Search Results (266)

Objectives: This paper aims to explore optical coherence tomography (OCT)-based choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents, faricimab and ranibizumab, in a pilot study. Methods: This retrospective pilot cohort study enrolled 28 treatment-naïve nAMD patients who received three consecutive intravitreal anti-VEGF injections at Nara Medical University Hospital. In total, 17 patients (61%) were Type 1 MNV and 11 patients (39%) were Type 2 MNV. Patients were divided into a faricimab group (13 eyes) and a ranibizumab group (15 eyes). The type of macular neovascularization (MNV) and the presence of polyps were recorded. The central choroidal thickness (CCT) and the ratio of luminal area to choroidal area (L/C ratio), derived from binarized OCT images, were measured at baseline after the first and third injections. Results: Type 1 MNV was observed in 61% of eyes, with polyps confirmed in 53%. There was no significant difference in best corrected visual acuity (BCVA) for both faricimab and ranibizumab during treatment (p = 0.12, 0.94, respectively). After the third injection, a dry macula was achieved in 62% of the faricimab group and 60% of the ranibizumab group. In the ranibizumab group, CCT significantly decreased after the first injection, while no significant change was observed in the faricimab group. Conversely, the L/C ratio significantly decreased in the faricimab group after the third injection (p = 0.010). Among faricimab-treated eyes, those with type 1 MNV showed a significantly greater reduction in the L/C ratio compared to type 2 MNV (p = 0.017). Conclusions: This pilot study suggests that faricimab may exert combined anti-VEGF and Ang-2 effects predominantly on type 1 MNV, potentially leading to vascular constriction. These exploratory findings warrant confirmation in larger studies. Full article

Objectives: Recent studies have shown that highly aspheric lenslets (HAL) are effective in slowing myopia progression. Moreover, research indicates that an enhancement in choroidal thickness might serve as a biomarker for evaluating the efficacy of myopia control treatments. Therefore, this study examined the short-term effects of HAL and full-field +3.00 diopters (D) myopic defocus on sub-foveal choroidal thickness (SFCHR). Design: Prospective experimental study. Participants: Twenty-five participants aged 20–30 (mean 24.56 ± 2.467) years with a refraction error of emmetropia to −5.0 D (mean −2.255 ± 1.514 D). The contralateral non-dominant eye was used as control for each participant. Methods: The participants watched a movie projected at 6 m for 90 min on two separate occasions while wearing HAL or +3 D full-field myopic defocus lenses on their dominant eye. The control eye wore only a single-vision contact lens with the best-corrected distance vision. Three measurements of AL and SFCHR were captured before defocus, and after 60 and 90 min of defocus for both eyes. The main outcome measures were changes in SFCHR and AL over time. Results: Exposure to HAL and +3 D myopic defocus significantly increased SFCHR in the defocused eyes compared to the baseline (p < 0.001). The increase in SFCHR was 6.62 ± 6.32 µm with the HAL intervention and 7.36 ± 8.83 µm with the +3 D intervention. The difference between the two interventions was not statistically significant (p = 0.595). A significant mean difference of 3.176 ± 1.318 µm in SFCHR increase was observed with +3.00 D full-field defocus in the defocused eyes compared to the control eyes over the measurement period (p = 0.020). Conclusions: Short-term exposure to full-field myopic defocus increased choroidal thickness, which was comparable with that observed in peripheral myopic defocus with HAL, although the effect appears less pronounced. Full article

Background: Glaucoma is a multifactorial optic neuropathy and the leading cause of irreversible blindness worldwide. Vascular mechanisms, including impaired perfusion of the optic nerve head, are increasingly recognized as contributors to disease progression. Optical coherence tomography angiography (OCTA) enables non-invasive assessment of retinal and choroidal microvasculature, including peripapillary microvasculature dropout (MvD), which may serve as a marker of glaucomatous damage. Methods: A cross-sectional case–control study was conducted, including patients with primary open-angle glaucoma (OAG) and healthy controls. All participants underwent a comprehensive ophthalmic evaluation and OCTA imaging using the PLEX Elite 9000 system. Peripapillary vessel density (pVD), flow index (pFI), peripapillary choroidal thickness (PCT), β-zone parapapillary atrophy (β-PPA), and choroidal vascular indices were measured. MvD was defined as the complete absence of microvasculature within the β-PPA boundary. Statistical analyses included univariate and multivariate regression models to examine variables associated with PCT and to assess the association between MvD and visual field mean defect (MD), as well as other glaucoma characteristics. ROC curve analysis was performed to evaluate the ability of MvD to discriminate between different levels of visual field defects. Results: A total of 87 eyes (41 glaucomatous, 46 controls) were analyzed. Glaucoma patients exhibited significantly lower pVD, pFI, PCT, and choroidal vascular indices compared to the controls. MvD was detected in 10 glaucomatous eyes and was associated with a larger β-PPA area, smaller choroidal luminal and stromal areas, and worse mean deviation (MD) values. Multivariate regression showed that the number of ocular hypotensive treatments and StructureIndex variables were significantly associated with PCT (adjusted R² = 0.14). Logistic regression analysis identified MD, MD slope, and β-PPA area as variables significantly associated with the presence of MvD. ROC analysis showed that the presence of MvD had good discriminatory ability for visual field mean defects (MDs) (AUC = 0.77, 95% CI: 0.69–0.87; p = 0.005). Conclusions: Peripapillary MvD detected by OCTA is associated with reduced choroidal vascularity, increased β-PPA, and greater visual field deterioration in glaucoma patients. MvD may serve as a structural marker associated with functional deterioration in glaucoma patients. Full article

Physical activity has been shown to influence ocular health, yet the acute effects of exercise on retinal and choroidal structures remain underexplored. This prospective pre-post study evaluated 30 low-fit adults without diagnosed cardiovascular disease who underwent comprehensive ophthalmologic assessments, including OCT and OCTA imaging, before and after a submaximal aerobic capacity test. Statistically significant thinning was observed in specific retinal sectors, affecting both inner and outer layers, including the retinal pigment epithelium (RPE). Vascular analysis using the OCTAVA toolbox revealed a significant post-exercise reduction in vessel length density, total vessel length, branchpoint density and fractal dimension in the peripapillary plexus; and mean tortuosity in the macular superficial vascular complex (SVC). Choroidal thickness also showed a significant reduction in several regions. No significant changes were found in the foveal avascular zone (FAZ). These findings suggest that acute submaximal physical activity induces transient yet measurable changes in retinal and choroidal microvasculature. The results have potential implications for understanding ocular vascular dynamics and for evaluating ocular health in clinical and sports medicine contexts. Full article

Background: Choroidal hemangioma, a rare benign vascular tumor, can cause visual loss due to subretinal fluid. Photodynamic therapy (PDT) with verteporfin has been the standard treatment, with plaque brachytherapy reserved for PDT failure. Verteporfin is unavailable in many regions in the Middle East, including Jordan, leaving plaque as the main alternative; however, plaque often leads to poor visual outcomes despite tumor control. To improve visual outcomes, we introduced transpupillary thermotherapy (TTT) via laser indirect ophthalmoscopy (LIO) as a practical, widely available, vision-preserving treatment. Methods: We retrospectively reviewed 13 patients with choroidal hemangioma treated at King Hussein Cancer Center. Patients received either plaque brachytherapy or LIO-guided TTT. Clinical data included visual acuity at baseline, tumor thickness reduction, subretinal fluid status, and visual outcome. Results: All patients had unilateral circumscribed choroidal hemangioma, and 10 (77%) were males. At diagnosis, the visual acuity was ≤0.5 in all patients (100%) and <0.1 in six (46%) patients. Seven patients (54%) received LIO-guided TTT and six (46%) underwent I-125 plaque brachytherapy. Tumor thickness was 3.0–5.0 mm in 12 (92%) cases; the median thickness in the I-125 plaque brachytherapy group was 4.5 mm (range, 4.5–5.0 mm), whereas in the LIO-guided TTT group it was 3.8 mm (range, 2.9–5.0 mm). At a median follow-up of 20 months (mean 24, range 12–48 months), five out of seven patients (71%) treated with TTT showed significant visual improvement, while the remaining two (29%) had stable vision; none experienced deterioration. In contrast, none of the six plaque-treated patients (0%) demonstrated any improvement in visual acuity; four remained stable and two worsened. This difference was statistically significant (p = 0.021). Tumor thickness was reduced in both groups, with a median reduction of −56% in the plaque group and −36% in the TTT group. All patients achieved complete resolution of subretinal fluid. Conclusions: LIO-guided TTT is an effective vision-preserving treatment for choroidal hemangioma. While both modalities-controlled tumor growth, only TTT resulted in significant visual improvement. This study demonstrates that LIO-guided TTT can replace plaque brachytherapy in regions where verteporfin (PDT) is unavailable, offering an accessible, practical, and superior alternative for preserving vision in patients with choroidal hemangioma. Full article

Background/Objectives: To compare the treatment outcomes of intravitreal faricimab (IVF) and intravitreal aflibercept (IVA) in treatment-naïve patients with neovascular age-related macular degeneration (nAMD), stratified by the presence or absence of punctate hyperfluorescence (PH). Methods: This retrospective study included 301 treatment-naïve patients with nAMD who underwent either IVF or IVA. After 1:1 propensity score matching based on baseline best-corrected visual acuity (BCVA), age, and PH status, 56 eyes (28 per group) were analyzed within each PH subgroup. Outcome measures included BCVA, central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and no retinal fluid rate during the loading dose regimen, and the retreatment rate after the loading dose regimen. The prespecified primary endpoint was the 1-year retreatment rate after completion of the loading dose regimen, analyzed by Kaplan–Meier curves with log-rank tests. Comparisons were performed separately between the PH and non-PH groups. Results: In the PH group, no significant differences were observed between IVF and IVA groups in terms of BCVA, CRT, SFCT, no retinal fluid rate, or retreatment rate at any time point. In the non-PH group, IVF and IVA groups showed no significant differences in BCVA, CRT, or SFCT at any time point; however, the IVF group achieved a significantly higher no retinal fluid rate (100.0% vs. 64.3%, p < 0.001) and a lower retreatment rate at 1 year (71.4% vs. 92.9%, p = 0.004) than the IVA group. Conclusions: IVF and IVA showed comparable efficacy in nAMD with PH. In contrast, IVF demonstrated superior anatomical outcomes in nAMD without PH. These retrospective findings suggest distinct pathophysiological mechanisms between PH and non-PH subtypes. Full article

Background/Objectives: This study aimed to investigate changes and synthesize the existing evidence in macular choroidal thickness in patients with keratoconus (KC) compared to healthy controls, utilizing optical coherence tomography (OCT). Methods: PubMed and Scopus databases were systematically searched for published articles comparing choroidal thickness between patients with KC and healthy controls. The Mean Difference (MD) with 95% confidence interval (CI) was computed to compare continuous variables. Our study was registered with PROSPERO with registration ID: CRD42024605227. Revman 5.4 was used for the analysis. Results 10 studies were included in the analysis. Subfoveal choroidal thickness was increased in patients with KC compared to controls. (MD = 43.94, 95% CI = 17.36–70.51, p = 0.001, I² = 95%). Leave-one-out sensitivity analysis confirmed this finding. Conclusions: Our meta-analysis demonstrated that eyes with keratoconus have significantly increased macular choroidal thickness compared to controls. These findings highlight the need for longitudinal studies stratified by disease severity to clarify the role of choroidal changes in keratoconus progression. Full article

Background and Objectives: To find morphological features on optical coherence tomography (OCT) and OCT-angiography (OCTA) influencing contrast sensitivity (CS) in patients with retinitis pigmentosa (RP). Materials and Methods: Cross-sectional study enrolling 18 eyes of 18 patients with RP. They were examined with CSV1000-E (VectorVision) under mesopic conditions (logarithmic scale), spectral-domain OCT (SD-OCT, Spectralis), swept-source OCT (SS-OCT, Triton), and OCTA (Triton). Automatic thickness measurements of every retinal layer were obtained in grids of 8 × 8 and 10 × 10 cubes. Foveal avascular zone and vascular densities (VD) were also analyzed. Statistical analysis included multiple lineal regression analyses, and a correlation analysis between age, axial length, and intraocular pressure, and retinal nerve fiber layer (RNFL) thickness. Results: Mean age was 47.34 ± 13.77 years. Mean CS with 3, 6, 12, and 18 cycles/degree (c/d) was 1.48 ± 0.37, 1.51 ± 0.39, 1.00 ± 0.42, and 0.44 ± 0.39, respectively. The most related variables to 3 c/d frequency were nasal RFNL thickness (R² = 0.54) and central outer plexiform layer (OPL) (R² = 0.33). In case of 6 c/d frequency, it was central VD in deep plexus (R² = 0.66), and retinal pigment epithelium (RPE) (R² = 0.22). As for 12 c/d frequency, it was central RNFL (R² = 0.50), and central VD in deep plexus (R² = 0.26). Regarding 18 c/d frequency, it was central RNFL (R² = 0.70). Conclusions: Central and nasal RNFL thickness seem to be main predictors of CS in patients with RP, as well as VD in deep retinal plexus. Others with limited influence might be central and nasal OPL thickness, and central RPE thickness. Full article

Background/Objectives: The purpose of this study was to investigate corneal biomechanical properties assessed with Corvis ST, structural features of myopia, and vessel density (VD) measured by optical coherence tomography angiography (OCT-A) and their associations with central visual function in myopic glaucoma patients. Methods: Forty-two eyes of 42 glaucoma patients with myopia without retinal lesions were subjected to analysis. Corvis ST was performed to measure the biomechanical properties of the eyeball. Superficial (retinal) and deep (choroidal) VDs in the peripapillary and macular regions were assessed using OCT-A, and retinal nerve fiber layer (RNFL) thickness was measured with OCT. The disc–foveal angle, disc torsion, and β-zone peripapillary atrophy (PPA) area were obtained from disc and retinal photography. Swedish interactive thresholding algorithm (SITA) 24-2 visual field (VF) testing was used to evaluate the function within the central 12 points. Results: A worse mean deviation (MD) from SITA 24-2 and higher whole-eye movement maximum from Corvis ST, representing deformable corneas, were associated with lower superficial peripapillary VD. A lower A1 deflection amplitude from Corvis ST, representing stiffer corneas, was associated with lower deep peripapillary VD. The sensitivity of the central 12 VF points was significantly associated with a larger disc–foveal angle, lower superficial peripapillary VD, and lower HC deformation amplitude from Corvis ST. Conclusions: Our preliminary findings suggest that more compliant corneas were associated with lower superficial VD, whereas stiffer corneas were associated with lower deep VD and central scotoma. Full article

Background/Objectives: Neoadjuvant systemic therapy may enhance ocular and visual preservation, also prolonging life in patients with choroidal melanoma. We investigated how many choroidal melanomas would be eligible for such treatment to enable Ruthenium-106 brachytherapy. Methods: The cohort comprised 5859 patients treated for choroidal melanoma at the Liverpool Ocular Oncology Centre between 1993 and 2023. Results: If the objective is ocular conservation, then, after excluding tumors > 16 mm in diameter, involving disc and/or more than two clock hours of angle or iris, and/or extending extraocularly, approximately 60.5%, 65.1%, and 67.6% of patients would remain eligible for neoadjuvant systemic therapy, according to whether the maximum allowable tumor thickness is 8 mm, 10 mm or 12 mm, respectively. If the objective is preservation of 20/80 vision, and if exclusion criteria also include vision worse than 20/80 and tumor extension to within 3 mm of optic disc and/or fovea, then 31.0%, 33.2% and 34.1% of tumors would remain in the three tumor-thickness groups, respectively. Chromosome 3 loss would be found in approximately 33%, 52% and 56% of tumors measuring 11–12 mm, 13–14 mm and >14 mm, respectively. Conclusions: Based on the provided data and with effective neoadjuvant treatment, approximately two thirds of subjects with choroidal melanoma requiring enucleation could potentially become candidates for ruthenium-106 brachytherapy and as many as one third could also have the potential for preservation of useful vision. Full article

Background/Objectives: We evaluated the clinical features and natural course of treatment-naïve non-exudative macular neovascularization (NE MNV) associated with age-related macular degeneration in Korean patients. Methods: This retrospective longitudinal study of 21 eyes of 21 patients with NE MNV involved a chart review of best corrected visual acuity (BCVA), optical coherence tomography (OCT), and OCT angiography parameters. Results: This study included 13 men (13/21, 61.9%) and 8 women (8/21, 38.1%), with a mean age of 71.5 ± 9.1 years. The average follow-up period was 15.1 ± 11.8 (range 6.0–49.6) months, and 14 eyes (66.7%) demonstrated exudative changes on OCT scans. The baseline BCVA was 0.15 ± 0.18 logMAR. The initial central macular thickness (CMT), subfoveal choroidal thickness, and the outer retinal layer thickness were 265.3 ± 37.1, 245.2 ± 95.2, and 86.6 ± 5.3 μm, respectively. Cox proportional hazards analysis revealed that older age (hazard ratio [HR]: 1.096, 95% confidence interval [CI]: 1.002–1.200; p = 0.045), larger baseline CMT (HR: 1.025, 95% CI: 1.002–1.049; p = 0.035), and larger baseline MNV (HR: 1.618, 95% CI: 1.035–2.529; p = 0.035) were significant risk factors for exudative changes. Conclusions: We observed the clinical features and natural course of NE MNV in Korean patients and identified that significant risk factors for exudative changes in NE MNV included old age, initially thick CMT, and larger MNV size at baseline. For eyes with NE MNV that have risk factors of exudative conversion, more frequent observation is recommended to ensure the appropriate management. Full article

Objectives: To investigate the association between the hole border morphology and choroidal structure in idiopathic macular hole (IMH) patients and its impact on visual outcomes. Methods: A retrospective case–control study of 34 IMH eyes and 34 control eyes was conducted. Spectral-domain optical coherence tomography (SD-OCT) was used to categorize the patients into groups with smooth or bumpy hole borders. Based on this classification, a further evaluation was conducted of MH morphology and choroidal structure, both before a vitrectomy and at 1 and 2 months post-surgery. The choriocapillaris, Sattler’s layer, and Haller’s layer were the divisions of each choroidal vascular layer. Then, binarization techniques were employed to calculate the choroidal area (CA), luminal area (LA), stromal area (SA), and central choroidal thickness (CCT). The L/C ratio was established as the ratio of LA to CA. Results: In the patients with IMH, the choroidal structure was associated with the morphology of the hole border. In particular, the eyes with bumpy hole borders were significantly correlated with reduced choroidal thickness and total choroidal area, as well as a reduced L/C ratio in the choriocapillaris. After surgery, visual acuity improved in both groups, but the patients with smooth hole borders achieved earlier and higher levels of visual recovery. The multivariate analysis suggested that a bumpy hole border and the basal hole diameter were independent predictors of postoperative choriocapillaris recovery. Conclusions: Bumpy idiopathic macular hole borders are associated with impaired choroidal vasculatures, particularly in the choriocapillaris, which may be a contributing factor to delayed visual acuity recovery post-surgery. Full article

Background/Objectives: Chronic central serous chorioretinopathy (cCSC) is a vision-threatening disorder characterized by persistent subretinal fluid (SRF). While several treatment options exist, their efficacy varies, and optimal management remains uncertain. This retrospective pilot study aimed to evaluate the efficacy and safety of intravitreal brolucizumab in patients with symptomatic cCSC without pachychoroid neovasculopathy (PNV). Methods: In total, 15 eyes of 15 patients diagnosed with symptomatic cCSC without PNV were treated with a single intravitreal injection of brolucizumab. Patients were followed for six months. Primary outcomes included resolution of SRF and changes in central subfield thickness (CST) and subfoveal choroidal thickness (SCT). Best-corrected visual acuity (BCVA) and ocular safety profiles were also assessed. Results: Complete SRF resolution was observed in 14 of 15 eyes (93.3%) within six months. Mean CST significantly decreased from 317.13 ± 73.40 µm to 205.53 ± 20.17 µm (p < 0.001), and mean SCT from 475.87 ± 107.66 µm to 390.13 ± 121.67 µm (p < 0.001). BCVA improved in 12 eyes (80.0%) and remained stable in 3 eyes; however, the mean improvement (logMAR 0.34 ± 0.33 to 0.14 ± 0.13) was statistically significant (p = 0.007). No significant ocular adverse events were reported. Conclusions: Intravitreal brolucizumab may be an effective and safe treatment for reducing SRF and choroidal thickness in patients with cCSC without PNV. Larger, controlled studies are needed to validate these findings. Full article

Blue-light stimulation of the optic disc has been suggested as a means of myopia prevention by activating dopaminergic amacrine cells via intrinsically photosensitive retinal ganglion cells. This prospective, adequately powered study investigated this approach by examining its effects on pattern electroretinogram (PERG) N95 amplitude and choroidal thickness (ChT), established biomarkers associated with retinal ganglion cell function and myopia progression, respectively. Forty-six healthy adults received one minute of 450 nm blue-light stimulation to either the optic disc or central retina of the right eye, with the fellow left eye serving as control. PERG responses were measured before and 20 min after stimulation (N = 15 per stimulation location), while ChT, using swept-source optical coherence tomography images, was measured before, 20, and 60 min after stimulation (N = 8 per stimulation location). Only retinal stimulation significantly increased PERG N95 amplitude (baseline 16.16 µV, post-stimulation 17.61 µV [p = 0.01]), whereas optic disc stimulation did not (baseline 18.71 µV, post-stimulation 18.81 µV [p = 0.76]). Neither optic disc nor retinal stimulation significantly changed ChT at any time point. No significant differences were observed between myopic and non-myopic participants. Our findings do not support the hypothesis that short-duration blue-light stimulation of the optic disc is a viable strategy to activate retinal dopaminergic pathways for myopia prevention. Full article

Objectives: This study aimed to evaluate the 6-month real-world outcomes of switching to faricimab in patients with aflibercept-resistant neovascular age-related macular degeneration (nAMD). Methods: A retrospective review was conducted on the eyes of 60 patients with aflibercept-resistant nAMD that were switched to faricimab. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters, including central subfield thickness (CST), subfoveal choroidal thickness (SFCT), and both the maximum height and width of pigment epithelial detachment (PED), at baseline and 1, 3, and 6 months after switching were evaluated. The type of PED and retinal fluid were also analyzed. Results: The results showed that BCVA remained stable at month 6 (p = 0.150), while CST significantly decreased (p = 0.020), and SFCT remained unchanged (p = 0.072). The maximum PED height significantly decreased (p = 0.030), while the maximum PED width did not change (p = 0.07). The mean injection interval significantly increased from 6.8 ± 2.4 weeks before switching to 11.2 ± 1.7 weeks after switching (p = 0.068). Furthermore, the dry macula rate was 43.3% at month 6. Conclusions: Switching to faricimab in aflibercept-resistant nAMD patients showed stable visual outcomes, significant anatomical improvements, and reduced treatment burden over 6 months in real-world clinical settings. Full article