Ahmad M. Mansour

Purpose: To evaluate the acute anatomical changes of Bruch’s membrane opening (BMO) and optic nerve head (ONH) pit depth in patients receiving 0.05cc of anti-VEGF intravitreal injections (IVIs). Methods: We prospectively enrolled patients receiving IVIs and collected data including age, sex, race, phakic status, presence or absence of glaucoma, injection agent utilized, axial length, and cup-to-disc ratio (C/D). High-resolution spectral domain OCT imaging and measurements were made pre- and within five minutes post-IVI. Results: Fifty-one eyes of 51 patients were included in the study. 35.29% of patients were male. The mean age at the time of IVI was 78.27 ± 11.17 years. The average change in the pit depth after IVI was 31.57 ± 24.36 μm (p < 0.001). The number of IVIs previously received significantly correlated with a decreased change in pit depth post-injection (r = − 0.369, p = 0.004). No significant relationship was identified between categorical or continuous variables and the change in pit depth or BMO after IVI. No significant associations were identified between the magnitude of IOP elevation and the change in pit depth post-IVI (r = 0.03, p = 0.834) or the number of previous IVIs (r = 0.005, p = 0.973). Conclusion: IVI was associated with a modest increase in ONH pit depth. The number of prior injections inversely correlated with this change, suggesting a potential cumulative effect on structural response. Given the link between ONH biomechanics and retinal nerve fiber layer (RNFL) thinning, our findings raise the possibility that repeated IVIs may contribute to structural changes relevant to glaucomatous progression.

Purpose: To describe an alternate delivery of high-dose aflibercept using previous formulations (ie, prefilled syringe, vial, or compounded). Methods: A prospective pilot study was performed to analyze the short-term safety and visual gain (expressed in logMAR), including increase in intraocular pressure (IOP), resulting from a modified regimen consisting of 0.18 mL paracentesis followed by an intravitreal injection of 0.18 mL aflibercept (prefilled syringe), 0.20 mL aflibercept (vial), or 0.22 mL ziv-aflibercept (compounded). Results: The study comprised 32 eyes (16 naïve; 18 neovascular age-related macular degeneration; 8 retinal vein occlusion). Over a follow-up of 4.1 (± 3.2) months, a mean (± SD) of 1.7 (± 0.9) high-dose injections were administered. The baseline best spectacle-corrected vision was 1.35 ± 0.71 (Snellen VA) and improved to 0.68 ± 0.46 at 1 month ( P < .001) and 0.57 ± 0.43 at the final follow-up ( P < .001). An increase in IOP of 0.43 ± 4.26 mm Hg was seen 1 minute after injection ( P = .58). In 2 eyes (6.3%), reflux as a tiny bleb was noted. Conclusions: When high-dose aflibercept is neither available nor affordable, a patient’s readily accessible and cost-effective regimen of aflibercept will allow an exact delivery of high-dose aflibercept, combining minimal drug reflux, minimal immediate increase in IOP, and potential clinical efficacy in the short term.

Objective: To explore the relationship between subfoveal choroidal thickness (SFCT) and persistent subretinal fluid (pSRF) at the macula after successful rhegmatogenous retinal detachment (RRD) surgery. Methods: This is a retrospective multicenter comparative study of Caucasian subjects with successful RRD repair. SFCT was measured in 2 groups: Group 1 with persistent subretinal fluid (pSRF) 1 month after repair, and Group 2 with absence of pSRF. SFCT was measured by a masked observer based on ImageJ. Multiple regression analyses were implemented to control for age, refraction, and gender. Results: Surgery type was as follows: Group 1 (24 scleral buckle SB, 23 pars plana vitrectomy PPV, 9 SB+PPV, and 5 pneumoretinopexy), and Group 2 (68 PPV). Adjusted mean 1-month SFCT was thicker in Group 1 than in Group 2 by 41.0 μm (p = 0.049). Within Group 1, PPV subgroup tended to have thinner SFCT than the other subgroups by: SB (117.4 μm), SB-PPV (9.3) and pneumoretinopexy (1.2 μm) (all p> 0.05). SFCT at 1-month was not different between pSRF (237.5± 77.2 μm) and no pSRF (213.7± 72.1 μm) in PPV groups (p=0.2). Conclusion: SFCT post PPV appeared similar in eyes with or without pSRF. In eyes with pSRF, SFCT tended to be thicker following SB compared to PPV. Plain Lanugage Summary: What was known before:Persistent subretinal fluid one month after successful retinal detachment surgery is associated with a thicker choroid and pachychoroid. What this study adds:Persisting subretinal fluid one month after successful retinal detachment repair by pars plana vitrectomy is not influenced by the subfoveal choroidal thickness.Scleral buckle leads to increased subfoveal choroidal thickness due to compression of the choroid.

Purpose: When branch retinal artery occlusion is linked to prepapillary artery loop, is a systemic work-up necessary? Methods: Case Report and literature review. The databases searched were MEDLINE OVID, Scopus, Web of Science, and Embase. The search was for all relevant articles published from inception until October 31, 2024. Results: A total of 33 cases of prepapillary artery loop with retinal artery occlusion were reviewed. Median age at diagnosis was 24 years (range 10– 64). Twenty five cases had no systemic disease while 9 had unrelated systemic disorder. Systemic workup was carried in 17 cases and was negative. The location of the branch retinal artery occlusion was inferior in 21 cases, superior in 6 cases, and combined superior and inferior in 2 cases. Paracentral acute middle maculopathy was noted in 2 cases. Precipitating factors included exercise in 4 cases, head trauma in 2 cases, blunt ocular trauma, severe sneezing, ocular rubbing and sun exposure in 1 case each. Conclusion: A branch retinal artery occlusion linked to a prepapillary loop appears as a distinct ocular condition in young healthy individuals. There is no definite need for additional diagnostic testing in such patients with a negative systemic history.

Purpose To detect choroidal markers of disease activity in eyes with chronic active unilateral pachychoroid disease spectrum (PDS) compared to the non-active contralateral eyes, based on multimodal imaging and particularly indocyanine green angiography (ICGA). Methods An observational retrospective case-control study. The study evaluated individuals diagnosed with chronic active unilateral PDS (group 1) by comparing the eyes with the non-active fellow eyes (group 2). Imaging was performed using fundus photographs, ICGA, and spectral-domain optical coherence tomography (SD-OCT). Choroidal thickness, choroidal vascular density, choroidal vasodilation, choroidal vascular leakage, and choroidal meridian breakdown were evaluated. Results Of the 90 patients with chronic PDS with ICGA at our database, 27 Caucasians (mean age: 55.9 years) were identified with active unilateral PDS. Group 1 showed a higher prevalence of the following parameters compared to Group 2: choroidal meridian breakdown (81.5% vs. 25.9%; p < 0.001), choroidal vasodilation (88.9% vs. 48.1%; p < 0.001), greater subfoveal choroidal thickness (420 ± 79.8 μm vs. 346 ± 78.5 μm; p = 0.002), ICGA choroidal vascular leakage (96.3% vs. 29.6%; p < 0.001), and choroidal hyperpermeability (100% vs. 29.6%; p < 0.001), with a nonsignificant increase in choroidal vascular density (55.4%±13.4 vs. 49.3%±13.5 in the contralateral eye; p = 0.167). Conclusion Choroidal meridian breakdown, thicker choroid, choroidal vasodilation, and ICGA choroidal vascular leakage are potential posterior choroidal markers of disease activity in PDS.