Teck Boon Tew

Purpose: This study aims to compare baseline characteristics and treatment outcomes of Type 1 and Type 2 myopic choroidal neovascularization (CNV) after 1 year of antivascular endothelial growth factors therapy and identify clinical factors associated with visual outcomes, recurrence rates, and injection numbers. Methods: In this retrospective study, we reviewed 171 patients with active myopic CNV treated with antivascular endothelial growth factors therapy and followed for at least 1 year. CNV types were classified using optical coherence tomography. Baseline characteristics, including best-corrected visual acuity, myopic maculopathy grade, and optical coherence tomography findings, were compared. Results: Type 1 CNVs (19.3% of cases) exhibited worse baseline best-corrected visual acuity and more advanced macular degeneration than Type 2 CNVs. Both types showed significant visual improvement equivalent to 2.2 lines post-therapy, with no difference in recurrence rates or injection numbers. Multivariate analysis revealed that baseline best-corrected visual acuity, severity of myopic macular degeneration, and presence of subretinal hyperreflective exudation were significant predictors of final best-corrected visual acuity, while CNV type was not an independent predictor. Conclusion: Despite more severe macular degeneration in Type 1 CNV, both types myopic CNVs benefit significantly from antivascular endothelial growth factors therapy. These findings support extending treatment to Type 1 CNVs and highlight the need for individualized management strategies.

PURPOSE: The purpose of the study was to evaluate macular microvascular alterations using optical coherence tomography angiography (OCTA) in typical retinitis pigmentosa (RP) patients with and without isolated macular lesions, and to assess their relationship with best-corrected visual acuity (BCVA). MATERIALS AND METHODS: This retrospective study included 77 patients with typical RP from the Taiwan Inherited Retinal Degeneration Project, categorized into two groups: with isolated macular lesions (T+M, n = 44) and without (T, n = 33). Eighteen age-matched healthy individuals served as controls. All participants underwent comprehensive ophthalmic examinations and OCTA imaging. Quantitative parameters–vessel density in superficial and deep retinal plexuses, foveal avascular zone (FAZ) area, and outer retinal flow–were analyzed and correlated with BCVA. RESULTS: Both RP groups showed compromised macular microcirculation compared to controls. FAZ area was significantly larger in the T+M group than in controls (P = 0.01) and showed a trend toward enlargement compared to the T group (P = 0.06). BCVA was significantly worse in the T+M group than in the T group and controls (P = 0.002). In the T+M group, decreased vessel density in the deep plexus, enlarged FAZ, and reduced outer retinal flow were significantly correlated with poorer vision; these correlations were not observed in the T group. CONCLUSION: Macular microvascular impairment is a common feature in typical RP, but its association with central visual loss is particularly pronounced in those with isolated macular lesions. OCTA parameters may serve as useful biomarkers for clinical monitoring and prognosis in this subgroup.

Optic neuritis, inflammation of the optic nerve, can cause visual impairment through retinal nerve fiber layer (RNFL) degeneration. Optical coherence tomography could serve as a sensitive noninvasive tool for measuring RNFL thickness and evaluating the neuroprotective effects of treatment. We conducted a meta-analysis to compare RNFL loss between novel add-on treatments and corticosteroid therapy at least 3 months after acute optic neuritis. The outcome measures were mean differences (MDs) in (1) RNFL thickness compared with the baseline in the affected and unaffected eye and (2) LogMAR visual acuity (VA). Seven studies involving five novel agents (memantine, erythropoietin, interferon-beta, phenytoin, and clemastine) were analyzed. When compared with the baseline RNFL thickness of the affected eye, the neuroprotective effects of novel add-on treatments could not be demonstrated. The difference in visual outcomes was also not significant between the two treatment groups. One study revealed that phenytoin has the potential to alleviate RNFL loss when the baseline thickness of the unaffected eye is considered. Larger randomized controlled trials with suitable outcome measures are warranted to evaluate the neuroprotective effects of novel treatments. Further studies should also tailor therapies to specific patient populations and investigate a more targeted treatment for acute optic neuritis.

Importance: The clinical implications of different morphologies of choroidal neovascularization (CNV), as evaluated by ocular coherence tomography angiography (OCTA) in neovascular age‐related macular degeneration (nAMD), are lacking.Background: To describe the morphology of CNV in nAMD using OCTA, and to compare the visual prognosis and other structural OCT biomarkers between different morphologic patterns.Design: Retrospective cohort study.Participants: One hundred and forty eyes with nAMD treated with anti‐vascular endothelial growth factor (VEGF).Methods: Patients were examined using OCTA prior to and at 3, 6 and 12 months after receiving anti‐VEGF therapy.Main Outcome Measures: Best‐corrected visual acuity (BCVA) and morphologic retinal features.Results: Organized CNV was identified in 110/140 eyes (78.6%) using OCTA. These CNV complexes could be divided into three OCTA patterns: the ‘medusa’ pattern (n = 41), characterized by branching vessels radiating in all directions; the ‘seafan’ pattern (n = 43), characterized by branching vessels radiating to one side of the lesion; and the ‘tangled’ pattern (n = 26), characterized by globular entwined vessels without a main trunk. At baseline, the eyes with the tangled pattern were from younger patients (P = .031) with better BCVA (P = .007). There were also fewer intraretinal cysts (P = .021), less fibrovascular pigment epithelial detachment (P = .009), and more pachychoroid (P = .007) in eyes with the tangled pattern on OCT. At 12 months post‐treatment, patients with the tangled CNV pattern also showed greater visual improvement than patients with the other two patterns (P = .049).Conclusions and Relevance: Using OCTA, distinct morphologies of CNV in nAMD patients were identified. These different patterns might be useful predictors for the prognosis of nAMD patients after anti‐VEGF therapy.