NIU incidence and prevalence were higher in adults than in children, and in populations with specific conditions like JIA and AS.

Purpose: To determine the long-term functional and structural outcomes of intravitreal anti-VEGF therapy for macular neovascularization (MNV) in PRPH2-associated retinopathy. Methods: Multicenter retrospective case series including patients with molecularly confirmed PRPH2-associated retinopathy complicated by unilateral MNV. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were selected as outcome measures and compared between eyes with MNV undergoing anti-VEGF therapy and fellow eyes. Results: Six patients affected by PRPH2-associated retinopathy developed MNV at a median age of 55 years (range, 34 to 71). Two novel PRPH2 variants were found [c.499del p.(Cys150Phefs*3) and c.660dup p.(Pro221Alafs*80)]. In all patients, the phenotype was characterized by a pattern dystrophy with multifocal flecks. At baseline, eyes with MNV had a median BCVA (logMAR) of 0.2 (range, 0.2 to 0.7), corresponding to 20/32 Snellen, while the median CST was 320 µm (range, 228 to 362). After a median follow-up of 6.2 years and 5.5 injections per patient, 5 eyes (83%) retained a BCVA of at least 20/32 Snellen, while CST decreased by a median of −69 µm (range, −117 to +15). No additional CST thinning was observed in eyes with MNV compared with their fellow eyes. In 4 eyes (67%), OCT angiography revealed large neovascular networks growing below the retinal pigment epithelium that persisted after resolution of exudation. Conclusion: A favorable long-term outcome can be obtained in PRPH2-associated retinopathy complicated by MNV when timely intravitreal anti-VEGF therapy is administered. Further research is needed to understand the significance of subretinal pigment epithelium neovascular networks.

Purpose: To provide a comprehensive overview of quantitative adaptive optics imaging (AOI) photoreceptor parameters in retinitis pigmentosa (RP). Methods: A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library from January 2000 to June 2023 for articles reporting on quantitative photoreceptor measurements from AOI systems in RP. Our primary outcomes were cone density, regularity, and spacing measurements at various eccentricities. Results: Twenty-six studies reporting on 299 eyes with various forms of RP that underwent AOI were included. Seventeen studies reported on cone density parameters in RP, which mostly decreased with increasing eccentricity from the fovea and were reduced in RP eyes relative to normal control eyes. Four studies reported on cone regularity in RP, which was reduced relative to normal control eyes. Twelve studies reported on cone spacing parameters in RP, which were often increased relative to normal control eyes. Conclusion: RP eyes showed a reduced cone density, reduced cone regularity, and increased cone spacing relative to control eyes. There is considerable variability in the reporting of AOI parameters in this setting, a paucity of data comparing AOI parameters in RP eyes with age-matched controls, and best practices of AOI use have yet to be established.

Purpose: This study evaluated outcomes and foveal morphological changes following human amniotic membrane transplantation (hAMT) in complex macular holes. Methods: A multicenter, retrospective analysis was conducted on 30 eyes that underwent vitrectomy with hAMT for indications including failed prior macular hole closure, macular hole-associated retinal detachment in high myopia (axial length >28mm), giant macular holes (>1000µm), and large macular holes (≥400µm) unsuitable for internal limiting membrane flaps (ILM). Postoperative assessments included closure rates, visual outcomes, and foveal structural changes on optical coherence tomography (OCT) at 1, 3, and 6 months. Results: Macular hole closure with retinal tissue reconstitution was observed in 73.3% of eyes at 1 month, whereas 23.3% showed foveolar dehiscence with exposed hAM in the subretinal space. Visual acuity improved from logMAR 1.22 (20/320) to 0.99 (20/200) at 1 month (P= 0.026), 0.98 at 3 months (P=0.013), and 0.97 at 6 months (P=0.013). The bare hAM area decreased over time in eyes with foveolar dehiscence (P=0.016), and retinal tissue reconstitution was observed in three of these cases. A larger preoperative minimal linear diameter was significantly associated with this pattern (P=0.033). Conclusion: hAMT demonstrated favorable outcomes in complex macular holes, supporting its potential role in the anatomical restoration.

To evaluate the differences in choroidal vascularity index (CVI) measurements between images acquired at the 1:1 pixel scale and at the 1:1 µ m scale of the Heidelberg optical coherence tomography device. Forty-five healthy eyes of 45 healthy subjects were included for this study. Fovea-centered scans were obtained with an enhanced-depth imaging mode with a high-speed protocol scan. Each scan was exported in 3 different types: 1) 1:1 pixel scale type; 2) 1:1 µ m scale type (MST); and 3) 4×-magnified MST (4×MST; 400%-magnified 1:1 µ m images exported via screenshot). A comparison between CVI measurements based on the different scale types of optical coherence tomography images was conducted using the Bland-Altman analysis and intraclass correlation coefficient. The image with the worst clarity was acquired via the MST, and the CVI was found to be higher in MST images (69.05 ± 3.21) compared with the other groups. The intraclass correlation coefficient between the CVI values of the 4×MST and pixel scale type images was 0.92, between those of the 4×MST and MST images was 0.33, and between those of the pixel scale type and MST images was 0.44. The optical coherence tomography scale and export method type significantly influence the image resolution, CVI, and choroidal area measurements.

To describe and report the anatomical and functional outcomes of a novel sutureless peripheral intravascular catheter (PIVC)-assisted scleral fixation of three-piece IOL. A retrospective chart review of all patients who underwent scleral fixation surgery performed by a single surgeon was conducted. In all cases, a novel scleral fixation technique of three-piece IOL was performed with the aid of a 24-gauge PIVC cannula. Patients were followed up at postoperative months 1, 3, and 6. Thirteen eyes of 12 patients were included in the analysis. Preoperatively, mean best-corrected visual acuity was 1.26 ± 0.82 LogMar (20/364 Snellen Equivalent), and it improved significantly at all follow-up endpoints being of 0.52 ± 0.25 LogMar at 1 month (20/66 Snellen Equivalent, P = 0.02), 0.4 ± 0.22 LogMar at 3 months (20/50 Snellen Equivalent, P = 0.007) and 0.37 ± 0.2 LogMar (20/47 Snellen Equivalent, P = 0.008) at 6 months postoperatively. No serious intraoperative or postoperative complications were registered. Postoperatively, there were no cases of conjunctival erosions. Over the follow-up period, in all the included cases, the IOL remained centered and stable. The PIVC-assisted scleral fixation technique may be a safe and reliable surgical option for secondary IOL placement in cases of insufficient capsular support.

To evaluate the efficiency and safety of using an intraocular foreign body forceps with two nitinol loops at its tip to capture and chop dropped nucleus (DN) during vitrectomy as an alternative method and to evaluate the outcomes and complications of this surgical technique. The eyes that underwent 23-gauge vitrectomy with removal of DN using nitinol forceps with a minimum follow-up time of 1 year are included in this study. The efficiency of surgical technique and anatomical and functional results with complications is recorded. Nine patients with a mean age of 73.11 ± 2.15 years were included in this study. The mean time between DN and vitrectomy was 7.67 ± 3.74 (5-14) days. In all eyes, DN was easily chopped and removed with aspiration. Argon laser photocoagulation was performed in 4 eyes (44.44%) during surgery. All eyes were followed up for a mean time of 21.11 ± 12.36 (12-48) months. The mean preoperative best-corrected visual acuity increased significantly during the postoperative follow-up ( P < 0.001). No complications related to the cataract surgery or DN removal were observed. Surgical removal of DN with the help of these forceps with nitinol loops is found to be safe and effective in this study. This method avoids ultrasonographic energy and enables 23-gauge vitrectomy without a fragmatome.

To describe the clinical and imaging features of sarcoid granuloma of the choroid and ciliary body. Retrospective case series of patients with choroid and/or ciliary body sarcoid granuloma managed at the Ocular Oncology Service at Wills Eye Hospital. The mean patient age at diagnosis was 51.0 years (54.1, 11.0-83.8 years). The mean logMAR visual acuity at presentation was 0.3 (0.2, 0.0-3.0) [Snellen equivalent 20/40 (20/30, HM-20/20)]. Clinical features included mean basal dimension of 5.2 mm (4.0, 0.3-20.0 mm) and thickness of 1.7 mm (1.8, 0.0-3.6 mm), yellow color (41, 82%), multifocality (18, 36%), and irregular vermiform margins (46, 92%). Related clinical features included inflammation of the anterior chamber (1, 2%), vitreous (5, 10%), and retina (5, 10%). Imaging features by optical coherence tomography of the choroid lesions (n = 49) demonstrated clear subretinal fluid (6, 12%), "dirty" subretinal fluid (14, 28%), cystoid macular edema (1, 2%), overlying retinal edema (6, 12%), and localized vitreous cellularity (1, 2%). Management included sub-Tenon's triamcinolone (11, 22%), intravitreal triamcinolone (3, 6%), systemic corticosteroids (19, 38%), or observation (26, 52%). Systemic sarcoidosis was present before ocular diagnosis (13, 26%), detected during ophthalmic care (4, 8%), detected after ocular diagnosis (3, 6%), or not found (30, 60%) over a mean follow-up of 13.7 months (6.9, 0.0-138.2). Sarcoid granuloma of the choroid and/or ciliary body can manifest without anterior segment or vitreous/retina inflammation in many cases and reveal underlying systemic sarcoidosis in 40% of cases. A distinguishing feature of choroidal sarcoid granuloma was its vermiform margin.

To assess the characteristics of completed panretinal photocoagulation (PRP), using ultra-widefield imaging in proliferative diabetic retinopathy. Quantitative assessment of ultra-widefield imaging images of 133 patients with proliferative diabetic retinopathy with completed PRP was made using ImageJ software. The parameters assessed included distance of laser spots from the optic disk, foveal center, superior and inferior arcades, and extent of the maximum width of laser. Areas assessed were total area of the image, area of the inner limit within which laser spots are restricted, minimum areas of unlasered patches, total area lasered, and ideal area to be covered by PRP. Two hundred one images were assessed for the final analysis. The mean distance of laser spots was 4.2 ± 2.4 mm from the optic disk (nasal) and 6.6 ± 2.5 mm from the foveal center (temporal). The mean distance of laser spots from the superior arcade vessel was 3.2 ± 1.9 mm and 6.2 ± 4.4 mm from the inferior arcade. The mean area of the retina that should have been ideally lasered was found to be 900 ± 267 mm 2 , and the actual area lasered was found to be 681 ± 254.4 mm 2 . Approximately one-quarter area of the retina continues to remain ischemic because of the lack of inadequate coverage of PRP. Further longitudinal studies are recommended, using ultra-widefield imaging to objectively assess the adequacy of PRP and its role in modulating the course of progression of the retinopathy.

To study the status of retinal pigment epithelium in nonexudative and active choroidal neovascularization (CNV) in neovascular age-related macular degeneration. Only treatment-naïve neovascular age-related macular degeneration patients were enrolled in this prospective case-control study, including 17 eyes with nonexudative CNV (6 males and 11 females, 74.9 ± 10.0 years) and 28 eyes with active CNV (8 males and 20 females, 69.3 ± 6.8 years). All patients received a comprehensive ophthalmic examination, optical coherence tomography, dark-field scanning laser ophthalmoscopy, and fundus autofluorescence. The status of the retinal pigment epithelium was assessed with ImageJ software as the brightness of the CNV region on transillumination optical coherence tomography, dark-field scanning laser ophthalmoscopy, and fundus autofluorescence images. Choroidal neovascularization vessel density was measured based on optical coherence tomography angiography. The brightness of CNV region in nonexudative CNV was statistically significantly lower than in active CNV with both optical coherence tomography transillumination ( P = 0.004) and dark-field scanning laser ophthalmoscopy ( P = 0.0015). No difference in brightness of the CNV region between nonexudative and active CNV was found based on fundus autofluorescence ( P = 0.44). The vessel density of nonexudative CNV was statistically significantly higher than that of active CNV with a median value of 64.5% (95% confidential interval [CI] 53.4-79.0%) and 55.3% (95% CI 52.2-60.0%), respectively ( P = 0.05). Multimodal imaging revealed substantial alteration of the retinal pigment epithelium in active CNV but not in nonexudative CNV which correlates with the higher vessel density of nonexudative CNV.