Search

Purpose To develop an artificial intelligence (AI) model for estimating best-corrected visual acuity (BCVA) using horizontal and vertical optical coherence tomography (OCT) scans of various retinal diseases and examine factors associated with its accuracy. Methods OCT images and associated BCVA measurements from 2,700 OCT images (accrued from 2004 to 2018 with an Atlantis, Triton; Topcon, Tokyo, Japan) of 756 eyes of 469 patients and their BCVA were retrospectively analysed. For each eye, one horizontal and one vertical OCT scan in cross-line mode were used. The GoogLeNet architecture was implemented. The coefficient of determination (R2), root mean square error (RMSE) and mean absolute error (MAE) were computed to evaluate the performance of the trained network. Results R2, RMSE, and MAE were 0.512, 0.350, and 0.321, respectively. R2 was higher in phakic eyes than in pseudophakic eyes. Multivariable regression analysis showed that a higher R2 was significantly associated with better BCVA (p p 2 of 0.19. R2 values for retinal vein occlusion and age-related macular degeneration were 0.961 and 0.373 in the internal validation but 0.20 and 0.22 in the external validation. Conclusion Although underspecification appears to be a fundamental problem to be addressed in AI models for predicting visual acuity, the present results suggest that AI models might have potential for estimating BCVA from OCT in AMD and RVO. Further research is needed to improve the utility of BCVA estimation for these diseases.

Learning Point for Clinicians Bilateral diffuse uveal melanocytic proliferation (BDUMP) can occur not only in patients with cancer, but also as the first sign of subclinical malignancies. Clinicians should be aware of BDUMP when a patient presents with rapid vision loss with fundus changes.

PURPOSE To classify macular neovascularization (MNV) based on pachychoroid and drusen features and to examine the aqueous humor cytokine signatures of each group. METHODS In total, 106 consecutive eyes with treatment-naive MNV and 104 control eyes were examined. The aqueous humor concentrations of 15 cytokines were compared among the MNV groups classified based on the presence of drusen and/or pachychoroid features. Multidimensional scaling analysis was used to visualize the similarity level of the MNV subtypes according to their cytokine profiles. RESULTS Thirty-one, 18, 43, and 10 eyes were classified into the pachychoroid-associated, drusen-associated, pachychoroid/drusen-associated, and non-drusen/non-pachychoroid MNV groups, respectively. Compared with the control group, cytokines were differently upregulated among the MNV groups. CRP and CXCL12 were significantly upregulated in all MNV groups, whereas CXCL13 and IL-8 were significantly upregulated in three MNV groups, excluding the non-pachychoroid/non-drusen-associated MNV group. Ang-2 was significantly upregulated in three MNV groups except the drusen-associated MNV group. PlGF was significantly upregulated in the pachychoroid-associated and drusen-associated MNV groups. CCL-2 was significantly upregulated in the pachychoroid-associated and pachychoroid/drusen-associated MNV groups. VEGF was downregulated in the pachychoroid-associated and drusen-associated MNV groups, respectively. Multidimensional scaling analysis showed a distinct cytokine profile for each MNV group. CONCLUSION All MNV groups showed distinct cytokine profiles. Eyes with "neovascular age-related macular degeneration with drusen and concomitant pachychoroid" may share a similar etiology to those with "pachychoroid neovasculopathy" and "choroidal neovascularization with drusen," but have a distinct etiology to those without these. These findings suggest the importance of evaluating drusen and the choroid during the diagnosis of neovascular age-related macular degeneration.

The aim of this study was to compare aqueous humour (AqH) cytokine profiles before and after Descemet’s membrane endothelial keratoplasty (DMEK) in eyes with bullous keratopathy (BK) and age-matched normal eyes. A total of 49 participants (mean age 75.0 ± 13.5 years) were divided into three groups: (1) BK patients scheduled for DMEK (BK group); (2) patients after DMEK (DMEK group; average postoperative time 1,018 ± 460 days); and (3) control participants without corneal endothelial disease scheduled for cataract surgery (control group). AqH (0.2 mL) was collected from all participants, and the levels of various AqH cytokines were simultaneously measured using a multiplex bead immunoassay. The DMEK group exhibited significantly lower concentrations of several pro-inflammatory cytokines, such as IL-1β, IL-5, IL-6, IL-10, and IL-8, and granulocyte colony stimulating factor than the BK group. In addition, the levels of IL-1β and IL-5 were significantly lower in the DMEK group than in the control group. The AqH levels of several pro-inflammatory cytokines were significantly reduced after DMEK, indicating that regeneration of the endothelial pump owing to the transplantation of a healthy endothelium might have a positive effect on anterior chamber inflammation.

Accidental intraocular lens (IOL) implantation into the corneal stroma is a rare clinical entity that can occur during the wound-assisted technique. In this report, we describe a case of an 81-year-old man who underwent cataract surgery in which the IOL was implanted into the corneal stroma with the wound-assisted technique, and we present changes in anterior segment optical coherence tomography. The IOL was removed and reinserted after widening the incision. Air tamponade was created by intracameral injection. An anterior chamber tap was performed 10 h later to reduce increased intraocular pressure. Interlayer separation of the corneal stroma was confirmed 30 min postoperatively but was corrected 4 days later. The patient’s best-corrected visual acuity (BCVA) was logMAR 0.30, and he had been diagnosed with age-related macular degeneration before surgery. Although the opacity of the corneal stroma persisted, BCVA improved to logMAR 0. When using the wound-assisted technique for IOL insertion, surgeons should take care not to implant the IOL into the corneal stroma.

Objective To apply artificial intelligence (AI) for automated identification of corneal condition and prediction of the likelihood of need for future keratoplasty intervention from optical coherence tomography (OCT)-based corneal parameters. Design Cohort study. Participants We collected 12,242 corneal OCT images from 3162 subjects using CASIA OCT Imaging Systems (Tomey, Japan). We included 3318 measurements collected at the baseline visit of each patient. A total of 333 eyes had post-operative penetrating keratoplasty (PKP), lamellar keratoplasty (LKP), deep anterior keratoplasty (DALK), descemet's stripping automated endothelial keratoplasty (DSAEK) or descemet's membrane endothelial keratoplasty (DMEK) intervention. Method We developed a pipeline including linear and nonlinear data transformations followed by unsupervised machine learning and applied on corneal parameters from the baseline visit of each patient. Five non-overlapping clusters of eyes were identified. Post hoc analyses revealed that clusters corresponded to different likelihoods of need for future keratoplasty. These clusters on a 2-dimensional map can be used by clinicians and surgeons to identify patients with higher risk of need for future keratoplasty intervention. Main outcome measures The likelihood of the need for future surgery. Results The mean age of participants was 69.7 (standard deviation; SD = 16.1) and 59% were female. The normalized likelihood of need for future corneal keratoplasty intervention for eyes mapped onto clusters one to five were 2.2%, 1.0%, 33.1%, 32.7%, and 31.0%, respectively. Conclusions The AI system can assist the (cornea) surgeon in identifying those patients who may be at higher risk for future keratoplasty using comprehensive corneal shape, thickness, and elevation parameters. Future research utilizing independent datasets is necessary to validate the proposed system.

Purpose To evaluate the efficacy of deep learning in judging the need for rebubbling after Descemet's endothelial membrane keratoplasty (DMEK). Methods This retrospective study included eyes that underwent rebubbling after DMEK (rebubbling group: RB group) and the same number of eyes that did not require rebubbling (non-RB group), based on medical records. To classify the RB group, randomly selected images from anterior segment optical coherence tomography at postoperative day 5 were evaluated by corneal specialists. The criterion for rebubbling was the condition where graft detachment reached the central 4.0-mm pupil area. We trained nine types of deep neural network structures (VGG16, VGG19, ResNet50, InceptionV3, InceptionResNetV2, Xception, DenseNet121, DenseNet169, and DenseNet201) and built nine models. Using each model, we tested the validation data and evaluated the model. Results This study included 496 images (31 eyes from 24 patients) in the RB group and 496 images (31 eyes from 29 patients) in the non-RB group. Because 16 picture images were obtained from the same point of each eye, a total of 992 images were obtained. The VGG19 model was found to have the highest area under the receiver operating characteristic curve (AUC) of all models. The AUC, sensitivity, and specificity of the VGG19 model were 0.964, 0.967, and 0.915, respectively, whereas those of the best ensemble model were 0.956, 0.913, and 0.921, respectively. Conclusions This automated system that enables the physician to be aware of the requirement of RB might be clinically useful.

To investigate changes in the interpupillary distance (IPD) after continual instillation of topical prostaglandin analogs (PGAs) in glaucoma patients as an objective indicator of prostaglandin-associated periorbitopathy (PAP).Retrospective, comparative case series.A total of 152 institutional patients with glaucoma were enrolled in this study. Inclusion criteria were visual acuities exceeding 10/20 bilaterally and no intraocular surgery during observation. Intervention/observation procedures: First-time bilateral instillation of bimatoprost, travoprost, latanoprost, or tafluprost and IPDs measured by automatic refractometry. IPDs, intraocular pressures (IOPs), and refractive errors were measured before and after continual drug administration (treatment, 2-24 months).Post-treatment changes in IPDs. A total of 61 untreated patients served as controls.The IPDs shortened significantly (P0.001) after treatment (-0.80 ± 2.1 mm); the IPDs of control subjects remained unchanged (0.05 ± 0.96 mm; P = 0.69). The IPD change after bimatoprost instillation (-2.20 ± 0.97 mm) was significantly (P0.001) greater than with other PGAs (-0.65 ± 2.09 mm). The IOPs decreased significantly (P0.001) (-3.7 ± 4.3 mm Hg); the refractive errors did not change significantly (P0.099) (-0.07 ± 0.69 diopter) post-treatment. The percentages of subjects with 2-mm or greater decreases in IPD after bimatoprost, travoprost, latanoprost, or tafluprost were 85.7%, 20.0%, 18.2%, and 17.2%, respectively, and with 3-mm or greater decreases in IPD 35.7%, 12.0%, 14.5%, and 12.1%, respectively. The specificities were 93.4% and 100% in the control group, respectively, with IPD threshold changes of 2 and 3 mm or more, respectively.The IPD decreased significantly after topical PGAs within 24 months. The effect was significantly greater with bimatoprost than with other PGAs. The noninvasive, immediate automatic refractometry measurement may be an objective numerical indicator of PAP.

We report a case of giant macular hole progression after rupture of giant retinal pigment epithelial detachment (PED). The patient was a 91-year-old man who had a giant PED in the left eye. He had bilateral hypermetropia (+2.00 dpt), and he had developed posterior vitreous detachment. The PED was 5,800 μm in diameter and 800 μm in height and ruptured during follow-up. A macular hole was formed, with a diameter of 400 μm, and the height of the PED had reduced to 360 μm. After 5 months, the macular hole expanded up to a diameter of 600 μm. Therefore, some cases of giant PED may lead to macular hole.

Purpose: To investigate the efficacy of half-dose photodynamic therapy (PDT) for treating symptomatic serous non-neovascular pigment epithelial detachment (PED) and to identify factors associated with treatment outcome. Patients and methods: This is a single-institute retrospective case series involving 12 eyes of 12 consecutive patients with serous non-neovascular PED who received half-dose PDT. We investigated the temporal change in best-corrected visual acuity (BCVA), the anatomic outcomes of PED, including recurrence, central choroidal thickness (CCT), and also choroidal thickness as a possible factor associated with treatment outcome. Results: At baseline, mean logMAR BCVA was 0.06 (range Snellen equivalent 6/20 to 24/20); 24 months later, it was 0.01 (Snellen equivalent 6/20 to 24/20; P=0.3). At 3 months, PED had completely flattened in 8, decreased in height in 2, and remained unchanged in 2. The CCT in eyes with PED was 410 µm and thicker than that in fellow eyes (290 µm, P 350μm or a 100 µm difference in CCT responded favorably to half-dose PDT (P=0.02). Conclusion: Half-dose PDT is effective in patients with non-neovascular PED. Thicker choroid and some difference in CCT between affected and fellow eye might be a good index for predicting the efficacy of this treatment.

Supplemental Digital Content is Available in the Text., Purpose: To investigate factors associated with cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes. Methods: In this retrospective, interventional, consecutive case series, 77 eyes of 65 patients who underwent DMEK were evaluated; in 53 eyes, cataract surgery was performed 1 month before DMEK (staged DMEK), and 24 eyes underwent DMEK alone (simple DMEK). Central retinal thickness, incidence of CME, postoperative best-corrected visual acuity, central corneal thickness, and corneal endothelial cell density were assessed at 1, 3, and 6 months after surgery. Multiple regression analysis and stepwise variable selection were performed for parameters such as type of surgery, iris damage scores, age, sex, axial length, preoperative visual acuity, rebubbling, air volume in the anterior chamber on postoperative day 1, history of diabetes, and endothelial cell density loss rates at 6 months after surgery. Results: CME occurred in 12 (15.6%) of 77 eyes. There was no significant difference in best-corrected visual acuity between eyes with and without CME (P = 0.27). Multivariable analysis revealed that the difference in iris damage scores between before and after DMEK (P < 0.001), air volume in the anterior chamber (P = 0.012), simple DMEK (P = 0.020), and rebubbling (P = 0.036) were significantly associated with CME. Stepwise variable selection indicated that iris damage (P < 0.001) was the most important risk factor for CME. Conclusions: Iris damage due to DMEK might be a possible risk and aggravating factor for the development of CME after DMEK. Surgeons should attempt to minimize damage to the iris.

Purpose: To assess the efficacy and safety of a modified treat-and-extend (mTAE) regimen of aflibercept for macular edema (ME) due to branch retinal vein occlusion (BRVO). Methods: This prospective multicentre intervention study evaluated 50 eyes of 50 patients enrolled from October 2016 to September 2017. The patients received intravitreal aflibercept (IVA) injections on an mTAE regimen for a total of 12 months. The main outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 12 months. Results: The baseline BCVA and CST were 0.33 (0.27) and 488 (171) &micro, m (mean (standard deviation)), respectively. The BCVA and CST were significantly improved at month 12 (0.067 (0.19) LogMAR and 295 (110) &micro, m, both p &lt, 0.0001, paired t-test). The mean number of clinic visits and IVA injections was 6.71 (1.41) and 4.26 (0.71), respectively. The time to first recurrence from the first injection was most frequently 3 months. Conclusion: The mTAE regimen of IVA injections for ME due to BRVO effectively improved BCVA and reduced CST, and thus might be an effective therapy to reduce the number of injections and visits.

PurposeTo investigate the factors associated with endothelial survival after Descemet's membrane endothelial keratoplasty (DMEK) in eyes of Asian patients with bullous keratopathy (BK).MethodsIn this retrospective, consecutive interventional case series, 72 eyes of 72 patients who underwent DMEK were evaluated. Best corrected visual acuity (BCVA) and corneal endothelial cell density (ECD) were assessed at 12 months postoperatively. Multiple regression analysis was performed to assess parameters such as age, sex, axial length, preoperative visual acuity, re-bubbling, the ratio of graft to cornea area, iris damage scores, types of filling gases, air or SF6 volume in the anterior chamber (AC) on postoperative day 1, and ECD loss rates at 12 months postoperatively.ResultsBCVA improved significantly at 12 months after DMEK (P < .001). The rate of ECD loss at 12 months after DMEK was 54.4 ± 16.1%. Multiple linear regression analysis showed that a larger ratio of graft to corneal area (P = 0.0061) and higher donor ECD (P = 0.042) were the primary factors for a lower ECD loss rate at 12 months after DMEK.ConclusionA relatively larger graft size compared to the host cornea and more donor ECD might help endothelial survival in patients with BK. Moreover, for such patients, the surgeon should attempt to use a relatively larger graft size when performing DMEK, particularly in Asian eyes.

Hidenori Takahashi,1–3 Yuji Inoue,1,2 Xue Tan,2,3 Satoru Inoda,1 Shinichi Sakamoto,1 Yusuke Arai,1 Yasuo Yanagi,4–6 Yujiro Fujino,2,3 Hidetoshi Kawashima1 1Department of Ophthalmology, Jichi Medical University, Shimotsuke, 2Department of Ophthalmology, The University of Tokyo, Bunkyo, 3Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Shinjuku, Japan; 4Medical Retina, Singapore National Eye Centre, 5Medical Retina, Singapore Eye Research Institute, 6Eye-ACP, Duke NUS Medical School, National University of Singapore, Singapore Purpose: To investigate the correlation between visual acuity and central macular thickness (CMT) and choroidal thickness (CCT) in patients with wet age-related macular degeneration (AMD). Methods: In this retrospective analysis, 14 eyes that received >10 ranibizumab injections (based on pro re nata [PRN] regimen) and maintained initial visual acuity gain were analyzed. The following 5 parameters were measured at the foveal center: CMT (distance from the inner limiting membrane [ILM] to Bruch’s membrane); central retinal thickness (CRT; distance from the ILM to the inner limit of the retinal pigment epithelium or subretinal fluid [SRF]); SRF thickness (SRFT); pigment epithelium detachment thickness (PEDT); and CCT. The correlation between the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and the 5 parameters was examined with generalized estimating equations. Results: CMT, CRT, and CCT were negatively correlated with logMAR BCVA (P=0.031, 0.023, and 0.036, respectively) when only CMT values less than the thickness that maximized visual acuity for each eye were used for the analysis. Each 100-µm reduction in CMT, CRT, or CCT improved logMAR BCVA by -0.1, -0.08, or -0.07, respectively. SRFT and PEDT were not correlated with BCVA. The median CMT that maximized the visual acuity was 230 µm. Conclusion: Dry macula with CMT

This study aimed to evaluate the long-term (24-month) efficacy and safety of a modified treat-and-extend (mTAE) regimen of aflibercept for macular edema (ME) due to branch retinal vein occlusion (BRVO). This was a prospective multicenter intervention study. We evaluated 50 eyes in 50 patients with ME due to BRVO enrolled between October 2016 and September 2017. The patients received intravitreal aflibercept (IVA) injections according to a mTAE regimen for 24 months. This study reports the secondary endpoints of best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 24 months and compares them with previously reported primary endpoints. Compared with baseline BCVA and CST of 0.33 (0.27) and 488 (165) µm (mean (standard deviation)), respectively, BCVA and CST were significantly improved at 12 and 24 months (12 months: 0.059 (0.19) LogMAR and 299 (112) µm, 24 months: 0.034 (0.18) LogMAR and 272 (81) µm, respectively, both p &lt, 0.0001). Over the 24-month period, the mean number of IVA injections and clinic visits was 7.4 (3.3) and 11.1 (2.0), respectively. The mTAE regimen of IVA injections for ME due to BRVO was effective for improving BCVA and reducing CST over 24 months. This regimen shows promise for reducing the number of injections and clinic visits.

Ryota Takahashi,1 Atsushi Yoshida,2 Satoru Inoda,3 Akira Okubo,4 Hidetoshi Kawashima5 1Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, 2Division of Ophthalmology, The Cancer Institute Hospital of JFCR, Koto, Tokyo, 3Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, 4Okubo Eye Clinic, Tochigi, 5Department of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, Japan Purpose: To investigate uveitis incidence of new patients who visited Jichi Medical University Hospital, Tochigi, north of Tokyo, during 2011–2015, and to compare the results with previously reported data from other facilities. Methods: We retrospectively analyzed clinical records of new patients with uveitis from April 2011 to March 2015 and compared the uveitis incidence with those from other hospitals. Results: A total of 502 patients were enrolled in the study; definite diagnoses were made in 262 patients (52.2%). The top 4 diseases were sarcoidosis, 47 patients (9.4%); Vogt–Koyanagi–Harada (VKH) disease, 35 patients (7.0%); herpetic iritis, 29 patients (5.8%); and Behçet’s disease, 21 patients (4.2%). Conclusion: The most commonly diagnosed diseases in our study were sarcoidosis, VKH disease, herpetic iritis, and Behçet’s disease. Compared with the latest nationwide survey in Japan, our results showed similar trends. Keywords: uveitis, Behçet’s disease, sarcoidosis, Vogt–Koyanagi–Harada disease, herpetic iritis, etiological analysis

Shinichi Sakamoto,1 Hidenori Takahashi,1,2 Yuji Inoue,1 Yusuke Arai,1 Satoru Inoda,1 Natsuko Kakinuma,2 Yujiro Fujino,2 Tatsuro Tanabe,2 Hidetoshi Kawashima,1 Yasuo Yanagi3–5 1Department of Ophthalmology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan; 2Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan; 3Medical Retina, Singapore National Eye Centre, Singapore; 4Medical Retina, Singapore Eye Research Institute, Singapore; 5Eye-ACP, Duke NUS Medical School, National University of Singapore, Singapore Purpose: We report the 2-year outcomes of intravitreal aflibercept (IVA) for exudative age-related macular degeneration (AMD) with good visual acuity (VA) and examine the baseline factors associated with good visual outcome. Materials and methods: This multicenter, prospective study evaluated 39 eyes (39 AMD patients) enrolled from August 2013 to August 2014 at 12 and 24 months. Only patients with initial best-corrected VA (BCVA) >0.3 logarithm of the minimum angle of resolution (20/40 Snellen) were eligible. Three consecutive monthly IVA injections were followed by 2 monthly injections for 12 months. Thereafter, patients received injections on a treat-and-extend regimen for up to 24 months. Outcome measures included BCVA and central macular thickness (CMT) at 12 and 24 months. Post hoc analysis, BCVA, and CMT were evaluated by AMD types (typical AMD [tAMD], type 1, and type 2 polypoidal choroidal vasculopathy [PCV]). Baseline characteristics and BCVA associations were evaluated with linear regression analysis and Student’s t-test. Results: Mean age was 69 years and 26 of 39 eyes were male. tAMD, type 1 and type 2 PCV occurred in 18, 12, and 9 eyes, respectively. Baseline mean BCVA was 0.097 logarithm of the minimum angle of resolution (20/25 Snellen) and showed significant improvement to 0.058 (20/22 Snellen, P=0.03) at 12 months and 0.066 (20/23) at 24 months. CMT improved significantly from 320 (99) µm (mean [SD]) to 250 (93) µm (P=0.002) at 12 months and 240 (93) µm (P=0.0005) at 24 months. BCVA and CMT were not significantly different among the three groups. Only subretinal hemorrhage (SRH) was significantly associated with improved BCVA. BCVA change from baseline was -0.12 with SRH and -0.011 without SRH (P=0.017) at 12 months. Conclusion: IVA showed good efficacy for exudative AMD with good VA at 24 months. tAMD and type 1 and 2 PCV showed similar prognosis. Baseline SRH predicted favorable long-term vision in AMD with good VA. Keywords: polypoidal choroidal vasculopathy, aflibercept, age-related macular degeneration, fixed regimen, good visual acuity, prospective study, treat-and-extend

We developed an unsupervised machine learning algorithm and applied it to big corneal parameters to identify and monitor keratoconus stages. A big dataset of corneal swept source optical coherence tomography (OCT) images of 12,242 eyes acquired from SS-1000 CASIA OCT Imaging Systems in multiple centers across Japan was assembled. A total of 3,156 eyes with valid Ectasia Status Index (ESI) between zero and 100% were selected for the downstream analysis. Four hundred and twenty corneal topography, elevation, and pachymetry parameters (excluding ESI Keratoconus indices) were selected. The algorithm included three major steps. 1) Principal component analysis (PCA) was used to linearly reduce the dimensionality of the input data from 420 to eight significant principal components. 2) Manifold learning was used to further reducing the selected principal components nonlinearly to two eigen-parameters. 3) Finally, a density-based clustering was applied to the eigen-parameters to identify eyes with keratoconus. Visualization of clusters in 2-D space was used to validate the quality of learning subjectively and ESI was used to assess the accuracy of the identified clusters objectively. The proposed method identified four clusters; I: a cluster composed of mostly normal eyes (224 eyes with ESI equal to zero, 23 eyes with ESI between five and 29, and nine eyes with ESI greater than 29), II: a cluster composed of mostly healthy eyes and eyes with forme fruste keratoconus (1772 eyes with ESI equal to zero, 698 eyes with ESI between five and 29, and 117 eyes with ESI greater than 29), III: a cluster composed of mostly eyes with mild keratoconus stage (184 eyes with ESI greater than 29, 74 eyes with ESI between five and 29, and 6 eyes with ESI equal to zero), and IV: a cluster composed of eyes with mostly advanced keratoconus stage (80 eyes had ESI greater than 29 and 1 eye had ESI between five and 29). We found that keratoconus status and severity can be well identified using unsupervised machine learning algorithms along with linear and non-linear corneal data transformation. The proposed method can better identify and visualize the keratoconus stages.

Purpose To investigate the correlation between visual acuity and central macular thickness (CMT) and choroidal thickness (CCT) in patients with wet age-related macular degeneration (AMD). Methods In this retrospective analysis, 14 eyes that received >10 ranibizumab injections (based on pro re nata [PRN] regimen) and maintained initial visual acuity gain were analyzed. The following 5 parameters were measured at the foveal center: CMT (distance from the inner limiting membrane [ILM] to Bruch’s membrane); central retinal thickness (CRT; distance from the ILM to the inner limit of the retinal pigment epithelium or subretinal fluid [SRF]); SRF thickness (SRFT); pigment epithelium detachment thickness (PEDT); and CCT. The correlation between the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and the 5 parameters was examined with generalized estimating equations. Results CMT, CRT, and CCT were negatively correlated with logMAR BCVA (P=0.031, 0.023, and 0.036, respectively) when only CMT values less than the thickness that maximized visual acuity for each eye were used for the analysis. Each 100-μm reduction in CMT, CRT, or CCT improved logMAR BCVA by −0.1, −0.08, or −0.07, respectively. SRFT and PEDT were not correlated with BCVA. The median CMT that maximized the visual acuity was 230 μm. Conclusion Dry macula with CMT

We report a case with bilateral endogenous fungal subretinal abscesses. To our knowledge, this is the first report from Japan in which Scedosporium prolificans (S. prolificans) was cultured from intraocular tissue.A 74-year-old man, receiving chemotherapy for acute myeloid leukemia, complained of visual loss in both eyes. Best-corrected visual acuity was hand motion in the right and 2/200 in the left eye. His right eye showed exophthalmos, inflammation in the anterior chamber and iris neovascularization. Funduscopy revealed no details as there was vitreous opacity in the right eye, and irregular round yellowish-white subretinal lesions involving the macula in the left eye. Blood culture was negative, and C-reactive protein (CRP) and β-D glucan titers were high. An antifungal drug and broad-spectrum antibiotics were initiated. Two days after the initial visit, right visual acuity had deteriorated to light perception. Enucleation of the right eye was performed for diagnosis and treatment. Fungi were cultured from the subretinal lesion, confirming a diagnosis of S. prolificans infection. After systemic administration and intravitreal injections of antifungal agents, the subretinal abscess in the left eye gradually diminished. At present, six months after the first visit, left visual acuity is 20/200.Although S. prolificans endophthalmitis can be intractable, this case suggests that repeated intravitreal antifungal agent injections can be effective.