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Purpose: To describe two patients affected by optic disk pit-maculopathy ODP-M surgically treated with pars-plana vitrectomy (PPV) and the apposition of a human Amniotic Membrane (hAM) patch., Methods: Patients underwent a PPV with the apposition of a hAM patch to cover the ODP. In case 1, a 2 nd surgery was necessary to push the hAM patch inside the pit, whereas in case 2 the patch was pulled inside the pit following the pressure gradient when infusion was turned on., Results: After surgery the hAM patch filled the ODP and in both cases, during follow-up, there was a progressive reduction of macular OCT changes and a concomitant BCVA improvement., Conclusion: Our experience seems to support the idea that the dynamic fluctuation of pressure between intra-ocular and intra-cranial spaces can direct the movement of fluid through the anomalous communication created by the ODP. In this perspective, our cases seem to support the idea that the primary goal of any surgery should be to create a permanent barrier to fluid migration through the ODP to the intra-ocular space, and that hAM can be successfully used to fill the OPD and to create that permanent barrier to achieve the resolution of ODP-M., Competing Interests: Declaration of conflicting interestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are multifactorial disorders that affect the macula and cause significant vision loss. Although inflammation and neoangiogenesis are hallmarks of DME and nAMD, respectively, they share some biochemical mediators. While inflammation is a trigger for the processes that lead to the development of DME, in nAMD inflammation seems to be the consequence of retinal pigment epithelium and Bruch membrane alterations. These pathophysiologic differences may be the key issue that justifies the difference in treatment strategies. Vascular endothelial growth factor inhibitors have changed the treatment of both diseases, however, many patients with DME fail to achieve the established therapeutic goals. From a clinical perspective, targeting inflammatory pathways with intravitreal corticosteroids has been proven to be effective in patients with DME. On the contrary, the clinical relevance of addressing inflammation in patients with nAMD has not been proven yet. We explore the role and implication of inflammation in the development of nAMD and DME and its therapeutical relevance., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: S. Vujosevic is a consultant for Abbvie, Boehringer and Ingelheim, Bayer, Novartis, Roche, Zeiss. C. Astarita and V. Gallinari are AbbVie employee and may own AbbVie stocks/options., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Diabetic macular edema (DME), defined as retinal thickening near, or involving the fovea caused by fluid accumulation in the retina, can lead to vision impairment and blindness in patients with diabetes. Current knowledge of retina anatomy and function and DME pathophysiology has taken great advantage of the availability of several techniques for visualizing the retina. Combining these techniques in a multimodal imaging approach to DME is recommended to improve diagnosis and to guide treatment decisions. We review the recent literature about the following retinal imaging technologies: optical coherence tomography (OCT), OCT angiography (OCTA), wide-field and ultrawide-field techniques applied to fundus photography, fluorescein angiography, and OCTA. The emphasis will be on characteristic DME features identified by these imaging technologies and their potential or established role as diagnostic, prognostic, or predictive biomarkers. The role of artificial intelligence in the assessment and interpretation of retina images is also discussed., Competing Interests: Declaration of Competing Interest MOG: consultant and travel grant: Bayer, Novartis, Roche; DV: consultant for Abbvie, Bayer, Novartis, Roche. MP reports personal fees from Abbvie, Novartis, Bayer, Roche, Zeiss outside the submitted work. GC, LDA, ML, MR, MCS, DV and SV declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To test the prognostic role of anterior scleral substantia propria (ASSP) thickness in predicting the 3-month response after half-dose photodynamic therapy (PDT) in central serous chorioretinopathy (CSCR) and to assess its clinical relevance of ASSP in different CSCR phenotypes., Methods: A prospective, exploratory, multi-centre cohort study conducted at IRCCS San Martino Hospital (Genoa, Italy) and Jules-Gonin Eye Hospital (Lausanne, Switzerland). Demographic and clinical data, and optical coherence tomography (OCT) were collected at baseline and 3 months after PDT. Based on OCT images, we categorized CSCR phenotypes and collected clinically relevant imaging metrics. ASSP thickness was obtained from four different measurements using anterior segment (AS) OCT. Multivariable regression models were performed to evaluate the distribution of ASSP thicknesses among different CSCR phenotypes and to test the prognostic role of ASSP thickness in discriminating between PDT responders (complete subretinal fluid reabsorption) and partial responders., Results: The study cohort comprised 109 Caucasian patients (82 males, 75.2%) with a total of 142 eyes: 84 eyes simple (59.1%) versus 58 eyes complex (40.9%) CSCR. A linear normal model confirmed a positive association between complex CSCR and higher ASSP thickness (β = 26.1, 95% CL = 12.1/40.1, p < 0.001), with a low prevalence of ciliochoroidal effusion loculations in AS-OCT (1/142 eyes, 0.7%). ASSP thickening was positively linked to the presence of posterior cystoid retinal degeneration (PCRD; p = 0.002), indicating a potential role in the pathogenesis of severe CSCR phenotypes. In the subgroup of treated patients (61 eyes), 63.9% had a complete response after PDT. In these patients a logistic binary model highlighted a significantly higher risk of PDT non-responsiveness (OR = 9.62, 95% CL = 2.44/37.9, p = 0.001) associated with a 60-unit increase in ASSP thickness levels. By contrast, other anatomical parameters (i.e., body surface area, age, gender, axial length) showed no remarkable prognostic roles., Conclusion: This research highlighted the association of ASSP thickening with complex CSCR phenotype in Caucasian patients and its role in predicting PDT efficacy. These findings enhance our comprehension of the anatomical risk factors in patients affected with CSCR and potentially guide a better understanding of non-responsive cases to PDT treatment., (© 2024 The Author(s). Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To assess the associations between visual acuity (VA) and retinal thickness in age-related macular degeneration (AMD) eyes treated with anti-vascular endothelial growth factor (VEGF) therapy., Methods: Sixty-eight patients with neovascular AMD (68 eyes) undergoing anti-VEGF therapy with two years of follow-up imaging data after the initiation of treatment were retrospectively included. Linear and nonlinear regression analyses with curve fitting estimation were performed to explore the relationship between visual acuity and OCT-based parameters at the 3-month and 24-month follow-up visits. Regression analyses were also performed between visual acuity and the retinal thickness deviation which was calculated as the absolute value of the difference between measured and normative retinal thickness values., Results: The VA was not associated with either foveal (R 2  = 0.011 and p  = .401 at 3 months; R 2  = 0.032 and p  = .142 at 24 months) or parafoveal (R 2  = 0.045 and p  = .081 at 3 months; R 2  = 0.050 and p  = .055 at 24 months) retinal thicknesses. Compared with the linear models, a quadratic function yielded a relative increase in the R 2 coefficients. Conversely, the VA was linearly associated with foveal retinal thickness deviation (R 2  = 0.041 and p  = .037 at 24 months) and parafoveal retinal thickness deviation (R 2  = 0.062 and p  = .040 at 3 months; R 2  = 0.088 and p  = .014 at 24 months) values., Conclusions: Although there was no linear relationship between retinal thickness and VA, a weak but statistically significant linear relationship could be observed when a retinal thickness deviation was considered. This suggests that deviation-based parameters may be beneficial for structure-function correlations in the context of anti-VEGF therapy for neovascular AMD., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: This prospective study evaluated the impact of anatomical and tomographic biomarkers on clinical outcomes of intravitreal dexamethasone implants in patients with macular edema secondary to retinal vein occlusion (RVO). Methods : The study included 46 patients (28 with branch RVO (BRVO) and 18 with central RVO (CRVO)). Best corrected visual acuity (BCVA) significantly improved from a mean baseline of 0.817 ± 0.220 logMAR to 0.663 ± 0.267 logMAR at six months and 0.639 ± 0.321 logMAR at twelve months ( p < 0.05). Central retinal thickness (CRT) showed a significant reduction from 666.2 ± 212.2 µm to 471.1 ± 215.6 µm at six months and 467 ± 175.7 µm at twelve months ( p < 0.05). No significant differences were found in OCT biomarkers between baseline and follow-ups. Results : The study analysed improvements in visual acuity relative to baseline biomarkers. At six months, ellipsoid zone disruption (EZD) was significant for all subgroups. Disorganization of retinal inner layers (DRIL), external limiting membrane (ELM) disruption, macular ischemia (MI), CRT, and BRVO showed significance for any improvement, while DRIL and ELM were significant for changes greater than 0.3 logMAR ( p < 0.05). At twelve months, EZD remained significant for all subgroups. ELM, MI, CRT, and BRVO were significant for any improvement, while MI and BRVO were significant for changes greater than 0.3 logMAR ( p < 0.05). Hyperreflective foci were not statistically significant at either time point ( p > 0.05). Conclusions : The regression model suggested that MI and CRVO could be negative predictive factors for visual outcomes, while ELM and EZD were associated with BCVA improvement one-year post-treatment.

Background: To evaluate the correlations between anatomical and functional changes after idiopathic epiretinal membrane (iERM) surgery., Methods: In this prospective, observational, single-center study, consecutive patients who underwent iERM peeling were enrolled. Reported data were pre- and postoperative best-corrected visual acuity (BCVA), retinal sensitivity (RS) and fixation stability values on microperimetry, structural macular features on SD-OCT and OCTA. RS of foveal and parafoveal area was analysed and two sub-groups were identified whether RS improved or remained unchanged/worsened after surgery; consequently, vascular perfusion density (VPD) of the same area was studied., Results: Twenty-nine eyes of 29 patients were examined. The post-operative improvement in terms of BCVA, RS and fixation within the central 4 degrees was significant (p < 0.001, p < 0.001, p = 0.001), as well as the foveal thickness and macular volume change/reduction (p < 0.001). The pre-operative superficial VPD, choriocapillaris VPD and capillary free zone (CFZ) area were significantly reduced compared to the fellow healthy eye (p = 0.001, p = 0.02, p < 0.001). Choriocapillaris VPD showed a statistically significant increase after surgery (p < 0.02). Superficial, deep and choriocapillaris VPD of the improved RS group showed a significant increase both in foveal (p = 0.03, p = 0.03, p = 0.01) and parafoveal areas (p = 0.01, p = 0.03, p = 0.001)., Conclusions: We reported a higher VPD in the retinal area that experienced a retinal sensitivity improvement 6 months after ERM surgery. This result objectifies the tight bond between visual function and retinal perfusion in ERM patients., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background : To investigate anatomical and functional changes of the macula caused by epiretinal membrane (ERM) peeling procedures in patients with or without posterior vitreous detachment (PVD). Methods : This is a multicentric prospective observational study on thirty-seven (37) patients affected by symptomatic ERM who underwent 25-gauge pars plana vitrectomy (PPV), induction of a PVD (as needed) and peeling of both the internal limiting membrane (ILM) and ERM. Optical coherence tomography-angiography (OCT-A) ( RS 3000 , Nidek, Japan) and microperimetry ( MP-3 , Nidek, Japan) were performed; central retinal thickness (CRT), foveal avascular zone (FAZ) area and perimeter, vessel density and perfusion density, retinal sensitivity and fixation stability (as a total mean retinal sensitivity (MRS), and MRS in the ellipse area and bivariate contour ellipse area (BCEA)) were recorded at baseline and up to postoperative month 3. Results : Eyes were classified as having complete PVD (51.4%) or incomplete PVD (48.6%). At baseline, patients with incomplete PVD had worse best-corrected distance visual acuity (BCDVA), total MRS, MRS in the ellipse area and BCEA, and higher CRT than patients with complete PVD. At month 3, the differences in BCDVA between the two groups remained statistically significant, with patients with incomplete PVD having worse results (difference: 0.199 logMAR, p < 0.001). The difference in the MRS in the ellipse area was statistically significant at month 3 (-3.378 Db, p = 0.035), with greater improvement in patients with complete PVD. Conclusions : Our study shows that patients with incomplete PVD have worse conditions at baseline than patients with complete PVD, and the differences in visual acuity and retinal sensitivity were maintained postoperatively.

Purpose: To investigate the relationship between the macular values of fractal dimension (FD) and lacunarity (LAC) on optical coherence tomography angiography (OCTA) images and the presence of peripheral retina non-perfusion areas (NPAs) on fluorescein angiography (FA) in patients with treatment-naïve diabetic macular edema (DME)., Methods: Fifty patients with treatment-naïve DME underwent a full ophthalmic examination, including best-corrected visual acuity measurement, FA, spectral-domain optical coherence tomography, and OCTA. Specifically, FA was performed to detect the presence of retinal NPAs, whereas fractal OCTA analysis was used to determine macular FD and LAC values at the level of the superficial and deep capillary plexus (SCP and DCP). FA montage frames of the posterior pole and peripheral retina, as well as macular OCTA slabs of the SCP and DCP, were obtained., Results: Thirty (60%) eyes with FA evidence of peripheral retinal NPAs in at least one quadrant showed significantly lower FD and higher LAC in both SCP and DCP, when compared with eyes presenting a well-perfused peripheral retina. Furthermore, macular FD and LAC values were found to be significantly associated with the extent of retinal NPAs., Conclusions: Macular FD and LAC of both SCP and DCP seem to be strongly associated with the extent of peripheral retinal NPAs, thus suggesting that may be useful predictive biomarkers of peripheral ischemia in treatment-naïve DME eyes., (© 2024. The Author(s).)

Purpose: To report the emergence and progress of four late-stage characteristics: incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) and complete RPE and outer retinal atrophy (cRORA), drusen ooze and drusen collapse in eyes with dry age-related macular degeneration (AMD) using Spectral Domain Optical Coherence Tomography (SD-OCT)., Methods: This was a retrospective analysis of eyes with non-exudative AMD. Multimodal imaging was done at follow up visits ≤ 12 months. OCT volume scan was used to assess and identify the 4 characteristics. Univariate analysis was done for the various demographic and clinical characteristics.Patients with a mean age of 76.7 ± 10 years were followed up for 69.9 ± 20.6 months. iRORA, cRORA, drusen ooze was present in 15.6%, 15.6% and 15.6% of patients at baseline, respectively, and 25.0%, 40.6% and 53.1% of patients at the final follow-up, respectively. At baseline 9.1%, 0% and 9.1% of patients had bilateral drusen ooze, iRORA and cRORA, respectively. By the final follow-up, drusen collapse occurred in 46.9% and 18.8% patients in unilateral and bilateral eyes, respectively.For bilateral cases, the mean interval of time between emergence inthe two eyes for drusen ooze, drusen collapse, iRORA, and cRORA was 5 ± 1.4 years, 2.2 ± 2.2 years, 3.5 ± 0.7 and 1.7 ± 0.6 years, respectively., Conclusions: Late-stage OCT biomarkers are seen bilaterally at 21.9% at baseline and at 56.3% at 5.8 years follow-up. Once present in one eye, cRORA had the shortest mean interval before appearance in the other eye., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: AS, SA, MJ, SS, SA, DT, CC, ML: None, JC: Novartis; Allergan; OD-OS. Address for reprint: 203 lothrop Street, Pittsburgh, PA 15213.

Purpose: To analyse the gender-specific differences in central serous chorioretinopathy (CSCR) based on a new multimodal imaging classification system., Method: This was a retrospective, multicentric, longitudinal, observational study in patients with a diagnosis of unilateral or bilateral CSCR. Visual acuity outcomes and differences based on 'Simple' and 'Complex' CSCR were analysed. The occurrence of choroidal neovascularization (CNVM) and number of recurrences were also compared. Regression analysis was used to evaluate baseline predictors of final visual acuity., Results: The study included 109 eyes of 58 patients (55 eyes of 28 female patients and 54 eyes of 30 male patients). Simple CSCR was seen in 8 (14.8%) eyes and 21 (38.2%) eyes in male and female groups respectively, while complex CSCR was seen in 46 (85.2%) eyes and 34 (61.8%) eyes in male and female groups respectively (p = 0.005). Recurrence was more commonly seen in males (34 eyes) than in females (23 eyes) (p = 0.03). Males (96.7%) were also significantly more likely to have a bilateral presentation (78.6% in females) (p = 0.03). Conversely, CNVM was more commonly seen in female eyes (8 eyes) than male eyes (4 eyes) (p = 0.23). On multivariable regression analysis, factors affecting reduced need for treatment were history of steroid use, good visual acuity at baseline, and simple CSCR. Factors affecting good final visual acuity were history of steroid use, good visual acuity at baseline, and younger age., Conclusion: Males tended to have complex CSCR and recurrence compared to the female sub-group, while females exhibited CNVM more commonly than males., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)