Purpose: To evaluate the clinical outcomes and prognostic factors of double-dose aflibercept in patients with refractory neovascular age-related macular degeneration (nAMD). Methods: We reviewed the medical records of nAMD patients treated with a double dose of aflibercept (4 mg/0.1 mL) due to an inadequate response to standard 8-weekly intravitreal injections of 2 mg/0.05 mL aflibercept. The assessment at week 8 after treatment included changes in subretinal/intraretinal fluid (SRF/IRF) and best-corrected visual acuity, with patients showing absence or reduction in SRF/IRF classified as the response group. Baseline factors influencing clinical outcomes were analyzed, including central macular thickness (CMT), central choroidal thickness (CCT), size of choroidal neovascularization (CNV), CNV subtype, and maximum height of SRF and IRF. Results: The study included 95 eyes of 95 subjects, with 61 eyes (64.2%) categorized as the response group following double-dose treatment. Responders exhibited thicker CCT (290.4 μm vs. 194.0 μm, p < 0.001), thinner CMT (251.2 μm vs 311.1 μm, p = 0.018), smaller CNV area (2.718 mm2 vs. 3.964 mm2, p = 0.034), and a higher prevalence of type 1 CNV (85.2% vs. 58.8%, p = 0.011) compared to the non-response group. Multivariate binary logistic regression analysis identified thicker CCT (p < 0.001, r = 1.016), thinner CMT (p = 0.014, r = 0.988), smaller CNV area (p = 0.015, r = 0.662), and type 1 CNV (p = 0.001, r = 0.061) as factors associated with better anatomical outcomes. Conclusions Double-dose aflibercept was effective in 64% of patients with refractory nAMD, suggesting it may be considered for those with small CNV areas, thinner CMT, and thicker CCT.

Purpose: To assess the impact of toxoplasma immunoglobulin G (IgG) titers on the diagnosis of active ocular toxoplasmosis. Methods: We retrospectively analyzed the medical records of patients tested for toxoplasma IgG at our uveitis clinic. Active ocular toxoplasmosis was clinically diagnosed based on wide-angle fundus photography and disease progression. Patients with IgG titers ≥ 30 IU/mL were classified as seropositive-high titer, those with IgG titers of 1.6-30 IU/mL as seropositive-low titer, and the remaining patients as seronegative. We compared the proportion of active ocular toxoplasmosis among these groups. Additionally, we evaluated the sensitivity and specificity of each titer and attempted to determine an ideal reference titer for toxoplasma IgG in diagnosing active ocular toxoplasmosis. Results: Out of 824 patients, 86 (10.4%), 88 (10.7%), and 650 (78.9%) were categorized as seropositive-high titer, seropositivelow titer, and seronegative, respectively. Among these patients, 34 in the seropositive-high titer group and 2 in the seropositive- low titer group were clinically diagnosed with active ocular toxoplasmosis. The false-positive rate was significantly different between the groups, being 60.5% in the seropositive-high titer group and 97.7% in the seropositive-low titer group (p < 0.001). The receiver operating characteristic curve indicated that 37.70 IU/mL could be an ideal reference titer for diagnosing ocular toxoplasmosis. Conclusions The false-positive rate was notably lower (60.5%) in patients with IgG titers ≥ 30 IU/mL compared to those with titers of 1.6-30 IU/mL (97.7%). Therefore, not only the presence of IgG but also the level of titer appears to be important in diagnosing ocular toxoplasmosis.

Purpose: To report a case of spontaneous closure of a chronic recurrent full-thickness macular hole (FTMH) in a previously vitrectomized eye.Case summary: A 58-year-old female who underwent vitrectomy for the treatment of a rhegmatogenous retinal detachment (RRD) on the right eye 2 years ago complaint of decreased vision on the same eye. The best corrected visual acuity (BCVA) was 0.2. The fundus photograph and optical coherence tomography revealed a FTMH with perifoveal cystoid macular edema (CME). While surgical treatment for the macular hole (MH) was scheduled, the spontaneous closure of MH was observed with resolution of CME. BCVA improved to 0.5. During the long-term follow-up periods, FTMH with CME recurred 2 times or more. In all events, the hole was spontaneously closed in 1 month, accompanied with resolution of CME. Conclusions A FTMH with CME developed 3 times for 11 years following RRD repair, which was spontaneously closed with CME resolution in a month. In case of chronic recurrent FTMH in vitrectomized eye, it would be better to determine surgical treatment after closely monitoring changes in hole and CME.

Purpose: To investigate the clinical outcomes and intraocular inflammation (IOI) following intravitreal brolucizumab injection for the treatment of refractory neovascular age-related macular degeneration (nAMD). Methods: This retrospective study reviewed the medical records of nAMD patients who received intravitreal brolucizumab injection that was switched from other anti-vascular endothelial growth factor (anti-VEGF) agents due to limited responses. The changes in subretinal/intraretinal fluid (SRF/IRF) and development of IOI were evaluated using slit lamp examination, fundoscopy, and optical coherence tomography. Results: The study included 76 eyes of 75 patients (56 males, 19 females). SRF and IRF disappeared in 55.3% (42/76 eyes) after the first injection and in 52.3% (23/44 eyes) of the remaining eyes after the third injection. The mean treatment interval increased from 5.6 to 9.6 weeks (p < 0.001). Visual acuity did not change. Eleven eyes (14.5%) developed IOI: an anterior chamber reaction in two eyes, vitritis in nine eyes, retinal vasculitis in one eye, and no retinal vascular occlusion. All IOI was treated with steroid eye solution or oral medication and recovered within 3.8 weeks. Three eyes also underwent subtenon steroid injection. Early recovery from IOI was observed in the subtenon steroid injection group (1.67 ± 0.58 vs. 4.63 ± 2.97 weeks, p = 0.048). Visual acuity (logMAR) decreased from 0.51 to 0.67 when IOI developed (p = 0.018), but increased to 0.52 after recovery from IOI. Conclusions Approximately half of the eyes with refractory nAMD showed complete resolution of SRF/IRF when receiving brolucizumab. IOI had a high incidence, but recovery was successful, with careful monitoring and intensive steroid treatment.

Purpose: To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). Methods: We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. Results: Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin-resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). Conclusions Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.