Detection of macular ganglion cell complex loss and correlation with choroidal thickness in chronic and recurrent central serous chorioretinopathy

AIM:To investigate the association of ganglion cell complex thickness(GCCt),global loss volume percentage(GLV%),and focal loss volume percentage(FLV%)with structural and functional findings among patients with chronic central serous chorioretinopathy(CCSC)and recurrent central serous chorioretinopathy(RCSC)by optical coherence tomography(OCT).METHODS:Among 29 patients with monocular affected central serous chorioretinopathy(CSC),15 had CCSC,and 14 had RCSC.The GCCt,FLV%,GLV%,and subfoveal choroidal thickness(SFCT)and sublesional choroidal thickness(SLCT)values were determined using OCT,and the association of these characteristics with neural structure parameters,choroidal morphology,features and functional alterations were estimated for the CCSC and RCSC patients.RESULTS:In CCSC,the affected eyes had significantly lower GCCt values than the fellow eyes in the macular regions(all P<0.05),with the highest GCCt observed in the inferior area.A significant association was found between the GCCt in different regions and the change in best corrected visual acuity(BCVA;r=-0.696;-0.695;-0.694,P<0.05)in CCSC patients.A statistically significant moderate negative correlation indicated that long-term CCSC was associated with greater differences in the GCCt in different regions between affected and fellow eyes(r=-0.562;r=-0.556;r=0.525,P<0.05).Additionally,observation of thickened SFCT was associated with a worse FLV%(r=0.599;r=0.546,P<0.05)in both groups.Similarly,thickened SLCT was associated with FLV%in RCSC patients(r=0.544,P<0.05).CONCLUSION:The distribution and GCCt are associated with the duration and visual outcomes of CCSC,whereas there is no correlation among RCSC patients.FLV%may be instrumental in differentiating the various outer choroidal vessels(pachyvessels)in long-term CSC.These results suggest that neural structure parameters may aid in estimating and predicting the recovery of altered morphology and function in CCSC and RCSC patients.

Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion

AIM：To investigate the predictive factors for shortterm effects of intravitreal bevacizumab injections on central subfield foveal thickness（CSFT）in patients with macular edema（ME）secondary to central retinal vein occlusion（CRVO）.·METHODS：This was a retrospective study in 60 eyes treated with intravitreal bevacizumab injections for ME due to CRVO.Follow-up was three months.The Early Treatment Diabetic Retinopathy Study（ETDRS）score and CSFT measured by spectral-domain optical coherence tomography（SD-OCT）were used to observe the changes in best-corrected visual acuity（BCVA）.Baseline BCVA,CSFT,age,CRVO duration and the presence of cystoid macular edema（CME）or subretinal fluid（SRF）were analyzed as potential predictive factors of the effects of intravitreal bevacizumab injections.·R ESULTS：BCVA improved from 0.9 log MAR at baseline to 0.6 log MAR at 3mo,which was associated with a significant reduction in CSFT from 721μm to 392μm 3mo after injection.About 50%of CME cases and more than90%of SRF cases responded to treatment with a complete resolution at 3mo.Age（=0.036）and low baseline CSFT（=0.037）were associated with a good 3-month prognosis.Patients〉60 years old achieved better CME resolution（=0.031）and lower CSFT at 3mo（305μm 474μm,=0.003）.·CONCLUSION：Intravitreal bevacizumab significantly improved visual acuity and CSFT in patients with CRVO after 3mo.Older age and lower baseline CSFT were good predictors of short-term CSFT outcomes.The retinal thickness response to bevacizumab might depend on the resolution of CME rather than SRF.

Comparison of central macular thickness between two spectral-domain optical coherence tomography in elderly non-mydriatic eyes

AIM: To compare central macular thickness (CMT) measurements obtained by two spectral-domain optical coherence tomography (SD-OCT) exams, and to evaluate measurement reproducibility and agreement between these two exams, and to investigate the relationship between CMT and possible influencing factors such as age, sex, eye (OD/OS), and operators in elderly non-mydriatic eyes. METHODS: Seventy-two normal subjects were included. Every subject underwent CMT measurement twice using one of two SD-OCT (OSE-2000, Moptim, Shenzhen, China & 3-D OCT-1000, Topcon, Tokyo, Japan) instruments respectively where we randomly chose one eye in each patient for the test; these exams were performed by two operators over an hour period with a brief rest between sessions. Comparison of the OSE-2000 and 3-D OCT-1000 CMT measurements was based on paired- t test The mean difference between the CMT measurements was calculated. General linear model analyzed the relationships among eye (OD/OS), operator, sex, and CMT values using age as co-variant. All tests were considered statistically significant at P <0.05. The main outcome measures included CMT. RESULTS: When evaluated with general linear model analysis, CMT measurements were found to have high reproducibility across the two instruments between the two operators for the OSE-2000 single line scan and 3-D OCT-1000 macular scans (P=0.731; P=0.443). There was statistically significant difference in CMT values between the two instruments (P<0.001) and the mean difference was -46.83 mu m at 95% confidence limits (-49.15,-44.51). Age was positively correlated with CMT (beta coefficient =0.516, P=0.001; beta coefficient=0.453, P =0.009) and sex was correlated with CMT from the OSE-2000 (P=0.021) but not with the 3-D OCT-1000 (P=0.056). According to the actual thickness measurements, the CMT of the male was thicker than the female's but there was no statistical difference. There was interaction between sex and eye in OSE-2000 and not in 3-D OCT-1000 (P=0.02; P =0.374). No significant correlation was found between CMT and the influencing factor of eye in both of the instruments (P=0.884; P=0.492). CONCLUSION: Reproducibility of CMT measurement using the two SD-OCTs is excellent in normal eyes according to the operator factor analysis. OSE-2000 has a different posterior retinal boundary of CMT measurement, which results in the CMT value differences, compared with the 3-D OCT-1000. Age is positively correlated with CMT measurement while sex is correlated with CMT in the OSE-2000 but not in the 3-D OCT-1000 and eye (OD/OS) had no correlation with CMT values. Mydriatic drops may not be necessary for CMT measurement using high scan rate SD-OCT in normal eyes in dark room.

Using choroidal thickness to detect myopic macular degeneration

AIM:To explore the usage of choroidal thickness measured by swept-source optical coherence tomography(SS-OCT)to detect myopic macular degeneration(MMD)in high myopic participants.METHODS:Participants with bilateral high myopia(≤−6 diopters)were recruited from a subset of the Guangzhou Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study.SS-OCT was performed to determine the choroidal thickness,and myopic maculopathy was graded by the International Meta-Analysis for Pathologic Myopia(META-PM)Classification.Presence of MMD was defined as META-PM category 2 or above.RESULTS:A total of 568 right eyes were included for analysis.Eyes with MMD(n=106,18.7%)were found to have older age,longer axial lengths(AL),higher myopic spherical equivalents(SE),and reduced choroidal thickness in each Early Treatment Diabetic Retinopathy Study(ETDRS)grid sector(P<0.001).The area under the receiver operating characteristic(ROC)curves(AUC)for subfoveal choroidal thickness(0.907)was greater than that of the model,including age,AL,and SE at 0.6249,0.8208,and 0.8205,respectively.The choroidal thickness of the inner and outer nasal sectors was the most accurate indicator of MMD(AUC of 0.928 and 0.923,respectively).An outer nasal sector choroidal thickness of less than 74μm demonstrated the highest odds of predicting MMD(OR=33.8).CONCLUSION:Choroidal thickness detects the presence of MMD with high agreement,particularly of the inner and outer nasal sectors of the posterior pole,which appears to be a biometric parameter more precise than age,AL,or SE.

Comment on “Correlation between macular ganglion cell-inner plexiform layer thickness and visual acuity after resolution of the macular edema secondary to centralretinal vein occlusion”

Dear Editor,We would like to address several issues with the study of Kim et a". The study was retrospectively conducted with the existence of a selection bias attributable to inclusion of 2 completely different etiologic subgroups of patients with nonischemic central retinal vein occlusion (CRVO), namely, patients older than 50y, who usually have common systemic conditions such as hypertension and diabetes;and patients younger than 50y, in whom other mechanisms, such as the hyperviscosity syndrome or inflammatory condition, should be specifically considered.

Identification of retinal thickness and blood flow in agerelated macular degeneration with reticular pseudodrusen

AIM:To investigate thickness characteristics and vascular plexuses in retinas with reticular pseudodrusen(RPD)as an early detection strategy for age-related macular degeneration(AMD).METHODS:This retrospective study included 24 subjects(33 eyes)with RPD and 25 heathy control subjects(34 eyes).The superficial capillary plexus(SCP)and the deep capillary plexus(DCP)of the retinal posterior poles were investigated with optical coherence tomography angiography(OCTA).Retinal thicknesses and vessel densities were analyzed statistically.RESULTS:The general retinal thicknesses of RPD eyes were significantly decreased(95%CI-14.080,-0.655;P=0.032).The vessel densities of DCP in RPD eyes were significantly increased in the global(95%CI 1.067,7.312;P=0.027),parafoveal(95%CI 0.417,5.241;P=0.022),and perifoveal(95%CI 0.181,6.842;P=0.039)quadrants.However,the vessel densities of the SCP were rarely increased in the eyes with RPD.CONCLUSION:The thinning of retinas in the RPD group suggests a reduction in the number of cells.Additionally,the increased vessel density of the DCP in retinas with RPD indicates a greater demand for blood supply,possibly due to the hypoxia induced RPD compensation caused by RPD in the outer retina.This study highlights the pathological risks associated with RPD and emphasizes the importance of early intervention to retard the progression of AMD.

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO(non-iCRVO group,n=15)and ischemic CRVO(iCRVO group,n=12).The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab,followed by reinjections as needed or PRN.Retinal laser photocoagulation or intravitreal dexamethasone implants(DEX)were implemented in both groups when necessary.The best-corrected visual acuity(BCVA,logMAR)and central retinal thickness(CRT)were recorded at baseline,at 1,2,3,4,5,6,and 12mo,and at the final visit.The efficacy rates of BCVA and CRT before and after treatment were calculated.The number of injections at each visit and the incidence of adverse events were also recorded.RESULTS:The patients,aged 59.4±15.1y,were followed up for 24.7±8.8mo(range:15-42mo).After treatment,BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR(P=0.038)at the final visit in all patients.Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points,but there was no statistical significance(P=0.197 and 0.33,respectively).The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups(all P<0.001).The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection,48.15%for BCVA and 62.96% for CRT after 5 consecutive injections,and 74.08% for BCVA and 100% for CRT at the end of follow up.The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups(P>0.05).Laser treatment was applied to all eyes in the iCRVO group,while only 5 patients in the noniCRVO group.Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch.DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group.CONCLUSION:The 5+PRN anti-vascular endothelial growth factor(VEGF)regimen is found to be safe and effective for both iCRVO and non-iCRVO,especially in the iCRVO group.The best regimen for such patients needs to be further investigated.Adjuvant laser therapy and DEX are necessary in some cases.

The Mean Central Cornea Thickness and Associated Factors among Adult Patients Attending Mulago Hospital Eye Clinic Kampala, Uganda

Background: The mean central corneal thickness (CCT) values are known to have an influence on intraocular pressure measurement and vary widely with age, sex and ethnicity. Little is known about the pattern of CCT in central Uganda. Aim: To determine the mean central corneal thickness and its associated factors among adult patients attending Mulago Hospital eye clinic, Kampala Uganda. Design and Method: A cross sectional study was done from August to October 2016 on 270 adult patients selected by systemic random sampling. The study included all adult patients who attended the eye clinic during the study period and consented to the study excluding those who had conditions causing abnormal thinning, thickening or irregularity of the cornea. The participants were evaluated by history taking and ocular examination including visual acuity assessment, slit lamp examination, central cornea thickness measurement, intraocular pressure measurement and funduscopy. Data were collected using a pretested questionnaire, entered using Epidata and analyzed by STATA11.0. Results: Of the 270 patients examined, 61% were female, 39% male, the mean age being 42 years ranging from 18 to 96 years. The mean central corneal thickness for both eyes was 539.3 (SD ± 41.65 μm) ranging from 332 μm to 701 μm and mean intraocular pressure was 15 (SD ± 5.34) mmHg. Gender, ethnicity, IOP, glaucoma, hypertension, diabetes, refractive error, were not statistically significantly associated with central cornea thickness. However central cornea thickness was statistically significantly associated with systolic blood pressure (r = -0.24, p = 0.025) and age (p = 0.002). A one-year increase in age reduced the mean central cornea thickness by 0.54 μm. Conclusion: The average CCT of Ugandan adult population was 539.3 ± 41.65 μm which falls in the category of normal central cornea thickness. Central corneal thickness reduced with increasing age and increasing systolic blood pressure.

Central Corneal Thickness of Diabetic Patients in Yaoundé: Case Control Study

Background: To compare central corneal thickness (CCT) values measured in diabetic eyes and compare the CCT values in normal patients without diabetes. Methods: A total of 83 diabetic patients and 83 non-diabetic patients were prospectively enrolled in this comparative case series. CCT was measured using a Topcon CT-1P non-contact automated pachymeter, and values were compared. Results: Mean age was 57 ± 11 years, with a range of 23 and 80 years. The mean CCT was 508.87 ± 35.83 μm for diabetic patients and 513.41 ± 37.22 μm for non-diabetic patients. There was no statistically significant difference between the CCT of diabetic patients compared to non-diabetic patients (p = 0.260). We did not find a significant correlation between the CCT of diabetic patients and clinical characteristics of diabetes. However, there was a positive and statistically significant linear correlation between the CCT of diabetic patients and intra ocular pressure (IOP). Conclusion: The mean CCT in diabetic patients was lower than in non-diabetic control patients, although there was no statistically significant difference.

Real-World Study on the Treatment of Macular Edema in Central Retinal Vein Occlusion Using Traditional Chinese Medicine(TCM)and Its Medication Guidelines

Object:The aim is to evaluate how effective Traditional Chinese Medicine(TCM)is in treating patients who have central retinal vein occlusion with macular edema(CRVO-ME)in a real-world study.Furthermore,the objective of the research was to examine the TCM prescription trends in the management of CRVO-ME.Method:A single-center real-world study(RWS)was carried out over a span of 19 years,following the established design.The study encompassed 113 patients diagnosed with CRVO-ME.Out of these,74 patients received TCM treatment,while the remaining individuals underwent a combined therapy involving TCM and anti-VEGF drugs through intravitreal injection.The patients were matched using propensity score matching(PSM).The result measured in the RWS was BCVA.The oral prescriptions for CRVO-ME that led to observable and effective outcomes were collected.Excel and the TCM Inheritance Auxiliary Platform V2.5 were utilized to optimize mutual information,hierarchical clustering based on entropy,and other techniques to extract medication regulations and features.Result:After applying PSM,each group comprised 29 cases.Both groups exhibited improved BCVA following treatment;however,there was no statistically significant distinction in BCVA or effectiveness between the two groups(all P>0.05).Apart from the analysis of oral prescriptions for CRVO-ME,the investigation pinpointed the most frequently used TCMs,namely Flos Carthami,Semen Persicae,Radix Angelica sinensis,Radix Rehmanniae,and Radix et Rhizoma Notoginseng.Frequently utilized medications tended to possess cold,warm,or mild attributes and exhibited a taste profile that was either bitter or sweet.The primary meridians associated with the medicines employed in treating CRVO-ME were liver,spleen,stomach,heart,and lung.Through the application of association rule analysis,it was discerned that there were 195 commonly employed combinations of medicines.Additionally,a complex system entropy cluster analysis unveiled 13 key combinations of medicines.By employing an unsupervised entropy hierarchical clustering analysis,a novel prescription was formulated.Conclusion:Within a real-world population of CRVO-ME patients,TCM exhibited its effectiveness.The treatment approach for CRVO-ME predominantly involved the regulation of qi(Qi is an exceedingly subtle substance within the human body,brimming with vitality and ceaseless motion.It constitutes the fundamental element that shapes and sustains the various processes of human life.)and blood as well as the resolution of dampness.The oral prescriptions frequently targeted the meridians of liver,spleen,stomach,heart,and lungs.

Macular and peripapillary retinal nerve fiber layer thickness in children with hyperopic anisometropic amblyopia

AIM:To compare the retinal nerve fiber layer (RNFL) thickness and macular thickness in the amblyopic eye with that in the sound eye of children with hyperopic anisometropic amblyopia using optical coherence tomography (OCT). METHODS:A prospective, nonrandom, intraindividual comparative cohort study includes 72 children with hyperopic anisometropic amblyopia in a single center. Macular thickness, macular foveola thickness, and peripapillary RNFL thickness were compared between the amblyopia eyes and the contralateral sound eyes. ·RESULTS:There were 38 male and 34 female patients, with a mean age as 9.7 ±1.9 years (range, 5-16 years). Hyperopic was +3.62±1.16D (range +2.00D to +6.50D) in the amblyopic eyes, which was significantly higher in the control eyes with +0.76±0.90D (range 0D to +2.00D) (P 【 0.01). The mean peripapillary RNFL thickness was 113.9± 7.2μm and 109.2 ±6.9μm in the amblyopic eye and the normal eye, respectively, reaching statistical significance (P = 0.02). The mean macular foveola thickness was significantly thicker in the amblyopic eyes than the contralateral sound eyes (181.4±14.2μm vs 175.2±13.3μm, P 【0.01), but the 1mm, 3mm or 6mm macular thickness central macular thickness was not significantly different. Degree of anisometropia in the contralateral eyes was not significantly correlated with differences of peripapillary RNFL, macular foveola thickness or central macular thickness. CONCLUSION:Eyes with hyperopic anisometropic amblyopia are found thicker macular foveola and peripapillary RNFL than the contralateral eyes in children.

Foveal thickness reduction after anti-vascular endothelial growth factor treatment in chronic diabetic macular edema

AIM：To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor（anti-VEGF） therapy for center-involving diabetic macular edema（DME）.METHODS：Foveal thickness was assessed with optical coherence tomography to determine the central subfield foveal thickness（CSFT） and macular volume in 42 eyes with DME（CSFT〉275 μm）. Evaluations also included measurement of best-corrected visual acuity（BCVA）, and were performed at baseline, and upon foveal depression recovery achieved after 12 monthly intravitreal injections of either 1.5 mg/0.06 mL bevacizumab（n=21） or 0.5 mg/0.05 mL ranibizumab（n=21）. Data was compared to 42 eyes of normally sighted, non-diabetic, healthy individuals with similar age, gender and race distributions.RESULTS：Mean baseline BCVA was 0.59±0.04 and 0.32± 0.03 log MAR（P〈0.001） after treatment and resolution of DME, with all, but 3 eyes, showing BCVA improvement. Mean CSFT before treatment was 422.0±20.0 μm, and after treatment, decreased to 241.6±4.6 μm（P〈0.001）, which is significantly thinner than CSFT found in control subjects（272.0±3.4 μm; P〈0.001）. Moreover, in 33/42 DM eyes（79%）, CSTF was thinner than the matched control eye. Macular volume showed comparable results, but with lower differences between groups（control：8.5±0.4 mm^3; DME：8.2±1.0 mm^3; P=0.0267）.CONCLUSION：DME eyes show significantly lower foveal thickness than matched controls after DME resolution achieved with one-year anti-VEGF therapy. Further investigation into the reasonsfor this presumable retinal atrophy using fluorescein angiography and functional parameters as well as establishing possible predictors is warranted. This finding should be considered during the treatment of DME.

Anti-vascular endothelial growth factor drugs combined with laser photocoagulation maintain retinal ganglion cell integrity in patients with diabetic macular edema: study protocol for a prospective, non-randomized, controlled clinical trial

The integrity of retinal ganglion cells is tightly associated with diabetic macular degeneration that leads to damage and death of retinal ganglion cells,affecting vision.The major clinical treatments for diabetic macular edema are anti-vascular endothelial growth factor drugs and laser photocoagulation.However,although the macular thickness can be normalized with each of these two therapies used alone,the vision does not improve in many patients.This might result from the incomplete recovery of retinal ganglion cell injury.Therefore,a prospective,non-randomized,controlled clinical trial was designed to investigate the effect of anti-vascular endothelial growth factor drugs combined with laser photocoagulation on the integrity of retinal ganglion cells in patients with diabetic macular edema and its relationship with vision recovery.In this trial,150 patients with diabetic macular edema will be equally divided into three groups according to therapeutic methods,followed by treatment with anti-vascular endothelial growth factor drugs,laser photocoagulation therapy,and their combination.All patients will be followed up for 12 months.The primary outcome measure is retinal ganglion cell-inner plexiform layer thickness at 12 months after treatment.The secondary outcome measures include retinal ganglion cell-inner plexiform layer thickness before and 1,3,6,and 9 months after treatment,retinal nerve fiber layer thickness,best-corrected visual acuity,macular area thickness,and choroidal thickness before and 1,3,6,9,and 12 months after treatment.Safety measure is the incidence of adverse events at 1,3,6,9,and 12 months after treatment.The study protocol hopes to validate the better efficacy and safety of the combined treatment in patients with diabetic macula compared with the other two monotherapies alone during the 12-month follow-up period.The trial is designed to focus on clarifying the time-effect relationship between imaging measures related to the integrity of retinal ganglion cells and best-corrected visual acuity.The trial protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Beihua University with approval No.(2023)(26)on April 25,2023,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR2300072478,June 14,2023,protocol version:2.0).

Three-dimensional diabetic macular edema thickness maps based on fluid segmentation and fovea detection using deep learning

AIM: To explore a more accurate quantifying diagnosis method of diabetic macular edema(DME) by displaying detailed 3D morphometry beyond the gold-standard quantification indicator-central retinal thickness(CRT) and apply it in follow-up of DME patients.METHODS: Optical coherence tomography(OCT) scans of 229 eyes from 160 patients were collected.We manually annotated cystoid macular edema(CME), subretinal fluid(SRF) and fovea as ground truths.Deep convolution neural networks(DCNNs) were constructed including U-Net, sASPP, HRNetV2-W48, and HRNetV2-W48+Object-Contextual Representation(OCR) for fluid(CME+SRF) segmentation and fovea detection respectively, based on which the thickness maps of CME, SRF and retina were generated and divided by Early Treatment Diabetic Retinopathy Study(ETDRS) grid.RESULTS: In fluid segmentation, with the best DCNN constructed and loss function, the dice similarity coefficients(DSC) of segmentation reached 0.78(CME), 0.82(SRF), and 0.95(retina).In fovea detection, the average deviation between the predicted fovea and the ground truth reached 145.7±117.8 μm.The generated macular edema thickness maps are able to discover center-involved DME by intuitive morphometry and fluid volume, which is ignored by the traditional definition of CRT>250 μm.Thickness maps could also help to discover fluid above or below the fovea center ignored or underestimated by a single OCT B-scan.CONCLUSION: Compared to the traditional unidimensional indicator-CRT, 3D macular edema thickness maps are able to display more intuitive morphometry and detailed statistics of DME, supporting more accurate diagnoses and follow-up of DME patients.

The analysis of macular perimetry with octopus 900 in acute central serous chorioretinopathy

Background:To find the changes of macular perimetry(MP) and the correlations between MP and best correct visual acuity(BCVA) in different phases of the acute central serous chorioretinopathy(CSC).Methods:Twenty-one eyes with acute CSC and their fellow eyes were analysed retrospectively.MP at 2°,4°and BCVA in the active and resolved phase were collected and analyzed.The differences of these parameters in CSC eyes and fellow eyes were analyzed.Spearman correlation was used for analysis of correlation between MP and BCVA.Results:From 29 eyes with CSC analysed 27 eyes(93.10%) recovered to the previous VA.Compared with the active phase,MP at 2°,4° and BCVA were significantly improved in the resolved phase(P=0.000,0.000,0.000,respectively).MP at 2°,4° and BCVA of CSC eyes were significantly poor compared with the fellow eyes in the active phase(P=0.000,0.000,0.000,respectively).In the resolved phase there was no significant difference between the CSC eyes and fellow eyes(P=0.339,0.141,0.161,respectively).BCVA was shown to significantly correlate with MP at 2° in the active phase(ρ=-0.630,P<0.001).Conclusions:The acute CSC often had a good prognosis both in BCVA and MP.MP can provide an additional objective parameter to evaluate the retinal function changes at macula of acute CSC.

Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion

AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS: In group 1, the mean BCVA improved from 37.78 +/- 6.14 (baseline) to 48.06 +/- 3.86, 46.48 +/- 4.77 and 44.18 +/- 5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92 +/- 6.20 (baseline) to 50.69 +/- 4.22, 48.76 +/- 5.59 and 45.70 +/- 6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.

Comparison of central corneal thickness measurements with three new optical devices and a standard ultrasonic pachymeter

AIM:To compare the RTVue spectral optical coherence tomography(SD-OCT),Sirius Scheimpflug-Placido topographer,Lenstar optical low coherence reflectometry(OLCR)and ultrasound pachymetry(USP)devices in terms of their agreement and repeatability of measuring central corneal thickness(CCT).METHODS:In this prospective study,50 eyes of 50patients were included.Three repeated measures were obtained using SD-OCT,Scheimpflug-Placido topographer and USP and five measurements were determined with the OLCR.Bland-Altman plots were used to assess agreement among the instruments,and 95%limits of agreement(LoA)for each comparison were calculated.Intra-examiner repeatability was assessed using intraclass correlation coefficients(ICCs).RESULTS:The mean CCT by SD-OCT,ScheimpflugPlacido topographer,OLCR,and USP were 525.90±34.08μm,525.92±34.10μm,530.30±35.62μm,and543.50±37.11μm respectively.All 4 modalities of CCT measurements correlated closely with each other,with Pearson correlation coefficients ranging from 0.977 to0.995.The mean differences(and upper/lower LoA)for CCT measurements were-0.05±6.77μm(13.3/-13.3)between SD-OCT and Scheimpflug-Placido topographer,4.38±3.79μm(11.8/-3.1)between OLCR and SD-OCT,4.38±6.03μm(16.2/-7.5)between OLCR and ScheimpflugPlacido topographer,13.20±6.46μm(25.9/0.5)between USP and OLCR,17.59±6.76μm(30.8/4.3)between USP and SD-OCT,and 17.58±8.13μm(33.5/1.6)between USP and Scheimpflug-Placido topographer.Intra-examiner repeatability was excellent for all devices with ICCs】0.98.CONCLUSION:For most practical purposes,CCT measurements with the RTVue,Sirius and Lenstar can be used interchangeably.Although highly correlated,CCTmeasurement differences between USP and these 3optical instruments can be significant depending on the clinical situation.

Distribution of central corneal thickness and intraocular pressure in emmetropic eyes of healthy children of Palestine: a representative cross-sectional study

AIM: To determine the distributions of central corneal thickness(CCT) and intraocular pressure(IOP) in emmetropic eyes of healthy children of Palestine.METHODS: This representative cross sectional study included a total of 1156 eyes from 578 healthy school children aged 7-15 y. Inclusion criteria included emmetropia, no previous history of ocular or systemic diseases, no previous history of contact lens use, and the availability of both eyes. CCT and IOP were measured using ultrasound pachymeter and Goldmann applanation tonometer, respectively. The relationship of the results with age and gender was investigated.RESULTS: The mean age of school children was 11.13±2.8 y. Mean CCT was 542.2±37.4 and 544.3±39.2 μm for right and left eyes, respectively. Mean IOP was 12.5±2.2 and 12.3±2.2 mm Hg for right and left eyes, respectively. A positive correlation was observed between CCT and IOP of the right eye(P<0.001, R=0.358) and CCT and IOP of the left eye(P<0.001, R=0.324). No significant differences were observed in CCT and IOP due to age or gender(P>0.05). There were significant differences in mean CCT and IOP between right and left eyes(P=0.004, P=0.001, respectively).CONCLUSION: A population profile of CCT and IOP is established in Palestinian children for the first time. Mean CCT is comparable to some studies but differ from others. Mean IOP is considerably lower than that of majority children of other ethnic groups. Intereye difference of more than 36 μm in CCT, and 5 mm Hg in IOP should prompt evaluation for potential ocular disorders.

Changes of corneal central thickness of aphakia following congenital cataract surgery under the first six months of life

AIM: To observe the central corneal thickness (CCT) changes in infants and young children who had been undergone bilateral congenital cataract surgery, and to compare the changes with normal control group which was selected from healthy population. METHODS: A cross section case-control study contained 28 cases (56 eyes) of bilateral aphakia (aphakic group) due to congenital cataract surgery combining with posterior continuous curvilinear capsulorhexis and with anterior vitrectomy during 2-6 months after birth. Fourteen children (28 eyes) of age-sex matched with the aphalic group were selected as normal control group. CCT and intraocular pressure (TOP) were measured postoperatively and the results were compared between groups. RESULTS: The mean CCT was 653.5 +/- 82.4 mu m in the aphakic group and 579.6 +/- 39.2 mu m in the control group, with a significant difference (P=0.000). The mean value of TOP in aphakic group (22.0 +/- 1.6mmHg) was greater than that of control group (16.9 +/- 2.1mmHg), P=0.023. There was a negative correlation between age and CCT in normal control group (r=-0.531, P=0.026), and there was no correlation in bilateral aphakia group (r=-0.324, P=0.165). CONCLUSION: Aphakic children due to congenital cataract surgery have a greater CCT than normal children. It is necessary to consider CCT in evaluating IOP for children after congenital cataract surgery.

Changes in intraocular pressure and central corneal thickness during pregnancy:a systematic review and Meta-analysis

AIM：To conduct a Meta-analysis for investigating the variations in intraocular pressure（IOP）and central corneal thickness（CCT）during normal pregnancy.METHODS：We searched for clinical trials published up to November 2015 without language or region restrictions in Pub Med,EMBASE,Web of Science,the Cochrane Central Register of Controlled Trials,Ovid,EBSCO,Elsevier,the Chinese Biomedicine Database,Wan Fang,CNKI,CQVIP and Google Scholar.Studies of the ocular changes observed in pregnant women were selected.The main outcomes were assessed by changes in IOP and CCT.RESULTS：Fifteen studies were included.In subgroup analyses,IOP was significantly decreased during the second MD=-1.53,95%CI（-2.19,-0.87）;P〈0.00001,and third MD=-2.91,95%CI（-3.74,-2.08）;P〈0.00001 trimesters of pregnancy.CCT was increased during the second MD=10.12,95%CI（2.01,18.22）;P=0.01,trimester of pregnancy;moreover,during the third trimester of pregnancy,the CCT displayed an increasing trend,but the difference was not significant MD=5.98,95%CI（-1.11,13.07）;P=0.1.CONCLUSION：A decrease in IOP is accompanied by an increase in CCT in the second and third trimesters of a normal pregnancy in women.