OBJECTIVE

To evaluate cone- and rod-specific nonperfusion indices (CPI, RPI) on ultrawide field fluorescein angiography (UWF-FA) and their correlation with diabetic retinopathy (DR) severity and center-involving diabetic macular edema (ciDME).

Sixty-nine eyes of 43 patients with diabetes underwent UWF color photography (UWF-CP), UWF-FA, and macular optical coherence tomography (OCT). DR severity was graded by a masked reader on UWF-CP. UWFFA images were segmented into posterior pole (≤10 mm from fovea), mid-periphery (10–15 mm) and far periphery (>15 mm), and into the macula, within ETDRS fields and extended peripheral fields. Ischemic areas were quantified using ImageJ to calculate nonperfusion index (NPI), CPI, and RPI. ciDME was determined on OCT. Correlations were analyzed using Pearson coefficients (r).

DR severity correlated significantly with global NPI (r = 0.56, p < 0.0001) and across all retinal zones (r = 0.35– 0.57). Both CPI (global: r = 0.56, p < 0.0001; zones: r = 0.42–0.59) and RPI (global: r = 0.55, p < 0.0001; zones: r = 0.40–0.59) showed similar associations. ciDME presence was also correlated with NPI (global: r = 0.40, p = 0.0014; zones: r = 0.42–0.54), CPI (global: r = 0.47, p = 0.0001; zones: r = 0.32–0.55), and RPI (global: r = 0.46, p = 0.0002; zones: r = 0.33–0.54).

Cone- and rod-related retinal nonperfusion strongly correlate with DR severity and ciDME. UWF-FA may help identify high-risk eyes and guide surveillance of ischemia-related progression. Further studies are needed to define ischemic thresholds predictive of vision-threatening complications.

PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.
Acyclovir ; Anterior Chamber ; Ganciclovir ; Hand ; Herpesvirus 3, Human ; Humans ; Intravitreal Injections ; Light Coagulation ; Male ; Middle Aged ; Polymerase Chain Reaction ; Retina ; Retinal Detachment ; Retinal Hemorrhage ; Retinal Necrosis Syndrome, Acute ; Retinal Vessels ; Retinaldehyde ; Retinitis ; Silicon ; Silicones ; Visual Acuity ; Vitrectomy

PURPOSE: To investigate correlations between macular retinal ganglion cell (RGC) layer thickness and best-corrected visual acuity (BCVA) and visual field parameters in patients with bilateral temporal optic atrophy.METHODS: Thirty eyes of 15 patients with bilateral temporal optic atrophy and 30 eyes of 15 normal subjects that were age- and sex-matched were included in the study. We measured the thicknesses of the RGC layers of posterior poles using optical coherence tomography volume scanning. The RGC layer was divided into nine zones based on the Early Treatment of Diabetic Retinopathy Study baseline. Possible correlations of the RGC layer with the BCVA and visual field parameters were determined.RESULTS: The RGC layer thickness was significantly thinner in all patients compared to those in the control group (p = 0.001). The RGC layer thicknesses in the inner superior, inner temporal, inner inferior, and inner nasal areas were significantly correlated with the BCVA (r = −0.650, r = −0.626, r = −0.616, and r = −0.636, respectively; p = 0.000). The RGC layer thicknesses in the outer superior, outer temporal, outer inferior, and outer nasal areas were significantly correlated with the mean deviation of the visual field test (r = 0.470, r = 0.349, r = 0.496, and r = 0.469, respectively; p < 0.05).CONCLUSIONS: In patients with bilateral temporal optic atrophy, the RGC layer thickness in the medial region was correlated with the BCVA, and the RGC layer thickness in the lateral region was correlated with the mean deviation of the visual field test.
Diabetic Retinopathy ; Humans ; Optic Atrophy ; Retinal Ganglion Cells ; Retinaldehyde ; Tomography, Optical Coherence ; Vision Disorders ; Visual Acuity ; Visual Field Tests ; Visual Fields

PURPOSE: To compare the visual acuity and retinal thickness in patients with an idiopathic epiretinal membrane (ERM) after vitrectomy and membranectomy using two different methods.METHODS: This retrospective observational study included 77 eyes (32 eyes in the diamond-dusted membrane scraper [DDMS] group, and 45 eyes in the intraocular forceps [IOF] group) of 77 patients with idiopathic ERM who underwent pars plana vitrectomy and membranectomy. The main outcome measures were best-corrected visual acuity (BCVA, logMAR) and mean retinal thickness.RESULTS: In the IOF group, the BCVA at postoperative 1 week was significantly lower than at baseline and had improved at 12 weeks after surgery. In the DDMS group, the BCVA at postoperative 1 week showed no significant difference at baseline and had improved at 4 weeks after surgery. The central macular thickness at postoperative 6 months was significantly lower than at baseline (all, p < 0.001); there was no significant difference between the two groups (p = 0.400). The postoperative macular thickness of the DDMS group was significantly lower than that of the IOF group in the inner inferior and outer inferior areas at postoperative 12 weeks and 4 weeks (p = 0.046 and p = 0.039, respectively). Five eyes of the DDMS group and 15 eyes of the IOF group developed cystoid macular edema, 14 eyes of that improved without treatment.CONCLUSIONS: In patients with ERM, the use of DDMS or IOF for vitrectomy and membranectomy both resulted in improved visual acuity and decreased mean retinal thicknesses.
Epiretinal Membrane ; Humans ; Macular Edema ; Membranes ; Observational Study ; Outcome Assessment (Health Care) ; Retinaldehyde ; Retrospective Studies ; Surgical Instruments ; Visual Acuity ; Vitrectomy

PURPOSE: To report a case of non-glaucomatous retinal nerve fiber layer (RNFL) defect associated with paravascular inner retinal defect (PIRD) in a patient with idiopathic epiretinal membrane (ERM).CASE SUMMARY: A 70-year-old male who was diagnosed with ERM in his right eye and pseudoexfoliative glaucoma in his left eye visited our clinic. His intraocular pressure was 14 mmHg in both eyes while using topical hypotensive medications in both eyes. His right eye showed no glaucomatous change of the optic disc head, and also no glaucomatous visual field defect on standard automated perimetry. Red-free fundus photography and swept-source optical coherence tomography showed an ERM and wedge-shaped RNFL defect starting from the PIRD, not the optic disc head. He was diagnosed with non-glaucomatous RNFL defect in the right eye and was told to stop using topical hypotensive medication for the right eye. After 2 years of discontinuing the medication, the IOP was within the normal range, the RNFL defect showed no progression, and the visual field remained stationary.CONCLUSIONS: A non-glaucomatous RNFL defect can develop in association with PIRD in patients with idiopathic ERM. Examinations for PIRD as well as evaluation of the optic disc head are therefore necessary in patients with ERM and RNFL defect.
Aged ; Epiretinal Membrane ; Glaucoma ; Head ; Humans ; Intraocular Pressure ; Male ; Nerve Fibers ; Photography ; Reference Values ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Field Tests ; Visual Fields

PURPOSE: To evaluate the effectiveness of 0.1% topical bromfenac as an adjunctive treatment with intravitreal bevacizumab (IVB) injection for branch retinal vein occlusion (BRVO) patients.METHODS: We retrospectively evaluated 68 eyes of 68 patients with macular edema (ME) secondary to BRVO who were treated with IVB injection and followed up for at least 12 months. Of the 68 eyes, 38 were treated with IVB combined with 0.1% topical bromfenac and 30 were treated with IVB alone. IVB reinjection was performed in cases of recurrence. The primary outcome measurement was the number of IVB injections. Changes in the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) during the 12-month follow-up were compared.RESULTS: There was no significant difference in the BCVA or CFT between the two groups at the initial and final examinations. However, the number of IVB injections was significantly lower in the 0.1% bromfenac-treated eyes (p < 0.01) than in the control eyes (4.1 ± 0.7 vs. 5.0 ± 0.6 times).CONCLUSIONS: Compared to IVB monotherapy, topical bromfenac as an adjunctive treatment with IVB injection of eyes with ME secondary to BRVO did not affect visual outcomes, but it reduced the number of IVB injections.
Bevacizumab ; Follow-Up Studies ; Humans ; Macular Edema ; Recurrence ; Retinal Vein Occlusion ; Retinal Vein ; Retinaldehyde ; Retrospective Studies ; Visual Acuity

PURPOSE: To compare the intraocular pressure (IOP) in diabetic macular edema (DME) patients and macular edema associated with branch retinal vein occlusion (BRVO) patients after intravitreal preservative-free Triamcinolone injection.METHODS: This study included 36 patients diagnosed with DME and 44 patients diagnosed with BRVO with macular edema. Both groups were treated with intravitreal preservative-free Triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection, and we compared the IOPs of the two groups determined before injection and at 1, 2, 3, and 6 months after injection. We also compared the IOP elevation ratios and durations, and central foveal thickness (CFT) changes using optical coherence tomography.RESULTS: In both groups, there was no statistical significance in the IOP before injection and at 1, 2, 3, and 6 months after injection. However, the IOP elevation ratio in the DME patients (38.9%) was significantly higher than that in the BRVO patients (15.9%) (p = 0.02). The duration of IOP elevation in the DME patients (1.14 ± 1.85 months) was significantly longer than that in the BRVO patients (0.30 ± 1.20 months) (p = 0.03). When the IOP was not controlled, we used IOP-lowering agents, and two patients in the DME were treated with glaucoma surgery. There was no statistical significance in the CFT before injection and at 1, 2, or 3 months after injection between the two groups (p = 0.72, p = 0.26, p = 0.66, p = 0.34, respectively). However, the CFT after 6 months was 328 ± 103 µm in the DME group and 434 ± 189 µm in the BRVO; this difference was significant (p < 0.01).CONCLUSIONS: Intravitreal injection of preservative-free Triamcinolone was effective in the treatment of both DME patients and macular edema patients associated with BRVO. Furthermore, Triamcinolone was more safely injected in macular edema associated with BRVO patients than in DME patients.
Glaucoma ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Retinal Vein Occlusion ; Retinal Vein ; Retinaldehyde ; Tomography, Optical Coherence ; Triamcinolone

Cluster Analysis ; Ganglion Cysts ; Glaucoma ; Glaucoma, Open-Angle ; Machine Learning ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Fields

Diabetes retinopathy (DR) is one of the leading cause of blindness among people suffering from diabetes. It is a lesion based disease which starts off as small red spots on the retina. These small red lesions are known as microaneurysms (MA). These microaneurysms gradually increase in size as the DR progresses, which eventually leads to blindness. Thus, DR can be prevented at a very early stage by eliminating the retinal microaneurysms. However, elimination of MA is a two step process. The first step requires detecting the presence of MA on the retina. The second step involves pinpointing the location of MA on the retina. Even though, these two steps are interdependent, there is no model available that can perform both steps simultaneously. Most of the models perform the first step successfully, while the second step is performed by opthamologists manually. Hence we have proposed an object detection model that integrates the two steps by detecting (first step) and pinpointing (second step) the MA on the retina simultaneously. This would help the opthamologists in directly finding the exact location of MA on the retina, thereby simplifying the process and eliminating any manual intervention.
Blindness ; Retina ; Retinaldehyde

PURPOSE: To evaluate the changes of axial length (AXL) in eyes with unilateral idiopathic central serous chorioretinopathy (CSC) after resolution of serous retinal detachment. METHODS: A total of 31 patients diagnosed with idiopathic unilateral CSC were included in this study. The changes of AXL according to serous retinal detachment were examined. The keratometric value and AXL were measured using partial coherence interferometry. Serous retinal detachment and central macular thickness (CMT) were measured by spectral domain optical coherence tomography. RESULTS: The mean age of the 31 CSC patients, including 19 males, was 42.7 years. The AXL was significantly increased from 23.41 to 23.58 mm after resolution of serous retinal detachment (p < 0.001). The CMT was significantly decreased from 413.4 to 226.8 µm after resolution of serous retinal detachment (p < 0.001). The differences in AXL correlated with CMT differences and subretinal fluid height (r = −0.616, p < 0.001 and r = −0.637, p < 0.001, respectively), and the best-corrected visual acuity was significantly different after resolution of serous retinal detachment (p < 0.001). CONCLUSIONS: In unilateral idiopathic CSC with serous retinal detachment, a shortened AXL in the acute phase was restored after resolution of serous retinal detachment.
Central Serous Chorioretinopathy ; Humans ; Interferometry ; Male ; Retinal Detachment ; Retinaldehyde ; Subretinal Fluid ; Tomography, Optical Coherence ; Visual Acuity