Purpose: We evaluated factors predicting the recurrence of macular edema in patients with branch retinal vein occlusion using optical coherence tomography (OCT). Methods: This study enrolled 55 patients diagnosed with branch retinal vein occlusion who presented to the outpatient clinic between March 2022 and March 2023. A retrospective analysis categorized patients into non-recurrence and recurrence groups. Data on visual acuity, spherical equivalent, intraocular pressure, number of injections, and follow-up duration were collected from medical records. OCT images were obtained before and 6 months after intravitreal injection to measure and analyze central retinal thickness, subfoveal choroidal thickness, and disorganization of retinal inner layers. Results: No statistically significant difference was observed in the central retinal thickness change before and after treatment between the groups. Although no significant differences were observed in visual acuity between the two groups before treatment, significant improvement in visual acuity was observed in the non-recurrence group after 6 months of treatment. The non-recurrence group was younger compared to the recurrence group; moreover, the intraocular pressure in non-recurrence patients decreased significantly during the 6-month treatment period. In addition, a decrease in subfoveal choroidal thickness before and after treatment, the difference in subfoveal choroidal thickness between the affected eye and the fellow eye before treatment, and the reduction in disorganization of retinal inner layers before and after treatment were associated with a favorable prognosis without recurrence. Conclusions Changes in subfoveal choroidal thickness before and after treatment, variations in subfoveal choroidal thickness between the affected and fellow eyes before treatment, and the degree of disorganization of retinal inner layers exhibited significant associations with the recurrence of macular edema. This is significant because it allows for predictions based on baseline OCT images.

Purpose: To identify initial factors contributing to the resistance against intravitreal aflibercept treatment in polypoidal choroidal vasculopathy (PCV) patients. Methods: This study included PCV patients initially treated with aflibercept. Resistance was defined when treatment did not reduce subretinal fluid (SRF) or intraretinal fluid (IRF) by 100 μm or more after three consecutive 4-week intervals, and the treatment interval could not be extended beyond 8 weeks. To identify initial factors associated with resistance to aflibercept treatment, we examined visual acuity and central choroidal thickness before initial treatment and after three treatments. Choroidal thickness was divided into the thickness of the large choroidal vessel layer and the layer that includes choriocapillaris and medium choroidal vessel thickness (termed medium choroidal vessel/choriocapillaris layer thickness, MCCT). Additionally, the volume of SRF, IRF, subretinal hyperreflective material, and pigment epithelial detachment in optical coherence tomography (OCT) images was investigated. The statistical significance of each factor was assessed through logistic regression analysis. Results: The study included 39 eyes showing no resistance to aflibercept and 37 eyes that exhibited resistance. Multiple logistic regression analysis, adjusted for age and sex, indicated that a lower initial ratio of MCCT to choroidal thickness at the fovea was associated with resistance to aflibercept. Conclusions In patients with PCV treated with aflibercept, early OCT anatomical structures, such as the initial MCCT-choroidal thickness ratio at the fovea, may predict response to treatment injections.

PURPOSE: To investigate the correlation between 24-hour ambulatory blood pressure (BP) monitoring and peripapillary retinal vessel width and visual field (VF) defect progression in normal tension glaucoma (NTG) patients. METHODS: All patients were classified by 24-hour ambulatory BP monitoring as non-dipper (nocturnal dip < 10%) and dipper (nocturnal dip ≥ 10%) group. Vessel diameter, mean deviation (MD) value by VF test and VF progression from Glaucoma Progression Analysis (GPA) were compared among non-dipper and dipper groups. RESULTS: Retinal arterial diameter was wider in the non-dipper group compared to the dipper group (p = 0.015), while retinal venous diameter had no significant relationship between the two groups (p = 0.131). The MD value at baseline and 2 years after was worse in the non-dipper group than the dipper group, respectively (p = 0.006, p = 0.030). But, there was no significant relationship between nocturnal dip and GPA progression (p = 0.658). CONCLUSIONS: There was a statistically significant correlation between nocturnal dips and retinal arterial diameter and MD values. These results suggest that non-invasive fundus photography can predict hemodynamic features like nocturnal dip.
Blood Pressure* ; Glaucoma ; Hemodynamics ; Humans ; Low Tension Glaucoma* ; Photography ; Retinal Vessels* ; Retinaldehyde* ; Visual Fields*

OBJECTIVE: To determine if measurement of the diameter of the solid component in subsolid nodules (SSNs) on low-dose unenhanced chest computed tomography (CT) is as accurate as on standard-dose enhanced CT in prediction of pathological size of invasive component of lung adenocarcinoma. MATERIALS AND METHODS: From February 2012 to October 2015, 114 SSNs were identified in 105 patients that underwent low-dose unenhanced and standard-dose enhanced CT pre-operatively. Three radiologists independently measured the largest diameter of the solid component. Intraclass correlation coefficients (ICCs) were used to assess inter-reader agreement. We estimated measurement differences between the size of solid component and that of invasive component. We measured diagnostic accuracy of the prediction of invasive adenocarcinoma using a size criterion of a solid component ≥ 6 mm, and compared them using a generalized linear mixed model. RESULTS: Inter-reader agreement was excellent (ICC, 0.84.0.89). The mean ± standard deviation of absolute measurement differences between the solid component and invasive component was 4 ± 4 mm in low-dose unenhanced CT and 5 ± 4 mm in standard-dose enhanced CT. Diagnostic accuracy was 81.3% (95% confidence interval, 76.7.85.3%) in low-dose unenhanced CT and 76.6% (71.8.81.0%) in standard-dose enhanced CT, with no statistically significant difference (p = 0.130). CONCLUSION: Measurement of the diameter of the solid component of SSNs on low-dose unenhanced chest CT was as accurate as on standard-dose enhanced CT for predicting the invasive component. Thus, low-dose unenhanced CT may be used safely in the evaluation of patients with SSNs.
Adenocarcinoma* ; Humans ; Lung* ; Thorax* ; Tomography, X-Ray Computed

Background: and Purpose Left atrial or left atrial appendage (LA/LAA) thrombi are frequently observed during cardioembolic evaluation in patients with ischemic stroke. This study aimed to investigate stroke outcomes in patients with LA/LAA thrombus. Methods: This retrospective study included patients admitted to a single tertiary center in Korea between January 2012 and December 2020. Patients with nonvalvular atrial fibrillation who underwent transesophageal echocardiography or multi-detector coronary computed tomography were included in the study. Poor outcome was defined as modified Rankin Scale score >3 at 90 days. The inverse probability of treatment weighting analysis was performed. Results: Of the 631 patients included in this study, 68 (10.7%) had LA/LAA thrombi. Patients were likely to have a poor outcome when an LA/LAA thrombus was detected (42.6% vs. 17.4%, P<0.001). Inverse probability of treatment weighting analysis yielded a higher probability of poor outcomes in patients with LA/LAA thrombus than in those without LA/LAA thrombus (P<0.001). Patients with LA/LAA thrombus were more likely to have relevant arterial occlusion on angiography (36.3% vs. 22.4%, P=0.047) and a longer hospital stay (8 vs. 7 days, P<0.001) than those without LA/LAA thrombus. However, there was no difference in early neurological deterioration during hospitalization or major adverse cardiovascular events within 3 months between the two groups. Conclusions Patients with ischemic stroke who had an LA/LAA thrombus were at risk of a worse functional outcome after 3 months, which was associated with relevant arterial occlusion and prolonged hospital stay.

PURPOSE: We investigated the effect of the protease inhibitor, aprotinin, on mean arterial pressure (MAP), hematocrit (Hct), blood loss, and survival rate in rats with experimental splenic injury. METHODS: We created an experimental splenic injury model in anesthetized rats by cutting the splenic parenchyma into three fragments. We analyzed the effect of aprotinin on three different treatment groups. The aprotinin treatment group received a single dose of 30,000 U/kg of aprotinin in 10 ml/kg normal saline, the tranexamic acid group was treated with a single dose of 100 mg/kg of tranexamic acid in 10ml/kg normal saline, and the saline control group was treated with only 10 ml/kg normal saline. In addition, a sham-operated group (laparotomy without splenectomy) was treated with 10 ml/kg normal saline. RESULTS: MAP was higher in the sham-operated group and the aprotinin group than in the other groups. There were no significant differences for hematocrit except that the saline group exhibited a lower level than the other groups at the six-hour time point. The amount of intraperitoneal blood loss in the sham-operated and aprotinin groups due to splenic injury was significantly lower than in the tranexamic acid and saline groups. The survival rate in the aprotinin group was similar to the tranexamic acid group, but, the survival rate of the aprotinin-treated group was statistically higher than that of the saline control group. CONCLUSION: Hemodynamic changes resulting from splenic injury can be diminished by aprotinin treatment. Aprotinin could be considered in preference to other drugs as a first line treatment in hemodynamically unstable splenic injury patients.
Animals ; Aprotinin* ; Arterial Pressure ; Hematocrit ; Hemodynamics ; Hemoperitoneum ; Hemorrhage* ; Humans ; Protease Inhibitors ; Rats* ; Splenic Rupture ; Survival Rate ; Tranexamic Acid

PURPOSE: To investigate the prognostic factors of visual and anatomic outcomes in patients with diabetic macular edema (DME) treated with intravitreal injection of dexamethasone implant. METHODS: We retrospectively studied 32 eyes of 31 patients with DME for best-corrected visual acuity (BCVA), central macular thickness, and height and width of both intraretinal fluid (IRF) and subretinal fluid. Logistic regression analysis was used to examine correlations between the baseline characteristics and outcomes at 3 and 6 months. RESULTS: Baseline predictor of BCVA ≥20 / 40 at month 3 was short height of baseline IRF (p = 0.02), while good baseline BCVA was a predictor for month 6 (p = 0.01). Predictors of improvement in logarithm of minimum angle of resolution BCVA 0.2 at month 3 were the absence of baseline IRF and poor baseline BCVA (p = 0.02 and p = 0.009, respectively), while poor baseline BCVA was the sole predictor at month 6 (p = 0.01). Predictor of central macular thickness ≤300 µm at month 3 was younger age (p = 0.03), while the absence of IRF was the predictor for BCVA improvement at month 6 (p = 0.02). BCVA ≤20 / 100 at month 3 was predicted by poor baseline BCVA (p = 0.01), and increased width of total IRF was the predictor at month 6 (p = 0.02). Predictor of loss of logarithm of minimum angle of resolution BCVA 0.2 at month 6 was increased width of total IRF at baseline (p = 0.04). Additional injection within 6 months was negatively associated with the presence of baseline DME (p = 0.03). CONCLUSIONS: The visual and anatomical outcome of DME treatment with dexamethasone implant can be predicted by baseline visual acuity and IRF morphology.
Dexamethasone* ; Diabetic Retinopathy ; Humans ; Intravitreal Injections ; Logistic Models ; Macular Edema* ; Prognosis ; Retrospective Studies ; Subretinal Fluid ; Visual Acuity

Purpose: To investigate the safety of single and combined use of epinephrine and indocyanine green during cataract surgery by evaluating the effects on corneal endothelial cells. Methods: From January 2017 to October 2021, 121 patients (132 eyes) who underwent cataract surgery were enrolled. Patients were divided into 4 groups: epinephrine (n = 20), indocyanine green (n = 49), epinephrine and indocyanine green combination (n = 12), and control (n = 51). Retrospective medical chart findings and endothelial cell count change data were compared among study groups before and after operation. Results: Endothelial cell count change (△ECC) decreased for all groups; however, a significant difference among groups was not observed (p = 0.822). Univariate linear regression showed that △ECC was associated with postoperative hexagonality, nuclear sclerosis grade, ultrasound time, and cumulative dissipated energy (beta = -0.216, 0.254, 0.368, 0.351 and p = 0.013, p = 0.003, p < 0.001, p < 0.001). Multivariate linear regression showed that △ECC was associated with postoperative hexagonality and ultrasound time (beta = -0.215, 0.367, p = 0.010, p < 0.001). Conclusions Factors closely associated with postoperative endothelial cell loss were postoperative hexagonality and ultrasound time. No significant damage to the corneal endothelium was observed when epinephrine and indocyanine green were used alone or in combination. Thus, these agents appear safe for use in this context.

Purpose: The present study aimed to quantify various factors of vessel morphology, including vessel diameter, length, and complexity (fractal dimension and lacunarity) of both choroidal neovascularization (CNV) and en face Haller vessels using optical coherence tomography angiography (OCTA) and en face structural optical coherence tomography in typical neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) and to identify factors associated with visual acuity (VA) loss and number of injections within a year after the day of OCTA. Methods: We retrospectively analyzed 43 eyes of nAMD patients and 33 eyes of PCV patients whose OCTA was performed at least 12 months after an initial anti-vascular endothelial growth factor treatment. Quantitative parameters, including vessel area, vessel diameter, vessel length, fractal dimension, and lacunarity were analyzed from en face images of CNV and Haller vessels. Clinical information, including logarithm of the minimum angle of resolution visual acuity and injection number of anti-vascular endothelial growth factor were acquired after 12 months from OCTA date. Using logistic regression analyses, parameters associated with logarithm of the minimum angle of resolution VA loss of 0.2 or more (VA loss group) and a number of injections of four or more (unstable group) after 12 months were analyzed. Results: In typical nAMD, the VA loss group was associated with a smaller number of intersections of Haller vessels. The unstable group was associated with an increased lacunarity of CNV in typical nAMD. In PCV, both VA loss and unstable groups were associated with a higher maximal diameter of Haller vessels. Conclusions VA loss and injection number of nAMD and PCV 12 months after OCTA imaging were associated with different morphological parameters of CNV and Haller vessels. Therefore, quantitative analyses of both CNV and Haller vessels from OCTA and en face optical coherence tomography might provide prognostic information about visual outcome and injection frequency within 12 months after OCTA imaging.