Purpose: To determine the prevalence of tamoxifen retinopathy and assess the utility of a screening protocol using non-mydriatic fundus photography and optical coherence tomography (OCT). Methods: Between May and October 2024, patients on tamoxifen therapy at a breast surgery clinic were offered screening including non-mydriatic fundus photography and OCT. Among those who consented, 290 patients (580 eyes) were included after excluding other retinal diseases. We investigated tamoxifen duration, cumulative dose, central retinal thickness, BMI, underlying diseases, menopausal status, and history of chemotherapy, hormone therapy, or oral contraceptives. Results: All patients were taking 20 mg of tamoxifen daily. The mean treatment duration was 55.7 ± 29.5 months for those treated longer than two years (n = 193), with a mean BMI of 22.1 ± 3.0 kg/m2. Systemic comorbidities included dyslipidemia (n = 27, 14.0%), hypertension (n = 19, 9.8%), diabetes mellitus (n = 13, 6.7%), and cardiovascular disease (n = 4, 2.1%). Additionally, patient histories included chemotherapy (n = 84, 43.7%), postmenopausal status (n = 56, 29.1%), hormone therapy (n = 52, 27.0%), and oral contraceptive use (n = 14, 7.2%). Tamoxifen retinopathy was not observed in any of the patients. Conclusions In this cross-sectional study, the prevalence of tamoxifen retinopathy, as assessed by non-mydriatic fundus photography and OCT in this study, was 0%, which is lower than previously reported rates (0.9%–12%). Although specialized examination by an ophthalmologist, including a dilated fundus examination and OCT remains the diagnostic gold standard, practical constraints can limit its routine clinical use. Our study evaluated a screening protocol performed without ophthalmologist intervention. However, we found that limitations in image quality compromised the detection of subtle lesions, such as crystalline deposits. Consequently, this approach may be insufficient to serve as a primary screening strategy.

Purpose: To evaluate the anatomical changes in the fovea and macula after superior internal limiting membrane (sILM) flap surgery for treatment of large macular hole (MH). Methods: Patients with large MH (minimum diameter > 400 μm) who were followed for at least 6 months after vitrectomy and sILM flap surgery were retrospectively reviewed. The best-corrected visual acuity (BCVA) and anatomical changes in the fovea (macular hole closure rate, foveal contour, recovery of the ellipsoid zone [EZ] and external limiting membrane [ELM], presence of foveal hyper-gliosis, and changes in retinal thickness of the superior and inferior quadrants around the fovea) were investigated. Retinal thickness was evaluated using the superior and inferior quadrants of the inner and outer rings of the Early Treatment Diabetic Retinopathy Study ring. Results: Here, 20 eyes of 18 patients (14 idiopathic MHs, 1 traumatic MH, 2 age-related macular degeneration-related MHs, and 3 high myopia) were included in this study. The preoperative BCVA (logMAR) was 0.90 ± 0.39, and the minimum macular hole diameter was 608.3 ± 131.9 μm. Postoperatively, type 1 closure was achieved in all 20 eyes. Complete recovery of the EZ and ELM was observed in 6 (30.0%) and 13 eyes (65.0%), respectively. The retinal thickness of the superior and inferior quadrants of the fovea showed no significant difference in both the inner ring (289.5 ± 27.4 μm vs. 300.9 ± 24.2 μm) and the outer ring (260.3 ± 22.9 μm vs. 255.9 ± 21.1 μm). Conclusions The superior ILM flap technique involves creating an ILM flap from the superior area of the macula and then positioning it over the inferior area to cover the hole and provided a high success rate of hole closure. There was no anatomical difference in the upper and lower regions of fovea due to the residual internal limiting membrane.

Purpose: To report a case of spontaneous resolution of sub-internal limiting membrane (sub-ILM) fluid associated with an optic disc pit.Case summary: A 13-year-old girl presented with micropsia in her right eye that had onset 3 days prior upon rising from a lying position. Her best-corrected visual acuity (BCVA) was 20/25. Fundus examination revealed an optic disc pit, and optical coherence tomography showed sub-ILM fluid, perifoveal macular traction, and retinoschisis. Over a six-month observation period, the sub-ILM fluid, macular traction, and retinoschisis resolved spontaneously, and BCVA improved to 20/20 with no recurrence. Conclusions In this pediatric case, sub-ILM fluid associated with an optic disc pit resolved spontaneously. The course of this condition in children may differ from that in adults due to the greater elasticity of the ILM in the pediatric retina. The presence of cystic sub-ILM fluid with surrounding macular traction suggests that the fluid entered between the ILM and retinal nerve fiber layer via the optic disc pit, likely from the subarachnoid space.

Purpose: We report the estimated incidence of, and risk factors for, recurrent anterior uveitis in patients with initial acute-onset Vogt-Koyanagi-Harada (VKH) disease using survival analyses. Methods: Patients who were diagnosed with initial acute-onset VKH disease during 2003–2022 at two university hospitals were included. Recurrent anterior uveitis was defined as the first occurrence of the granulomatous anterior uveitis with anterior chamber cells and flare of 2+ or more by the Standardization of Uveitis Nomenclature (SUN) Working Group grading scheme, after the disappearance of conspicuous uveitis and serous retinal detachment for at least 3 months, regardless of systemic or local treatment. The univariate log-rank test and multivariate Cox regression analyses were performed, including patients’ demographic characteristics, underlying diseases, presence of prodromal symptoms, duration of visual symptoms, visual acuity, slit-lamp and fundus findings, and height of serous retinal detachment. The treatment method and response to treatment were also included. Results: The estimated incidence was 39.3% at 10 years. Fifteen of 55 patients (27.3%) had recurrent anterior uveitis during the mean follow-up of 4.5 years. The presence of focal posterior synechiae at the diagnosis increased the risk of recurrent anterior uveitis 6.97-fold compared to the absence of synechiae (95% confidence interval [CI], 2.20–22.11; p < 0.001). Use of systemic high-dose steroid therapy more than 7 days after the development of visual symptoms resulted in a hazard ratio of 4.55 (95% CI, 1.27–16.40; p = 0.020). Conclusions This study reports the estimated incidence and risk factors of recurrent anterior uveitis in VKH disease from survival analyses. However, because of the retrospective nature of this study, it is hard to confirm the consistency of the medical records regarding risk factors, thus, the presence of focal posterior synechiae can be inconclusive as a risk factor. Further studies are warranted.

Purpose: To report a case of macular hole closure using an internal limiting membrane (ILM) flap following implantation of a posterior chamber phakic implantable contact lens (ICL).Case summary: An 18-year-old female patient presented with visual loss of the left eye after ICL implantation. She had high myopia of -12.5 diopter (spherical equivalent) and a corrected visual acuity of 2/100. The fundus photograph and optical coherence tomography showed a full-thickness macular hole measuring 688 µm in width and 976 µm in length. The ILM around the hole was detached from the retinal surface, which was greater in size than the macular hole. The initial surgical intervention involved vitrectomy, inverted ILM flap placement, and gas tamponade. The decrease in gas volume was associated with a loss of the ILM flap. For hole closure, the remaining ILM flap in the peripheral macula was harvested and inserted in the hole during the second surgery. The silicone oil was used for tamponade. One month after ILM insertion, complete closure of the hole was observed. The visual acuity improved to 20/40 after silicone oil removal. Conclusions A large full-thickness macular hole developed after ICL implantation in a patient with high myopia. Macular hole surgery using ILM insertion and prolonged tamponade closed the hole and effectively improved the visual acuity.