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: 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.