy (PNV). Methods: This was a retrospective case-control study. Ultra-widefield indocyanine green angiography (UWICGA) and optical coherence tomography (OCT) images of 90 PNV eyes of 90 patients treated with aflibercept were enrolled. Responsiveness to aflibercept was defined as a complete resolution of sub- or intra-retinal fluid after three loading doses (50 dry and 40 non-dry eyes). Subfoveal choroidal thickness (SFCT) was measured on OCT images, and choroidal vessel density (CVD), CVD asymmetry, intervortex anastomosis, and choroidal vascular hyperpermeability (CVH) were assessed on UWICGA images. Results: CVD on UWICGA differed between groups in terms of the total area (0.323 ± 0.034 in dry vs. 0.286 ± 0.038 in non-dry, p < 0.001) and area of each quadrant (superotemporal: 0.317 ± 0.040 vs. 0.283 ± 0.040, superonasal: 0.334 ± 0.040 vs. 0.293 ± 0.045, inferonasal: 0.306 ± 0.051 vs. 0.278 ± 0.052, inferotemporal: 0.334 ± 0.047 vs. 0.290 ± 0.046; all p ≤ 0.010). The CVH grade differed between groups (mean 1.480 ± 0.735 vs. 1.875 ± 0.822, p = 0.013). ST and IT intervortex anastomoses were common in the dry group, while SN, ST, and IT were most common in the non-dry group (p = 0.001). Conclusions: A poor short-term response to aflibercept treatment in PNV eyes was associated with a lower Haller vessel density, higher CVH grade, and intervortex anastomosis involving more quadrants on UWICGA.

Purpose. In the present study, the retinal and choroidal vascular densities (VDs) in type 2 diabetes mellitus (DM) patients were analyzed using optical coherence tomography angiography (OCTA). Methods. The study included 282 eyes of 152 patients with type 2 DM (114 without retinopathy, 79 nonproliferative diabetic retinopathy (NPDR), 48 severe NPDR, and 41 proliferative diabetic retinopathy (PDR) eyes). The superficial and deep retinal vessel, choriocapillaris, and choroidal VDs were measured using a binarization method on OCTA images. VDs were compared based on retinopathy severity. Correlations among densities were analyzed. Results. Retinal and choriocapillaris VDs were lower in PDR than in NPDR (all P

AIM: To assess the optimal conditions for preventing condensation of objective lens during vitrectomy with noncontact wide-angle viewing systems (WAVSs). METHODS: We explored the effectiveness of the coating with ophthalmic viscoelastic device (OVDs) on the corneal surface and the soaking the objective lens in warm-saline for preventing condensation of objective lens. First, to find the optimal soaking time to keep the objective lens warm, we measured the temperature of objective lens every minute after soaking in warm saline. Second, to find optimal distance between cornea and objective lens, which provide as wide a view as possible and less condensation at the same time, we measured the condensation time with different distances. With the obtained optimal soaking time and distance, we explored the effect of coating cornea with OVDs and soaking objective lens in warm saline on condensation time. RESULTS: One and 5min of soaking in warm saline was most effective for keeping the lens warm enough (45.1℃±2.1℃ for 1min and 46.4℃±1.0℃ for 5min, P=0.109). The mean condensation times for the control group at 1, 3, and 5 mm from corneal surface to objective lens were 1±0.4, 4±1.4, 190±26.1s, respectively, thus 5 mm was most optimal distance for vitrectomy with WAVSs. For the OVD coating group, the mean condensation times were 1.5±0.3, 13±1.4, and 200±23.9s at 1, 3, and 5 mm distance and borderline significant compared with control group (P=0.068, 0.051, and 0.063, respectively). With the 1-minute warm saline soaking group, the mean condensation time were extended to 188±34.4, 416±65.7, and 600±121.3s at 1, 3, and 5 mm distance and statistically significant compared with control (P=0.043, 0.041 and 0.043, respectively). CONCLUSION: OVD coating on corneal surface shows no difference on condensation time with control group. However, soaking the objective lens in warm saline revealed statistically significant extension of condensation time compared to control group. Therefore, keeping the objective lens warm with soaking in warm saline is a simple but effective to prevent condensation of objective lens during vitrectomy. The thermodynamics between objective lens and cornea during vitrectomy warrants further investigation.

A 30-year-old female presented with macular edema and discoid exudation at the posterior pole. Diffuse vascular sheathing was observed at the peripheral retina. Fluorescein angiography revealed multiple microaneurysms at the posterior pole and leakage from the peripheral vessels. Two monthly intravitreal bevacizumab led to minimal improvement, and resolution of macular edema was achieved by an additional intravitreal triamcinolone. The findings at the posterior pole resembled those of Leber's miliary aneurysm. However, this case also demonstrated a peculiar vascular sheathing at the periphery and showed response to triamcinolone, which are evidences for an inflammatory condition.

PurposeThe effects of gravity on bevacizumab or the recommended head position after intraocular bevacizumab injection have not been reported. To evaluate the effect of gravity on bevacizumab in vitro, we added bevacizumab to the upper part of a test tube filled with balanced salt solution (BSS) and examined its distribution over time.Materials and methodsSixty-four test tubes were divided equally into two groups; group 1 (32, collected from upper part of the tube) and group 2 (32, collected from lower part of the tube). Each test tube was filled with 5 mL BSS before bevacizumab (1.25 mg/0.05 mL) was added, and then stored at 36°C. Bevacizumab concentration in 8 test tubes from each group was measured at 12, 24, 48, and 168 h using an enzyme-linked immunosorbent analysis (ELISA) kit. Mann-Whitney and Jonckheere-Terpstra tests were used for statistical analysis.ResultsBevacizumab concentration was significantly higher in Group 2 than in Group 1 at 12, 24, 48, and 168 h (12, 24, 48, and 168 h; P < 0.01 each; Mann-Whitney test). The mean change in bevacizumab concentration over time tended to increase in Group 1 (P < 0.01; Jonckheere-Terpstra test), but tended to decrease in Group 2 (P < 0.01; Jonckheere-Terpstra test).ConclusionsThe significant differences in concentration between the upper and lower parts even after a considerable amount of storage time showed that bevacizumab did not dissolve immediately and diffused evenly throughout the solution. It appeared that more bevacizumab settled in the lower part of the tube than in the upper part because of gravitational force. However, the concentration difference between the upper and lower parts decreased as bevacizumab gradually diffused over time, indicating that the difference in concentration due to gravity was more significant at the beginning of bevacizumab injection.

[This corrects the article DOI: 10.1371/journal.pone.0206690.].

BACKGROUND:Interventions that can facilitate early diagnosis of age-related macular degeneration (AMD) will facilitate early treatment and improve clinical outcomes but there has been concerns about additional medical costs to the health care system. An examination through a retina fundus photography by a non-specialist has been suggested as a potential cost-effective alternative to a direct examination by a specialist, but limited scientific data exists on the cost-effectiveness of screening strategies for AMD. Our objective is to conduct an economic evaluation of various population-wide screening strategies for AMD among the South Korean population. METHODS AND FINDINGS:Using a Markov cohort model, we evaluated the cost-effectiveness of four AMD screening strategies (opportunistic examination, opportunistic treatment, systematic photography, and systematic examination) in comparison with status quo (no screening) for South Korean adults. We projected a life time horizon to study a hypothetical cohort of 100,00 persons of age 40 with and without AMD at baseline. The outcome measures were quality-adjusted life-years (QALYs) gained, cost from the societal perspective, and the incremental cost-effectiveness ratio (ICER) of each strategy. Interventions were evaluated at a willingness-to-pay (WTP) threshold of 30,000,000 KRW ($27,538) per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to address the model uncertainty. Opportunistic examination was strongly dominated because it generated fewer expected QALYs but incurred greater expected cost than the other screening strategies. The mean lifetime expected costs were 289,013 KRW, 363,692 KRW, 9,351,964 KRW, and 12,309,783 KRW, and the mean QALYs gained were 37.73, 37.75, 40.47, 40.68, for no screening, opportunistic treatment, systematic photography, and systematic examination, respectively. The results were most sensitive to the utility weight of mild AMD, the probability of complication from treatment, the cost of being in mild AMD, and the probability of recovery from complication. After eliminating the two weakly dominated strategies, systematic photography was cost-effective at the ICER of 3,310,448 KRW per QALY in comparison to status quo. CONCLUSIONS:Under the WTP threshold of 30,000,000 KRW per QALY, systematic photography is cost-effective for screening AMD in South Korean adults. Systematic examination by ophthalmologists generates more expected QALY and cost compared to systematic photography.