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To compare the progression of myopic maculopathy with or without vitrectomy in patients with myopic traction maculopathy (MTM).Seventy-seven eyes with MTM were classified into either the observation group (n = 38) or the vitrectomy group (n = 39). Progression of myopic maculopathy was assessed with fundus photography using infrared images. Progression within stage was evaluated as an increase in the area of atrophic lesions on infrared images using ImageJ software. The rate of progression was compared using the paired t -test.The mean follow-up period was 60.0 ± 47.5 months. The initial mean stage of myopic maculopathy for the observation group was 1.86 ± 0.86, and it progressed to 2.00 ± 0.83 ( P = 0.023) at the last visit. For the vitrectomy group, the stage progressed from 1.82 ± 0.96 to 2.05 ± 1.09 ( P = 0.011). Four eyes (10.5%) in the observation group showed progression at 87.3 months, and seven eyes (17.9%) in the vitrectomy group showed progression at 31.3 months.Surgery in patients with MTM may accelerate the progression of myopic maculopathy. Therefore, care should be taken when considering surgery for patients with MTM.

This study investigates the etiology and clinical features of delayed vitreous prolapse after cataract surgery and evaluates the long-term surgical and visual outcomes. Consecutive patients with vitreous prolapse into the anterior chamber occurring ≥ 3 months after cataract surgery at two hospitals between December 2006 and June 2020 were retrospectively reviewed. The primary outcome was associated ophthalmological events that triggered delayed vitreous prolapse. Secondary outcomes included long-term visual and subjective symptom changes after treatment. Among 20 eyes (20 patients), all had visual symptoms, the most common being blurry vision (12 patients; 60%). Five (25%) were detected after YAG laser capsulotomy, three (15%) had a history of intraocular lens(IOL) implantation in sulcus due to intraoperative posterior capsular tears, three (15%) had prolapsed vitreous alongside dislocated IOLs, and three (15%) were aphakic after previous cataract surgeries. After surgical treatment, the mean corrected distance visual acuity improved from 20/50 to 20/31(P = 0.02) and the mean preoperative intraocular pressure (IOP) that was 26.4 mmHg decreased to 15.6 mmHg, remaining stable until the last follow-up. All reported symptoms were relieved. YAG laser capsulotomy or a history of defective posterior capsule from iatrogenic causes may trigger delayed vitreous prolapse. The long-term outcomes were favorable, particularly after posterior vitrectomy, with improved IOP control and symptom resolution.

To compare the clinical features and long-term treatment outcomes of patients undergoing secondary intraocular lens (IOL) surgery with scleral-fixated (SFIOL) versus retropupillary iris-claw IOL (RPICIOL).Consecutive patients treated between June 2014 and December 2019 at two tertiary centres were retrospectively reviewed. The primary outcome was the best-corrected visual acuity (BCVA). Secondary outcomes included factors associated with significant corneal endothelial injury and postoperative redislocation.This study included 395 eyes undergoing surgery with SFIOL (237 eyes, 60%) or RPICIOL (158 eyes, 40%), with no differences in baseline BCVA (p = 0.76) or endothelial cell density (ECD) (p = 0.39). Compared with the SFIOL group, the RPICIOL group had faster visual recovery (postoperative month 1, 20/37 vs. 20/46, p = 0.005) sustained to over 36 months (p = 0.034), favourable absolute prediction errors (within 0.5D, 67.3% vs. 54.9%, p = 0.027), and shorter operation times (52.7 vs. 60.9 min, p = 0.015). There was no difference in ECD after 12 months (P = 0.282). Over a mean follow-up duration of 33 months (152 cases3 years, 38.5%), the SFIOL group experienced more cases of tilted/decentred IOLs (14 vs. 1, p = 0.006), suture exposure (7 vs. 0, p = 0.045), and redislocation (17.7% vs. 10.1%, p 0.001). Multivariable regression showed that a final BCVA below 20/40 was associated with SFIOL (P = 0.007), older age (p = 0.001), intraoperative complications (p = 0.002), past history of vitrectomy/glaucoma surgery or uveitis (p = 0.046), and surgically induced astigmatism1D (p = 0.029).RPICIOL appears to be a safe and effective surgical option for secondary IOL surgery over a long-term follow-up, comparing favourably against conventional SFIOL.

Purpose To describe the clinical features and prognosis of patients with uveal metastasis in Korea. Design Retrospective, observational case series. Participants Patients diagnosed at 2 tertiary high-volume centers between November 2005 and November 2019. Methods Evaluation of multimodal imaging and electronic medical records. Main Outcome Measures The clinical features and outcomes were assessed based on the primary cancer site. Results A total of 134 uveal metastases (128 choroidal, 3 iris, and 3 ciliary body tumors) were diagnosed in 95 eyes of 80 patients. Mean age at diagnosis was 56 years (median, 55 years; range, 24–86 years), with a minor preponderance of women (61%). Tumors were bilateral in 15 patients (19%) and the primary origin was established in 49 patients (61%) before ocular detection. The primary tumor originated in the lung (48%), breast (24%), gastrointestinal tract (10%), liver (3%), pancreas (3%), kidney (1%), cervix (1%), and nasopharynx (1%), with some remaining unknown (10%). The overall 5-year survival rate was 21%. Kaplan-Meier analysis revealed that the worst survival was found in pancreatic cancers (mean survival, 5.9 months; P = 0.045), and the best survival was found in gastrointestinal tract cancers (mean survival, 44.5 months). Conclusions The primary tumor origins in Korean patients with uveal metastases differed from those reported in primarily population-based studies of White patients, with a higher prevalence of lung and gastrointestinal tract cancers.

To investigate the relationship between pachydrusen and features of choroidal vascular hyperpermeability (CVH) and punctate hyperfluorescent spots (PHS) on serial imaging in patients with polypoidal choroidal vasculopathy (PCV) or pachychoroid neovasculopathy (PNV). Patients diagnosed between January 2007 and June 2016 at 2 high-volume, tertiary hospitals were retrospectively reviewed with serial multimodal imaging assessment. The primary outcome was the association between drusen subtypes (hard/soft drusen, subretinal drusenoid droplets, or pachydrusen) with CVH and PHS, previously described in central serous chorioretinopathy. Among the 105 eyes (105 patients; mean age, 67.0 years), 87 (82.9%) were diagnosed with PCV and 18 (17.1%) with PNV. Pachydrusen was the most frequently identified subtype (54 eyes, 51.4%). CVH (72.2% vs 41.4%, P = 0.021) and PHS (72.2% vs 44.8%, P = 0.041) were observed with greater frequency in PNV eyes. Significant correlations were found between CVH and PHS (phi coefficient φ 0.30, P = 0.003), and PHS with pachydrusen (φ 0.20, P = 0.040). Over a mean follow-up of 74.8 months, new drusen co-localizing to PHS were noted in 22 (21.0%) eyes (φ 0.54, P

To define a “super stable” subset of polypoidal choroidal vasculopathy (PCV) patients that have a long period of remission following anti-vascular endothelial growth factor (VEGF) therapy. Twenty-one eyes that showed no recurrence for over 18 months following anti-VEGF monotherapy were included in the “super stable PCV group” and compared with 37 eyes with recurring disease. Patient demographics, visual acuity, and imaging data from optical coherence tomography (OCT) and fluorescein angiography/indocyanine green angiography were compared between the two groups at baseline and at 3 months after treatment initiation. The super stable group maintained remission for a mean duration of 31.0 months following a mean of 4.1 anti-VEGF injections. The super stable group was younger at baseline (64.6 ± 8.8 vs. 71.4 ± 7.9 years, P < 0.05) with a higher ratio of females (52.4% vs. 24.3%, P < 0.05) compared with the control group. The super stable group had a higher percentage of eyes with a single polyp, as opposed to multiple polyps (66.7% vs. 32.4%, P < 0.05), and the diameter of the largest polyp was smaller (328.4 ± 98.2 vs. 398.3 ± 112.2 μm, P < 0.05). Baseline choroidal thickness was greater in the super stable group (357 ± 102.7 vs. 293.2 ± 94.6 μm, P < 0.05). At 3 months after treatment, OCT features including central retinal thickness, pigment epithelial detachment (PED) size, and presence of subretinal fluid showed superior response in the super stable group. The reduction in PED height was almost 3 times as large in the super stable group (− 250.1 ± 228.5 μm vs. − 84.4 ± 221.1 μm, P < 0.05). Binary logistic regression further showed that factors such as age, polyp configuration, PED diameter at 3 months, and change in PED height at 3 months were associated with super stable remission. Identifying super stable PCV patients can prevent overtreatment and lessen treatment burden.

This study aimed to investigate the clinical features and risk factors for poor visual outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKE).This retrospective interventional case series reviewed the medical records of 17 patients (21 eyes) with EKE from January 2007 to December 2019. Clinical findings, treatments, visual outcomes, and potential prognostic factors were evaluated.The mean age of the patients was 55.9 years and 13 patients (76.5%) were males. Diabetes (23.5%) was the most commonly associated systemic disease and liver abscess (70.6%) was the major infection source. Poor initial visual acuity worse than counting fingers was significantly associated with poor final visual outcome (p = 0.003). In this study, adjunctive intravitreal dexamethasone injection and primary vitrectomy were not associated with final visual outcome. Secondary enucleation/evisceration was performed in 14.3%.EKE usually has a poor visual prognosis, and early diagnosis with fair initial visual acuity would be crucial in saving vision.

BACKGROUND Acute retinal necrosis (ARN) is a fulminant necrotizing vaso-occlusive retinitis associated with a high incidence of vision loss. Prognostic factors associated with the treatment of ARN have not been comprehensively identified. This study aimed to determine therapeutic prognostic factors associated with long-term clinical outcomes in eyes with ARN. METHODS This retrospective cohort study included patients with ARN who were treated between 2005 and 2019 in two tertiary ophthalmology departments in Seoul, Korea. Multiple logistic regression analysis was performed to investigate prognostic factors associated with late-onset retinal detachment (RD) and vision loss (

PURPOSE This study aims to report complications, treatments, and visual prognosis of choroidal osteoma. METHODS We retrospectively reviewed electronic medical records and multimodal images of 41 patients with choroidal osteoma. RESULTS Visually significant complications included choroidal neovascularization (CNV) in 21 (47.7%) eyes and subretinal fluid (SRF) without CNV in 14 (31.8%) eyes. The most common treatment was intravitreal anti-vascular endothelial growth factor (VEGF) injection: 13 (61.9%) eyes with CNV received an average of 6.3 injections, and 6 (42.9%) eyes with SRF but without CNV received 1.8 injections. As the first-line treatment, intravitreal anti-VEGF injection induced complete or partial remission in 93.4% of eyes with CNV and 57.1% of eyes with SRF. The probability of legally low vision estimated at 3 and at 5 years was 29.1% and 34.2%, respectively. The presence of CNV and outer retinal tubulation (ORT) was independent risk factors for vision loss (adjusted odds ratio, 8.08 and 6.94, respectively). CONCLUSIONS The development of CNV and ORT was strong risk factors for visual impairment. Due to the frequent recurrence of complications and poor visual prognosis, regular check-ups and appropriate treatment choices are warranted.

Purpose Endothelin-1 (ET-1) is a potent vasoconstrictor which seems to be involved in the pathogenesis of diabetic retinopathy (DR). However, studies on intraocular ET-1 in DR have been limited. Thus, we investigated aqueous ET-1 levels in patients with DR. Methods A total 85 subjects were included in this prospective study. Those were classified into three groups: advanced DR group included those with severe nonproliferative DR or proliferative DR, whereas early DR group included those with mild nonproliferative DR or moderative nonproliferative DR. Those who underwent cataract surgery and had no concomitant ocular disease were included in the control group. Aqueous humor levels of ET-1 were obtained before intravitreal bevacizumab injection (IVB) and after 1 month for the DR patients, and at the time of cataract surgery for the control group. Results Advanced DR group included 40 eyes (47.1%), whereas early DR group did 19 eyes (22.4%), and control group (26 eyes, 30.5%). Mean aqueous ET-1 level was 10.1±4.1 pg/mL (6.0–21.0 pg/mL) in advanced DR group, 1.9±0.7 pg/mL (0.6–2.8 pg/mL) in early DR group, and 2.1±1.0 pg/mL (0.7–3.9 pg/mL) in control group (P < 0.001). Advanced DR group was further subdivided into severe nonproliferative DR (15 eyes, 12.8%) and proliferative DR (25 eyes, 34.3%). Mean aqueous ET-1 level was 10.1±4.3 pg/mL (6.0–20.1 pg/mL) in patients with severe nonproliferative DR, and 10.0±4.0 pg/mL (6.0–21.0 pg/mL) in those with proliferative DR (P = 0.928) at baseline. Mean ET-1 level at 1 month after intravitreal injection was 2.5±1.0 pg/mL (0.3–4.8 pg/mL) in patients with severe proliferative DR and 2.9±1.7 pg/mL (1.0–7.0 pg/mL) in those with proliferative DR (P = 0.443). Mean aqueous ET-1 level was significantly reduced in both groups (P < 0.001, respectively). Conclusion The mean aqueous ET-1 level was significantly higher in the eyes with advanced DR than those with early DR and the control group. The mean aqueous ET-1 level was significantly reduced after intravitreal injections in the advanced DR group. Based on our results, future studies on the exact role of ET-1 in the pathogenesis of DR and future implication for intervention would be helpful for managing DR.

To evaluate the efficacy of adjuvant topical dorzolamide-timolol in patients with neovascular age-related macular degeneration unresponsive to anti-vascular endothelial growth factor therapy.This retrospective, interventional study included 15 patients with neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor. Patients used topical dorzolamide-timolol twice daily in the neovascular age-related macular degeneration eye and received anti-vascular endothelial growth factor therapy at each visit, with the same fixed interval and agent as before the addition of dorzolamide-timolol. Central macular thickness, maximal subretinal fluid height, and maximal pigment epithelial detachment height were measured at baseline and every visit.The mean follow-up period was 17.2 ± 5.5 weeks. The mean central macular thickness decreased from 383.5 μm at baseline to 298.3 μm at the final visit (P = 0.041). The mean maximal subretinal fluid height decreased from 105.0 μm at baseline to 58.3 μm at the final visit (P = 0.021). Complete resolution of subretinal fluid was observed in 3 of 11 subretinal fluid-type eyes. There was no significant change in the maximal pigment epithelial detachment height. The mean logarithm of the minimum angle of resolution visual acuity decreased from 0.61 (20/81 Snellen) at baseline to 0.66 (20/91 Snellen) at final visit, which was not significant (P = 0.314). The mean intraocular pressure decreased significantly from 14.9 mmHg at baseline to 12.3 mmHg at the final visit (P = 0.005).The use of adjuvant topical dorzolamide-timolol was effective in decreasing central macular thickness and subretinal fluid in patients with neovascular age-related macular degeneration refractory to continual fixed-interval intravitreal anti-vascular endothelial growth factor therapy, but did not result in functional improvement in this short-term study.

BACKGROUND: To analyze the optical coherence tomography (OCT) characteristics and visual outcome of vitrectomy in myopic foveoschisis (MF) patients and identify prognostic factors. METHODS: This study is a retrospective clinical cohort study in tertiary care hospital. Thirty-two eyes of 32 patients who underwent MF-related vitrectomy in were investigated retrospectively. Best-corrected visual acuity (BCVA) measured at 1 year post surgery and changes in central foveal thickness (CFT) and co-existing macular pathologies, such as foveal detachment (FD), lamellar holes, and macular holes were the main outcome measures. Prognostic factors were identified using multivariate linear regression analysis. RESULTS: Average BCVA (in logarithm of the minimum angle of resolution) and mean CFT had improved from 0.46 ± 0.06 to 0.37 ± 0.07 (P = 0.089) and from 485.72 ± 164.69 to 341.71 ± 109.70 (P

Infectious endophthalmitis (IE) is a severe complication that can lead to blindness even with treatment. However, the impact of antibiotic resistance and early vitrectomy on its prognosis has scarcely been documented. This study investigated the impact of antibiotic resistance of pathogen and early vitrectomy on the prognosis of IE. The medical records of 171 patients treated for IE at a tertiary referral center between 2007 and 2016 were retrospectively reviewed and analyzed for etiology, pathogen, drug resistance to vancomycin or third-generation cephalosporins, treatment types and timing, and visual outcomes. Multivariate logistic regression analysis was used to determine significant prognostic factors. Among 171 eyes, 121 (70.8%) eyes developed IE after intraocular surgery (cataract surgery, 46.3%; intraocular injection, 13.2%), 37 (21.6%) eyes developed IE endogenously, and 9 (5.3%) eyes developed IE after trauma. The major causative pathogens were Staphylococcus aureus (9.4%) and Klebsiella pneumoniae (7.0%). In total, 72.6% of the identified pathogens demonstrated antibiotic resistance. Antibiotic resistance was associated with a worse final vision (P = .027). Visual prognosis was better for eyes treated with early vitrectomy combined with intravitreal antimicrobial injections within 24 h of onset than for eyes that received only intravitreal antimicrobial injections before undergoing delayed vitrectomy (P = .003). Antibiotic resistance of organisms causing IE is one of the most important prognostic factors. Early vitrectomy (i.e., within 24 h) may be helpful for achieving a better visual outcome. Immediate vitrectomy can be recommended, especially in IE cases caused by organisms with resistance to empirically used antibiotics.

Background/AimsTo compare the efficacy, anatomical outcomes and complications of intravitreal ranibizumab with those of laser photocoagulation for retinopathy of prematurity (ROP).MethodsThis is a retrospective case series of 314 eyes from 165 infants diagnosed with type I ROP and treated with either laser photocoagulation (161 eyes) or intravitreal ranibizumab (0.25 mg/0.025 mL) injection (153 eyes) between January 2006 and December 2016 in a tertiary referral-based hospital. The main outcome was the rate of recurrence requiring additional treatment. Secondary outcomes included the incidence of major complications and final refractive error.ResultsThe mean follow-up was 36.3±31.9 months. Recurrences requiring further intervention were noted in 22 (13.7%) laser-treated and 15 (9.8%) ranibizumab-treated eyes (p=0.196). Retinal detachment (8 vs 1, p=0.037) and macular dragging (7 vs 1, p=0.039) were observed in the laser-treated and injection-treated groups, respectively, but no systemic or neurodevelopmental adverse events were reported. In the ranibizumab group, 95.6% showed fully vascularised retinas. Multivariate analyses revealed that birth weight (OR 0.993, p=0.023) and higher ROP stage (OR 11.222, p=0.008) influenced the incidence of major complications.ConclusionIntravitreal ranibizumab for ROP appears to achieve similar therapeutic effects than did laser photocoagulation, but with fewer surgical complications such as retinal detachment or macular dragging.

Purpose We sought to evaluate changes of mean peripapillary choroidal thickness (PCT) and subfoveal choroidal thickness (SFCT) over 12 months in patients with unilateral central retinal vein occlusion (CRVO). Methods Our retrospective, observational study included 19 patients with treatment-naïve, unilateral CRVO who completed at least 12 months of follow-up period. Mean PCT and mean SFCT in CRVO-affected eyes and unaffected contralateral eyes were measured at each follow-up visit, and then compared. Differences between baseline and 12 months (ΔSFCT and ΔPCT) and percentage changes (ΔSFCT or ΔPCT/baseline×100%) were determined. We also investigated the predictive factors for visual outcome in the CRVO-affected eyes. Results In the CRVO-affected eyes, mean PCT was 146.7±41.9 μm at baseline, and 106.5±24.2 μm at 12 months (P < 0.001). Mean PCT of the contralateral eyes was 129.8±42.6 μm at baseline and 124.6±39.7 μm at 12 months (P = 0.089). Mean SFCT of CRVO-affected eyes was 225.8±77.9 μm at baseline, and 199.4±66.6 μm at 12 months (P = 0.009). Mean SFCT of the contralateral eyes was 218.4±83.0 μm at baseline, and 208.4±78.1 μm at 12 months (P = 0.089). Δ PCT was -41.6±25.3 μm in the CRVO-affected eyes, and -5.2±5.8 μm in the contralateral eyes (P Conclusion Both peripapillary and subfoveal choroidal thickness reduced significantly over 12 months in the CRVO-affected eyes, but not in the contralateral eyes. In addition, the absolute reduction amount and reduction ratio of PCT and SFCT were significantly greater in the CRVO-affected eyes than the contralateral eyes.

This retrospective study assesses the clinical features, treatment strategies, and long-term outcomes of patients with Coats’ disease in Korea. Multimodal imaging and medical records of consecutive patients treated between July 2000 and April 2020 at two tertiary centers were evaluated based on onset age (adult vs. childhood [P = 0.02) and greater clock hours of retinal telangiectasia (7 vs. 5, P = 0.005). First-line treatment included laser (25%), combined laser/anti-VEGF (23%), cryotherapy (20%), surgery (16%), and anti-VEGF only (9%). Cryotherapy was associated with a higher risk for secondary interventions (OR 11.8, P P = 0.037). Multivariable regression showed that the number of anti-VEGF injections performed during the initial treatment period was associated with a 9.4 letter improvement in vision (P = 0.041). We observed a higher proportion of adult-onset Coats’ disease than previously reported in other non-Asian populations. An aggressive treatment with the addition of anti-VEGF may yield the most favorable long-term visual outcomes.

Purpose To evaluate multifocal evanescent white dot syndrome (MEWDS) patients with and without overlapping multifocal choroiditis (MFC). Methods Thirty-four patients diagnosed between November 2008 and August 2018 at 2 hospitals were retrospectively reviewed. Multimodal imaging including optical coherence tomography angiography (OCTA) was assessed. Results Twenty-seven (79%) patients were women (overall mean age, 30 years). Five developed MFC lesions in the affected eyes, and one developed MFC in the unaffected fellow eye. Another developed combined MEWDS and MFC in the fellow eye during follow-up. Eyes with MFC had thicker choroids (316.5 and 197.3 µm, respectively; P = .001) at presentation, which became thinner after resolution (P = .043). Those with subfoveal MFC had poor visual prognosis (P = .019). Areas of suspected choriocapillaris flow deficit were identified on OCTA. Conclusion Some MEWDS patients may develop overlapping MFC in the same or fellow eyes, presenting with increased choroidal thickness which decreased after resolution.

Background This study aimed to assess and compare the clinical value of aqueous humor polymerase chain reaction (PCR) and serologic tests in patients diagnosed with suspected infectious uveitis. Methods In this retrospective observational study, data of 358 patients who were diagnosed with suspected infectious uveitis and who underwent aqueous humor PCR testing were analyzed. PCR and serologic test results were compared with the clinical features. Results The rates of initial diagnoses for infectious uveitis were higher with PCR (99 patients, 28%) compared to those with serologic tests (38 pateints, 11%). The diagnostic positivity of PCR was 29% for anterior uveitis, 0% for intermediate uveitis, 5% for posterior uveitis, and 30% for panuveitis. In particular, PCR was useful in confirming the diagnosis of cytomegalovirus and varicella-zoster virus infections and Toxoplasma gondii-associated uveitis. For PCR test, the sensitivity was 0.431, specificity was 0.985, and the negative and positive predictive values were 0.506 and 0.980, respectively. For IgM test, the sensitivity was 0.151, specificity was 0.970, and the negative and positive predictive values were 0.403 and 0.895, respectively. Conclusion Aqueous humor PCR can be a valuable diagnostic tool for confirming the infectious etiology in patients clinically diagnosed with uveitis. PCR had good predictive and diagnostic value for anterior uveitis and panuveitis compared with that for intermediate and posterior uveitis.

PURPOSE We sought to evaluate the long-term outcomes for patients with exudative age-related macular degeneration (AMD) undergoing vitrectomy for breakthrough vitreous hemorrhage and to investigate possible prognostic factors. METHODS Consecutive patients treated at two high-volume referral-based tertiary hospitals between July 2006 and December 2019 were retrospectively reviewed. Surgery was performed using the standard three-port vitrectomy. The primary outcome was the change in best-corrected visual acuity (BCVA) over long-term follow-up, while secondary outcomes included the assessment of possible prognostic factors. RESULTS Among 50 eyes from 50 patients included in this study, 23 (46%) were diagnosed with polypoidal choroidal vasculopathy (PCV) and 27 (54%) were diagnosed with neovascular AMD. Preoperative vision at the time of vitreous hemorrhage onset was 20 / 3,027 (logarithm of the minimum angle of resolution [logMAR], 2.18 ± 0.34). At 12 months after surgery, the mean BCVA improved to 20 / 873 (logMAR, 1.64 ± 0.76; p < 0.001). At 24 months, the BCVA was 20 / 853 (logMAR, 1.63 ± 0.75; p < 0.001). Univariate analysis revealed that older age (odds ratio [OR], 0.879; p = 0.007] and the presence of submacular hemorrhage (OR, 0.081; p = 0.022) were factors associated with a poor 2-year visual outcome. Multivariable regression showed that older age (OR, 0.876; p = 0.026) and neovascular AMD (as compared with PCV) (OR, 0.137; p = 0.014) were significant negative factors influencing the 2-year visual outcome. The mean injection interval prior to vitrectomy was 4.53 months, which extended to 27.64 months after vitrectomy (p = 0.028). CONCLUSIONS Younger age, the absence of submacular hemorrhage, and PCV type were associated with a favorable 2-year visual outcome after vitrectomy for vitreous hemorrhage in patients with exudative AMD. Overall, vitrectomy resulted in improved visual acuity and patients showed a decreased need for anti-vascular endothelial growth factor therapy thereafter.

Purpose To investigate the prevalence of focal lamina cribrosa (LC) defects in patients with unilateral branch retinal vein occlusion (BRVO) and to compare ocular characteristics between eyes with and without focal LC defect and those eyes with normal-tension glaucoma (NTG). Methods This retrospective, cross-sectional study included 121 patients. Thirty-nine patients had unilateral BRVO (BRVO group), 36 patients had NTG (NTG group), and 36 patients had vitreous floaters, but no other ocular diseases (control group). In addition to baseline characteristics such as age, sex, refractive errors, the ocular characteristics such as peripapillary choroidal thickness (PCT), retinal nerve fiber layer thickness, and subfoveal choroidal thickness were retrospectively analyzed. Results Focal LC defects were detected in 20 eyes of 14 patients (38.9%) in the BRVO group, 24 eyes of 15 patients (41.7%) in the NTG group, and none in the control group (P

A retrospective cohort study of East-Asian patients previously treated with ranibizumab for myopic choroidal neovascularization in the RADIANCE trial. Clinical charts were reviewed to assess long-term efficacy and safety. Visual acuity was sustained for additional 36 months after trial completion with few patients requiring additional treatment and no new safety concerns observed., Purpose: To evaluate long-term efficacy and safety of ranibizumab for treatment of myopic choroidal neovascularization (mCNV) in clinical practice. Methods: Noninterventional, retrospective cohort study of East-Asian patients previously treated with ranibizumab during the RADIANCE trial. Forty-one patients who completed the RADIANCE trial were followed-up for up to 48 months (post-RADIANCE observation period). Outcome measures were best-corrected visual acuity changes from baseline (assessed at RADIANCE trial initiation), mCNV recurrences, and ocular adverse events. Results: Mean visual gain from baseline best-corrected visual acuity (56.5 ± 12.1 letters) (20/80) was significant at 12 months (+14.3 ± 11.4 letters, n = 40, P < 0.0001), 24 months (+10.4 ± 22.3 letters, n = 31, P = 0.0143), 30 months (+11.0 ± 22.4 letters, n = 29, P = 0.0134), 42 months (+12.9 ± 20.9 letters, n = 25, P = 0.0051), and 48 months (+16.3 ± 18.7, n = 16, P = 0.0034). Of the 16 patients who completed 48 months of follow-up, 63% gained ≥10 letters and 13% lost ≥10 letters. Over the post-RADIANCE observation period, 83% of patients required no further treatment for mCNV, 10% experienced mCNV recurrences, and 12% experienced a nonserious ocular adverse event. Patients who required additional treatment for mCNV received a mean of 5.0 (SD 5.9, range 1.0–18.0) ranibizumab injections. Conclusion: Best-corrected visual acuity gained at the end of the RADIANCE trial was sustained over additional 36 months of follow-up. Few patients required further treatment and no new safety concerns were observed.

PURPOSE To evaluate clinical correlations between the thicknesses of individual retinal layers in the foveal area of diabetic patients and the presence of diabetic peripheral neuropathy (DPN). METHODS This retrospective, observational, cross-sectional study enrolled a total of 120 eyes from 120 patients. The eyes were divided into 3 groups: normal controls (n = 42 eyes), patients with diabetes mellitus (n = 42 eyes) but no DPN, and patients with diabetes mellitus and DPN (n = 36 eyes). The primary outcome measures were the thickness of all retinal layers in the central 1-mm zone measured using the segmentation analysis of spectral-domain optical coherence tomography. Correlations between the thicknesses of the individual retinal layers and the presence of DPN were also analyzed. Logistic regression analyses were used to determine which change in layer thickness had the most significant association with the presence of DPN. RESULTS The mean thicknesses and the ratios of retinal nerve fiber layers to total retina thicknesses in the DPN group were 10.77 ± 1.79 μm and 4.10 ± 0.55%, which was significantly lower than those in normal controls and the diabetes mellitus with no DPN group (P = 0.014 and P = 0.001, respectively). Logistic regression analyses also showed that the decrease in thicknesses of the retinal nerve fiber layers and the inner nuclear layer are significant factors for predicting a higher risk for DPN development (odds ratio = 7.407 and 1.757; P < 0.001 and P = 0.001, respectively). CONCLUSION A decrease in the retinal nerve fiber layer and the inner nuclear layer thickness was significantly associated with the presence of DPN.

Secondary macular hole(MH) formation after vitrectomy is rare and its risk factors and pathogenesis are not clearly understood. This retrospective study was conducted to identify the risk factors of this complication and assess outcomes at 2 tertiary centres. The primary outcomes were the clinical characteristics associated with development of secondary MH, which included the primary diagnosis for initial vitrectomy, features on optical coherence tomography, and adjuvant surgical techniques used during the initial surgery. Secondary outcomes included the change in best-corrected visual acuity(BCVA), clinical factors associated with the need for re-operations for MH closure and prognostic factors for the visual outcomes. Thirty-eight eyes out of 6,354 cases (incidence 0.60%) developed secondary MH after undergoing vitrectomy for various vitreoretinal disorders over an 11-year period, most frequently after initial surgery for retinal detachment(RD) (9 eyes) and secondary epiretinal membrane (6 eyes). The mean age was 57.1 years (range: 17.8–76.7), and the mean follow-up was 51.1 months (range: 6.8 to 137.6). Prior to secondary MH formation, development of ERM was the most common OCT feature (19 eyes, 50%), and no cases of cystoid macular oedema (CME) were observed. A greater proportion of eyes with secondary MH had long axial lengths (32% ≥26 mm vs 5% of eyes ≤22 mm). MH closure surgery was performed in 36 eyes and closure was achieved in 34 (success rate 94%, final BCVA 20/86), with ≥3-line visual gain in 18 cases. BCVA at MH onset (OR = 0.056, P = 0.036), BCVA at post-MH surgery month 3 (OR = 52.671, P = 0.011), and axial length ≥28 mm (OR = 28.487, P = 0.030) were associated with ≥3-line visual loss; a history of macula-off RD (OR = 27.158, P = 0.025) was associated with the need for multiple surgeries for MH closure. In conclusion, secondary MH occurs rarely but most commonly after vitrectomy for RD. Patients with axial length ≥28 mm and poor BCVA at 3 months post-operation may have limited visual prognosis; those with a history of macula-off RD may require multiple surgeries for hole closure.

Purpose To compare the rate of progression to advanced stage in the fellow eye of patients with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) in a South Korean cohort. Design This is an observational, consecutive retrospective case series. Participants Patients with unilateral advanced stage AMD (n = 288; 180 typical AMD patients and 108 PCV patients). Methods Clinical assessment included detailed eye examination, including fundus photography, fluorescein angiography, and indocyanine green angiography. Main Outcome Measures Five-year progression rate to advanced stage in the fellow eye based on initial Age-Related Eye Disease Study (AREDS) score and the correlation between the initial AREDS score and progression to advanced disease in the fellow eye according to types of AMD. Results Five-year progression to advanced disease in the fellow eye was similar between typical AMD and PCV cases (11.1% vs. 14.8 %, respectively; P = 0.466, log-rank test). Among patients with initial AREDS score of 2 (normal macula or small drusen on the fellow eye), a higher proportion of patients progressed to advanced disease in the PCV group compared with typical AMD patients (10.4% vs. 2.4 %, respectively; P = 0.0042, log-rank test). Initial AREDS score correlated significantly with progression of the fellow eye to advanced stage in the typical AMD group, after adjusting for age, gender, and other comorbidities (hazard ratio [HR], 9.5; 95% confidence interval [CI], 2.80–32.12; P = 0.0003). However in the PCV group, initial AREDS score did not correlate with progression to advanced stage in the fellow eye (HR, 1.84; 95% CI, 0.83–4.05; P = 0.13). Conclusions Unlike typical AMD, PCV progresses without typical features such as drusen or pigmentary abnormality. Baseline AREDS score was less likely to predict progression of the fellow eye to advanced-stage disease in PCV compared with typical AMD. Therefore, the globally recognized risk-scoring AREDS system may not be applicable in Asia, where PCV is a prevalent subtype of AMD.

To determine the long-term effect of scleral encircling on the progression of myopia.Retrospective clinical cohort study.Setting: Single-center academic hospital (Severance Hospital).The study included 76 eyes of 38 patients (mean age 37.21 ± 15.76) who had undergone retinal detachment surgery with scleral encircling. Observational Procedures: Axial length was measured preoperatively, at 6 months after surgery, and at the most recent visit. Patients were followed up for at least 12 months.The changes of axial length per month between operated eyes and contralateral eyes (control group).The operated group showed more rapid changes in axial length from 6 months after surgery to the time of the last follow-up than did the control group (0.020 ± 0.033 mm/month vs 0.002 ± 0.002 mm/month, P = .002; mean follow-up, 26.05 ± 11.39 months). Similar trends were observed during the entire follow-up period (0.065 ± 0.062 mm/month vs 0.008 ± 0.020 mm/month, P.001). Subgroup analysis showed that both the myopic and highly myopic group showed no significant difference of change in rate of axial length during the first 6 postoperative months (P = .267), from 6 months after surgery to the final assessment point (P = .144), or over the entire observation period (P = .507).Encircling the sclera may accelerate progression of myopia by significantly increasing axial length. The degree of myopia itself does not contribute to a significant difference in the increased axial length.

To evaluate and compare the effect of silicone oil and gas on the thickness of all retinal layers in eyes with macula-on retinal detachment (RD).Three hundred and sixty-seven eyes of 367 patients who received silicone oil tamponade and 310 eyes of 310 patients who received gas tamponade for the treatment of rhegmatogenous RD were initially reviewed. Automated retinal segmentation method using Spectralis optical coherence tomography was used for analysis. The primary outcome measure was the change in thickness of each retinal layer in the central 1 mm zone (silicone oil vs. gas tamponade). The secondary outcome measure was best-corrected visual acuity at postoperative 6 months and 9 months after primary RD surgery.Eyes in the silicone oil group (n = 33) had a statistically significant decrease in total retinal thickness of 23.61 + 17.01 μm and in the thickness of all retinal layers, except for photoreceptor layer at 6 months after primary RD surgery (P0.001). In the gas group (n = 31), the postoperative change in total retinal thickness was only 0.14 ± 7.26 μm (P = 0.93), with no significant decrease in any of the individual retinal layers. Postoperatively, the best-corrected visual acuity in the silicone oil groups was significantly worse than that in the gas group at 6 months and 9 months after RD surgery (P = 0.003 and P = 0.004, respectively). The postoperative decrease of the ganglion cell layer, outer plexiform layer, and outer nuclear layer thicknesses showed significant correlation with best-corrected visual acuity in the silicone oil group (all P0.05).Silicone oil tamponade had a significant impact on the reduction of retinal thickness and that the reduction of ganglion cell layer, outer plexiform layer, and outer nuclear layer thicknesses showed the strongest correlation with worse visual acuity outcome.

PURPOSE To evaluate changes in peripapillary choroidal thickness in patients with branch retinal vein occlusion (BRVO) over 12 months, using spectral-domain optical coherence tomography with enhanced depth imaging. METHODS This retrospective, interventional case series included 20 treatment-naive patients with unilateral BRVO with at least 12 months follow-up. The peripapillary choroidal thickness was measured over 12 months. RESULTS In BRVO-affected eyes, the mean peripapillary choroidal thickness was 213.5 ± 51.7 μm (126.1[FIGURE DASH]326.9 μm) at baseline and 129.6 ± 39.3 μm (65.9[FIGURE DASH]197.1 μm) at 12 months. In nonaffected contralateral eyes, the mean peripapillary choroidal thickness was 194.1 ± 39.8 μm (158.5[FIGURE DASH]238.3 μm) at baseline and 156.6 ± 56.2 μm (125.9[FIGURE DASH]213.9 μm) at 12 months. The mean peripapillary choroidal thickness decreased significantly over 12 months in both BRVO-affected and nonaffected eyes (P < 0.001, both eyes). Although the mean peripapillary choroidal thickness was not significantly different between groups at baseline (P = 0.472), it was significantly lower in BRVO-affected eyes than in nonaffected eyes at 12 months (P = 0.036). CONCLUSION Peripapillary choroidal thickness decreased significantly over 12 months in BRVO-affected eyes and nonaffected eyes in patients with unilateral BRVO.

Background To evaluate the incidence and risk factors of contrast-induced nephropathy (CIN) in patients undergoing fluorescein angiography (FA). Methods One hundred sixty patients who underwent FA as a part of ophthalmic examination and had serum creatinine (SCr) results within 24 h before FA and within 72 h after FA between 2005 and 2013 at a tertiary medical center were included. According to baseline SCr levels, the subjects were divided into low-risk group (2.0 mg/dL) for CIN development. The CIN incidence, and changes in renal function defined by SCr levels and estimated glomerular filtration rate (eGFR) were evaluated. Demographics and comorbidities were analyzed to investigate an association with CIN development. Results Of 160 patients, 91 were males (56.9%). The mean age was 52.46 ± 17.81 years. Two (1.3%) patients developed CIN after FA, whose SCr levels returned to normal within 10 days without hemodialysis. Overall, there were no changes before and after FA in SCr level (1.52 ± 1.31 mg/dL vs. 1.51 ± 1.28 mg/dL, respectively; p = 0.93) and eGFR (67.02 ± 36.62 mL/min/1.73 m2 vs. 66.41 ± 36.54 mL/min/1.73 m2, respectively; p = 0.54). SCr level and eGFR remained unchanged after FA in low-risk and intermediate-risk groups. In high-risk group, eGFR remined unchanged, but SCr level decreased after FA (from 3.64 ± 1.59 mg/dL to 3.53 ± 1.60 mg/dL; p = 0.04). Basline SCr and cormorbidities did not predict CIN development. Conclusions Acute renal function deterioration was not evident in patients undergoing FA regardless of baseline renal function and comorbidities.

Purpose To evaluated the changes in choroidal vasculature in patients with ocular ischemic syndrome (OIS) and in the ipsilateral eyes of patients with symptomatic carotid artery stenosis (CAS) Method A total of 50 patients (15 patients with OIS, 10 patients with symptomatic CAS, 25 patients of age-and sex-matched control group) were included, and the medical records were retrospectively reviewed. The mean subfoveal choroidal thickness (SFCT) of each eye was measured, and binary images of the choroid were evaluated to compare the mean choroidal area and the luminal area. Results The mean SFCT was 170.5±75.3 μm in the eyes with OIS, 154.8±62.9 μm in the ipsilateral eyes with symptomatic CAS, and 277.5±73.2 μm in the right eyes of the control group patients (P

The incidence of myopia is increasing worldwide, and the investigation on pathophysiology of myopia is becoming more important. This retrospective study aimed to compare the thicknesses of individual retinal layers between high-myopic and control eyes, and to evaluate the effects of age and sex on each retinal layer thickness. We assessed 164 subjects and divided them into two groups based on axial length (AL) (i.e., high-myopic group (AL ≥ 26 mm) and control group (AL