PURPOSE: To characterize the structural features and mechanical failure patterns of macular posterior vitreous detachment (PVD) using volume-rendered swept-source optical coherence tomography (OCT) and to analyze the for...PURPOSE: To characterize the structural features and mechanical failure patterns of macular posterior vitreous detachment (PVD) using volume-rendered swept-source optical coherence tomography (OCT) and to analyze the forces governing cortical tearing versus vitreomacular separation. METHODS: In this retrospective study, eyes with developing or recent macular PVD were imaged with swept-source OCT optimized for vitreous visualization by defocusing into the vitreous cavity. Volumetric datasets were processed and rendered three-dimensionally. Structural findings were analyzed descriptively and interpreted using vector-based mechanical modeling of cortical tensile forces and insertion geometry. RESULTS: Fifty-three eyes of 44 patients were imaged; 48 were evaluable. Circumferential tears of the posterior vitreous cortex were identified in 43 of 48 eyes (89.6%), including partial and complete tears. In a minority of eyes, detachment occurred without cortical rupture. The premacular bursa was preserved in partial tears and absent in complete tears. Measured insertion angles at the vitreomacular interface were shallow (<10°). Vector analysis demonstrated that at small insertion angles, the normal component of cortical tension is markedly attenuated (F⊥ = F sin θ), favoring cortical rupture at the insertion site over adhesive failure at the macula. Volume rendering demonstrated residual full-thickness cortical plaques adherent to the macular surface following tearing. CONCLUSIONS: Volume-rendered swept-source OCT demonstrates that macular PVD commonly involves circumferential cortical tearing. Mechanical analysis indicates that shallow insertion geometry favors cortical rupture as an initial failure mode, dissipating traction but leaving a residual cortical plaque that may contribute to subsequent epiretinal membrane formation.
PURPOSE: To report the rates, culture results, and visual acuity outcomes of endophthalmitis after intravitreal injection. METHODS: Retrospective, consecutive case series of all patients who underwent intravitreal inject...PURPOSE: To report the rates, culture results, and visual acuity outcomes of endophthalmitis after intravitreal injection. METHODS: Retrospective, consecutive case series of all patients who underwent intravitreal injection at University of Miami - Bascom Palmer Eye Institute between January 1, 2021 and December 31, 2024. RESULTS: Endophthalmitis occurred following intravitreal injection in 3/29,802 (0.010%) eyes in 2021, 4/28,767 (0.014%) in 2022, 2/29,249 (0.004%) in 2023, and 1/27,549 (0.004%) in 2024. The use of ranibizumab decreased with time in the current study while faricimab usage increased. There was a slight increase in aflibercept usage after the approval of high dose 8 mg aflibercept in 2023. Vitreous cultures demonstrated growth of Streptococcus mitis/oralis in 1/10 (10%), Staphylococcus aureus in 1/10 (10%), Granulicatella adiacens in 1/10 (10%), Staphylococcus epidermis in 1/10 (10%), Abiotrophia defectiva in 1/10 (10%), and were negative in 5/10 (50%). The cumulative incidence of endophthalmitis over the 4-year time period was 0.0087% (10/115,367) and was similar to rates reported between 2005 and 2020 at the same institution (P = 0.48). There were no differences in the rates of endophthalmitis between various medications (P = 0.32). After treatment, mean best-corrected visual acuity at last follow-up examination was 1.42 logMAR (20/526; range: 20/20 to no light perception). CONCLUSION: Endophthalmitis is a rare complication of intravitreal injection. In the current study, the incidence of endophthalmitis was similar to previously reported rates and did not differ between agents.
PURPOSE: To identify the risk factors and predictive cutoff values for new-onset microscotoma following vitrectomy with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM). METHODS: This retrospective...PURPOSE: To identify the risk factors and predictive cutoff values for new-onset microscotoma following vitrectomy with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM). METHODS: This retrospective study included patients who underwent vitrectomy with ERM and ILM peeling. Visual acuity, metamorphopsia, and visual field (Humphrey Field Analyzer 10-2 program) were evaluated preoperatively and at 3-6 and 12 months postoperatively. New-onset microscotoma was defined as any test points decreasing from ≥10 dB preoperatively to <10 dB at 3-6 months. Risk factors, vulnerable regions, and preoperative threshold cutoff values for new-onset microscotoma were analyzed. RESULTS: New-onset microscotoma was observed in 31 (17.8%) of 174 eyes (174 patients; 67.7 ± 8.2 years). Visual acuity and metamorphopsia improved significantly at 12 months postoperatively (both p<0.0001). A multivariate analysis identified glaucoma (odds ratio [OR]=8.18), secondary ERM (OR=4.45), indocyanine green usage (OR=3.70), and male sex (OR=2.46) as significant risk factors. Vulnerable regions corresponded to the temporal and inferior macula (p<0.01). The overall preoperative threshold cutoff value was 27.5 dB (area under the curve [AUC] = 0.85, p < 0.001), whereas in eyes with glaucoma (n = 18), it was 26.5 dB (AUC = 0.90, p < 0.001). Both analyses demonstrated a negative predictive value (NPV) exceeding 99%. CONCLUSION: The identified risk factors, vulnerable regions, and cutoff values may guide preoperative patient counseling and development of safe strategies to prevent postoperative microscotoma. The high NPVs highlight reliable identification of low-risk areas, contributing to ILM peeling approach optimization.
PURPOSE: To examine trends in initial treatment modality for patients diagnosed with proliferative diabetic retinopathy (PDR). METHODS: A cross-sectional time series was performed between 2005 and 2024 using the TriNetX...PURPOSE: To examine trends in initial treatment modality for patients diagnosed with proliferative diabetic retinopathy (PDR). METHODS: A cross-sectional time series was performed between 2005 and 2024 using the TriNetX US Collaborative Network. Patients with new-onset PDR were identified and initial treatment modality within one year after diagnosis was recorded. The proportion of patients managed with panretinal photocoagulation (PRP) monotherapy, anti-vascular endothelial growth factor (anti-VEGF) monotherapy, or combination therapy (PRP + anti-VEGF) were compared using Cochran-Armitage tests for trend. Rates of change in treatment proportionality were compared between 2005-2014 and 2015-2024, the time period before and after the publication of the DRCR Protocol S. RESULTS: A total of 14,768 patients with newly diagnosed PDR met inclusion criteria. In 2005, PRP monotherapy accounted for 100% of initial treatment. In 2024, combination therapy was the most commonly utilized treatment modality, accounting for 42.4% of cases (overall trend, p<0.0001), followed by anti-VEGF monotherapy at 36.1% (overall trend, p<0.0001), and PRP monotherapy at 21.5% (overall trend, p<0.0001). After 2015, the annual rate of change differed significantly compared with the pre-2015 period for both monotherapies. The proportion of patients treated with PRP monotherapy showed a steeper relative annual decline (5.22% vs 3.56% per year, p=0.0338), while anti-VEGF monotherapy demonstrated a greater relative annual increase (2.03% vs 1.58% per year, p=0.0283). CONCLUSION: Management of PDR has shifted over the past two decades from PRP monotherapy toward anti-VEGF therapy, including both combination therapy and monotherapy.
PURPOSE: To investigate long-term outcome of retinal displacement for 1 year after idiopathic macular hole (MH) surgery with internal limiting membrane (ILM) peeling and evaluate its association with basal MH size. METHO...PURPOSE: To investigate long-term outcome of retinal displacement for 1 year after idiopathic macular hole (MH) surgery with internal limiting membrane (ILM) peeling and evaluate its association with basal MH size. METHODS: This retrospective study included seventy eyes of 70 consecutive patients undergoing MH surgery with ILM peeling. Retinal distance from the temporal edge of optic disc to the intersection or bifurcation points of retinal vessels was quantified using near-infrared images. Rates of change in retinal distance were calculated as retinal displacement (%RD). The basal and minimum diameters of the MHs were measured using Spectralis. RESULTS: The average retinal distance in the nasal sector did not change in the early postoperative period but decreased significantly at 6 months and 1 year (P < 0.001). In other sectors, retinal distance continued decreasing for 1 year (P < 0.001). %RD in the nasal sector was smaller than that in the temporal, superior, and inferior sectors at 12 months (all P < 0.001). %RD in the superior sector was larger than in the inferior sector (P = 0.011). Correlations of temporal %RD with horizontal and vertical basal MH diameters appeared at 1 month (rs = -0.301, P= 0.011 and rs = -0.277, P = 0.020) and were more evident at 1 year (rs= -0.565 and -0.512, P < 0.001). CONCLUSION: Retina surrounding MH keeps moving asymmetrically toward the optic disc for 1 year. Movement of temporal retina after ILM peeling may play an important role in the successful closure of MH.
PURPOSE: This study aims to determine the risk factors of loss to follow-up (LTFU) in patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy (PPV) therapy. METHODS: Information of PDR pat...PURPOSE: This study aims to determine the risk factors of loss to follow-up (LTFU) in patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy (PPV) therapy. METHODS: Information of PDR patients undergoing PPV at the Department of Vitreoretinal Surgery, the Eye Hospital of Wenzhou Medical University, between 2018 and 2024 was collected. LTFU was defined as at least 1 interval exceeding 3 months without a subsequent visit in the first 6 months after PPV and not having any provider encounters documented from 6 months to 1 year. RESULTS: Among 1234 patients with PDR after PPV, 668 (54.1%) were LTFU. Risk factors positively associated with LTFU on multivariable analysis included preoperative hemoglobin A1c 7.5-9.0% (odds ratio [OR], 1.88; P = 0.018), a duration of hypertension ≥10 years (OR, 1.61; P = 0.048), a history of chronic kidney disease or uremia (OR, 3.55; P = 0.005), and distance between home postal code and hospital >90 km (OR, 2.03; P = 0.008). Protective factors against LTFU included a history of intravitreal injection(s) in the study eye (OR, 0.67; P = 0.041), ≥3 preoperative visits (OR, 0.62; P = 0.011), and the use of silicone oil tamponade during vitrectomy (OR, 0.14; P < 0.001). CONCLUSION: We identified multiple factors associated with LTFU and warrant further study to confirm our results to minimize the risk of potential complications during the postoperative period.
PURPOSE: To quantify the effect of transient intraocular pressure (IOP) elevation after intravitreal injection on retinal blood flow using a validated speckle-based optical coherence tomography (OCT) method. METHODS: Nin...PURPOSE: To quantify the effect of transient intraocular pressure (IOP) elevation after intravitreal injection on retinal blood flow using a validated speckle-based optical coherence tomography (OCT) method. METHODS: Nineteen eyes of 19 patients with neovascular age-related macular degeneration underwent OCT imaging and IOP measurement before, immediately after, and for ∼15 minutes after anti-VEGF injection. Retinal blood flow was quantified using a speckle-derived flow index proportional to the erythrocyte velocity. Flow changes were analyzed with linear mixed-effects models incorporating IOP, age, and vessel type. RESULTS: Mean pre-injection IOP was 14.1 mm Hg, rising to 54.4 mm Hg immediately post-injection and decreasing to 24.1 mm Hg after 15.4 minutes. Flow remained stable for IOPs ≤ 40 mm Hg but declined by 3.6% per mm Hg above this threshold (P < 0.001). Older patients exhibited less arterial flow reduction at higher pressures, a modest effect observed only in arteries, not veins. In a limited comparison of the youngest and oldest participants, the arteriolar walls in older eyes appeared thicker and more reflective, consistent with arteriolosclerosis. CONCLUSIONS: Speckle-based OCT enables direct, quantitative assessment of retinal blood flow in vivo. Retinal perfusion remains stable through transient IOP elevations up to about 40 mm Hg, likely reflecting autoregulatory reserve, but declines at higher pressures. The relative flow preservation in older eyes may result from increased vascular wall rigidity. Speckle-based OCT provides a practical, quantitative method to assess retinal blood flow dynamics in vivo.
Kim IP, Orndahl C, Nyaiburi C
… +11 more, Anand R, Callanan D, Chong D, Coors L, Fuller T, McClellan A, Solley W, Wang R, Williams P, Yonekawa Y, Abbey AM
PURPOSE: To compare combined dexamethasone implant (DEX) and intravitreal aflibercept (AFB) to AFB monotherapy treatment in diabetic macular edema (DME). METHODS: This open-label RCT involved randomization of DME patient...PURPOSE: To compare combined dexamethasone implant (DEX) and intravitreal aflibercept (AFB) to AFB monotherapy treatment in diabetic macular edema (DME). METHODS: This open-label RCT involved randomization of DME patients (n=50) to pro re nata treatment with combined DEX and AFB or AFB alone according to pre-specified retreatment criteria. Best-corrected visual acuity (BCVA), central subfield retinal thickness (CST), and adverse events were monitored monthly for 48 weeks. RESULTS: The combined treatment and the AFB monotherapy group demonstrated CST reductions at each visit. The difference (95% CI) in the change from baseline in CST between the groups was -32.9 (-81.5, 15.6) µm at week 48, favoring the combination therapy group without significance (p=0.183). The difference in the change from baseline in BCVA was -3.3 (-9.2, 2.5) letters read at week 48 (p=0.266). Injection number was numerically higher in the aflibercept monotherapy group (mean ± SD, 5.9 ± 1.8) than in the combination group (4.9 ± 1.5). The AFB monotherapy group had a 90% higher injection rate over the study period (IRR [95% CI]=1.9 [0.9, 4.0]) without statistical significance (p=0.081). The combined treatment group achieved quicker time to resolution of DME (log-rank p-value=0.013) by a median difference (95% CI) of 12 (0, 24) weeks. Three eyes and two eyes in the combined therapy group developed worsening cataracts and IOP elevation requiring medical management, respectively. CONCLUSION: Combined treatment achieved similar anatomic and visual outcomes compared with AFB monotherapy, with quicker DME resolution but higher cataract and IOP risks.
PURPOSE: To assess the structural and functional outcomes of treatment with ciliary neurotrophic factor (CNTF) for patients with type 2 macular telangiectasia (MacTel). METHODS: Studies were retrieved from inception to M...PURPOSE: To assess the structural and functional outcomes of treatment with ciliary neurotrophic factor (CNTF) for patients with type 2 macular telangiectasia (MacTel). METHODS: Studies were retrieved from inception to May 2024 from Medline, Embase and Cochrane Library databases. The primary outcome was final best-corrected visual acuity (BCVA) and changes in BCVA from baseline, while ellipsoid zone (EZ) discontinuity area was a secondary outcome. Risk of bias for observational studies and randomized clinical trials (RCT) were assessed using the ROBINS-1 tool and Cochrane ROB2 tools, respectively. RESULTS: Five studies reporting on 498 eyes of 422 patients were included in this systematic review. One RCT of 99 eyes found decreased progression of retinal degeneration and reduced decline in reading speed in implant-treated eyes compared to sham-treated eyes. An uncontrolled phase 1 safety trial involving 14 eyes in 7 MacTel patients undergoing CNTF therapy demonstrated good tolerance, with no significant differences in visual acuity or retinal sensitivity between treated and untreated eyes over 36 months, though five participants experienced persistent miosis in the implanted eye. One study highlighted smaller changes in EZ defect areas in CNTF-treated eyes compared to sham-treated eyes. Recently published data demonstrated significant structural progression slowing, though functional outcomes were variable and safety was comparable to sham aside from increased delayed dark adaptation and miosis. CONCLUSION: CNTF therapy appears to slow retinal degeneration and preserve visual function in MacTel patients. While CNTF shows promise for earlier stages of MacTel, further trials are required to fully assess its long-term efficacy.
PURPOSE: To evaluate whether vascular enhancement processing of ultra-widefield fundus camera (UWFC) images improves the diagnostic performance for proliferative diabetic retinopathy (PDR), including sensitivity, specifi...PURPOSE: To evaluate whether vascular enhancement processing of ultra-widefield fundus camera (UWFC) images improves the diagnostic performance for proliferative diabetic retinopathy (PDR), including sensitivity, specificity, and neovascularization (NV) detection accuracy. METHODS: This retrospective cross-sectional study included 30 eyes of 24 patients with diabetic retinopathy (DR) who underwent UWFC imaging at Kagoshima University Hospital. Two image sets were prepared: original UWFC color images and UWFC images combined with vascular enhancement images generated from green-filtered overlay images using automated filtering techniques, including Gaussian, top-hat, homomorphic filtering, and unsharp masking. Ten ophthalmologists independently assessed both sets to determine NV presence and diagnose PDR. The main outcomes were sensitivity and specificity for PDR diagnosis and accuracy of NV detection, compared between sets using the Wilcoxon signed-rank test (P < 0.05). RESULTS: Sensitivity for diagnosing PDR significantly improved from 83.5% ± 9.7% with UWFC images alone to 90.9% ± 8.4% with the combined set (P = 0.033). Specificity showed no significant difference (70.1% ± 15.3% vs. 66.6% ± 28.2%, P = 0.662). NV detection accuracy improved significantly from 37.9% ± 8.2% to 52.8% ± 9.7% (P < 0.01). CONCLUSIONS: Combining vascular enhancement with UWFC images significantly improves sensitivity for PDR and NV detection accuracy while maintaining specificity, providing a simple, noninvasive, and practical tool for DR screening.
PURPOSE: To compare the effects of balanced salt solution (BSS), air, and perfluoropropane (C3F8) as intraocular tamponade agents on visual acuity and intraocular pressure (IOP) following silicone oil (SO) removal surger...PURPOSE: To compare the effects of balanced salt solution (BSS), air, and perfluoropropane (C3F8) as intraocular tamponade agents on visual acuity and intraocular pressure (IOP) following silicone oil (SO) removal surgery. METHODS: This retrospective study included 60 eyes that underwent 23-gauge SO removal and were assigned to the BSS, air, or 8% C3F8 groups (n = 20 per group). Best-corrected visual acuity (BCVA) and IOP were evaluated postoperatively at day 1, week 1, month 1, and month 3. RESULTS: On postoperative day 1, the BCVA was significantly better in the BSS group than in the air and C3F8 groups (P<0.001). At 1 week, BCVA in the air group improved to a level comparable with that in the BSS group (P=0.225), while the BCVA in C3F8 group remained worse than that in both groups (P<0.001 vs. BSS; P=0.009 vs. air). At 1 and 3 months, BCVA did not differ significantly between the BSS and air groups (P=0.204 vs. 1 month; P=0.168 vs. 3 months) but remained lower in the C3F8 group (all P<0.05). No significant differences in IOP were found between groups at any time point. CONCLUSION: BSS provides the fastest visual recovery after SO removal compared to air and C3F8. It is the optimal choice for improving both short- and long-term visual outcomes while maintaining normal IOP in routine cases.
Shields CL, Medina RJ, Sener H
… +11 more, Zafar A, Warszawski N, Miller EG, Patel OV, Ahmed AM, Lockridge CJ, Makkithaya N, Duffy AO, Attaseth T, Lally SE, Shields JA
PURPOSE: To evaluate ≥15-letter visual acuity loss following plaque radiotherapy of posterior uveal melanoma (PUM) in the pre-anti-vascular endothelial growth factor (anti-VEGF) era. METHODS: We reviewed data on 4000 con...PURPOSE: To evaluate ≥15-letter visual acuity loss following plaque radiotherapy of posterior uveal melanoma (PUM) in the pre-anti-vascular endothelial growth factor (anti-VEGF) era. METHODS: We reviewed data on 4000 consecutive patients managed between 1976 and 2008 regarding patient demographics, tumor features, treatment factors, and ≥15-letter visual acuity loss over time based on tumor size category of small (0-3.0 mm thickness), medium (3.1-8.0 mm) and large (>8.0 mm). RESULTS: Of the 4000 patients, there were small (n=1011 eyes, 25%), medium (n=2445, 61%), and large (n=544, 14%) tumor categories. The PUM touched the optic disc (n=560, 14%) and/or extended under the foveola (n=644, 16%). Comparative analysis (small versus (vs.) medium vs. large PUM) showed small tumor category with demographics of younger age (p<0.01) and greater Caucasian race (p<0.05), presenting features of visual acuity ≥20/40 (p<0.01) and closer proximity to the optic disc (p<0.01) and foveola (p<0.01), and radiation treatment parameters most intense at the foveola (p<0.01). The median radiation dose to the optic disc (3100 vs. 3257 vs. 4336 centiGray [cGy], p<0.01) and the foveola (3964 vs. 3864 vs. 4598 cGy, p<0.01) was noted. Overall, ≥15-letter loss was found in 62% patients at median 16 months. By Kaplan-Meier analysis of all cases, ≥15-letter loss at 1 vs. 2 vs. 3 vs. 5 vs. 10 years was present in 30% vs. 48% vs. 60% vs. 73% vs. 82%. CONCLUSIONS: In the pre-anti-VEGF days, following treatment of PUM with plaque radiotherapy, visual acuity showed ≥15-letter loss in 62% of patients at median 16 months.
PURPOSE: To determine prevalence and incidence trends of diabetic retinal disease (DRD) and its vision-threatening forms over the last 20 years among patients with diabetes mellitus (DM) among US racial and ethnic groups...PURPOSE: To determine prevalence and incidence trends of diabetic retinal disease (DRD) and its vision-threatening forms over the last 20 years among patients with diabetes mellitus (DM) among US racial and ethnic groups. METHODS: A retrospective cohort study of members of commercial and Medicare Advantage health plans between 2000 and 2022 was conducted, with cohorts of White(W), Black/African American(B/AA), Hispanic(H), and Asian(A) DM patients identified using ICD-9/10 codes. Outcomes included annual prevalence and incidence of DRD, diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR). Multivariable logistic and Poisson regression models analyzed trends in prevalence odds ratios and incidence rate ratios, respectively. RESULTS: B/AA patients had higher prevalence rates of DRD every year analyzed compared with White patients (2021 B/AA:23.1%; W:19.0%; p<0.001). Both Hispanic (2001 H:12.3%) and Asian (2001:11.9%) patients initially had lower DRD prevalence than White patients (2001:13.1%; p<0.001 for both); both are now higher with Hispanic patients having the highest rates (2021 H:26.0%; A:21.2%;W:19.0%, p<0.001). DME and PDR prevalence increased across all groups through 2015/2016, then decreased through 2021 (2021 DME:W:4.5%, B/AA:5.9%; H:5.9%, A:4.7%; 2021 PDR:W:2.9%, B/AA:4.3%, H:5.0%, A:2.9%).Since 2009, incidence rates for DRD, DME, and PDR in Hispanic and B/AA patients have been higher than for White patients (IRR=1.08-1.85; p<0.001 for all comparisons). Asian patients initially had higher DRD incidence rates than White patients, but that difference disappeared in 2021 before increasing again in 2022 (2022 IRR=1.07, 95%CI=1.01-1.14). CONCLUSION: Disparities in prevalence and incidence of DRD, DME, and PDR persist for B/AA and have worsened for Hispanic patients.
Parodi MB, Mansour A, Saladino A
… +9 more, Arrigo A, Cicinelli MV, Vilela M, March de Ribot F, Toscani R, Bianco L, Del Fabbro S, Bandello F, Antropoli A
PURPOSE: To investigate peripheral retinal findings in BEST1 -related retinopathies by means of ultra-widefield (UWF) imaging. METHODS: Observational, case-control study. All subjects underwent comprehensive ophthalmolog...PURPOSE: To investigate peripheral retinal findings in BEST1 -related retinopathies by means of ultra-widefield (UWF) imaging. METHODS: Observational, case-control study. All subjects underwent comprehensive ophthalmologic evaluation, including ultrawide-field fundus photography (UWF-FP) and UWF fundus autofluorescence, and selected cases also received UWF OCT. Peripheral retinal changes, including white or dark without pressure and vascular abnormalities, were assessed, and their prevalence was compared with a control group. RESULTS: Seventy-two eyes from 36 patients with BEST1 -related retinopathy (29 with autosomal dominant Best vitelliform macular dystrophy (BVMD), 14 eyes from 7 patients with autosomal recessive bestrophinopathy (ARB), and 78 eyes from 39 control subjects were enrolled. Compared to controls, patients had significantly higher odds of exhibiting peripheral alterations. White without pressure (WWP) and dark without pressure (DWP) were the most frequent findings, especially in ARB, where WWP and DWP were present in 86% of eyes. OCT imaging confirmed EZ reflectivity attenuation in areas of DWP, without signs of vitreous traction. Vascular abnormalities were detected in nearly half of all eyes, with intraretinal microvascular abnormalities (IRMAs) and vessel tortuosity more common in BVMD, and focal narrowing more frequent in ARB. Overall, peripheral changes were evenly distributed across Gass stages in BVMD. CONCLUSIONS: BEST1 -related retinopathies are associated with a spectrum of peripheral retinal changes, particularly retinal reflectance alterations.
Hasan N, Zarnegar A, Nouri H
… +23 more, Saju S, Cao J, Zhou A, Wykoff C, Shah P, Singhanetr P, Rossin EJ, Desideri LF, Hertkorn F, Munk MR, Vujosevic S, Checchin L, Pili L, Parodi MB, Rodriguez-Fernandez CA, Barquet LA, Zhang M, Ashfaq Y, Kroeger Z, Kim M, Wu L, Chhablani J, Macula society International CSCR Research Network-MICRoN
PURPOSE: This study aimed to explore prognostic factors for predicting ellipsoid zone integrity and its association with angiographic leakage and optical coherence tomography biomarkers at baseline. METHODS: In this mult...PURPOSE: This study aimed to explore prognostic factors for predicting ellipsoid zone integrity and its association with angiographic leakage and optical coherence tomography biomarkers at baseline. METHODS: In this multicenter retrospective study, resolved central serous chorioretinopathy (CSCR) eyes with perifoveal angiographic leak at baseline were included. Baseline demographics, clinical features, and anonymized imaging data, including fluorescein angiography, and optical coherence tomography were collected. The leakage site was identified on fluorescein angiography, and its corresponding location on optical coherence tomography was analyzed for structural changes and photoreceptor outer segment elongation. Central macular thickness, subfoveal choroidal thickness, Haller layer thickness, and Haller index (Haller layer thickness/subfoveal choroidal thickness) were measured at baseline and follow-up. Ellipsoid zone (EZ) integrity after resolution was classified as continuous, discontinuous, and atrophic. RESULTS: Eighty four eyes with resolved CSCR were included. Longer symptom duration ( P = 0.032) and complex CSCR ( P = 0.04) were associated with a higher likelihood of atrophic EZ. Significant reductions in central macular thickness, subfoveal choroidal thickness, and Haller layer thickness were observed in all groups, whereas the Haller index significantly reduced only in continuous EZ. Multinominal regression showed significant association between complex CSCR and atrophic EZ. CONCLUSION: Longer symptom duration, complex CSCR, and irregular photoreceptor outer segment thickening are associated with increased risk of EZ atrophy in resolved CSCR. Identifying these risk factors early may help predict visual outcomes and guide patient counselling.