The use of indocyanine green angiography (ICGA) is a criterion standard for diagnosing polypoidal choroidal vasculopathy (PCV), an endemic and common cause of vision loss in Asian and African individuals that also presents in white individuals. However, the use of ICGA is expensive, invasive, and not always available at clinical centers. Therefore, knowing the value of certain features detected using fundus photography (FP), optical coherence tomography (OCT), and fluorescein angiography (FA) to diagnose PCV without ICGA could assist ophthalmologists to identify PCV when ICGA is not readily available. OBJECTIVE To explore the sensitivity, specificity, and predictive accuracy of potential diagnostic features detected using FP, OCT, and FA in diagnosing PCV without ICGA. DESIGN, SETTING, AND PARTICIPANTS Deidentified images of FP alone, OCT alone, and FA alone were graded by 3 retina specialists masked to ICGA findings for potentially diagnostic features of PCV prespecified before grading compared with the criterion standard grading of 2 other retina specialists with access simultaneously to FP, OCT, FA and ICGA. Specialists graded images of 124 eyes of 120 patients presenting between January 1, 2013, and December 31, 2016, with newly identified serous or serosanguinous maculopathy who had undergone FP, OCT, FA, and ICGA before treatment at a large referral eye center in Thailand. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy from the area under the receiver operating characteristic curve (AUC). RESULTS The mean (SD) age of the patients was 57.7 (12.6) years, 52 were women, 68 were men, and the diagnosis (from ICGA) was PCV for 65 eyes (52.4%), central serous chorioretinopathy for 45 eyes (36.3%), and typical neovascular age-related macular degeneration for 12 eyes (9.7%). With the use of FP, a potential diagnostic feature for PCV was notched or hemorrhagic pigment epithelial detachment (AUC, 0.77; 95% CI, 0.70-0.85). With the use of OCT, potential diagnostic features for PCV were pigment epithelial detachment notch (AUC, 0.90; 95% CI, 0.85-0.96), sharply peaked pigment epithelial detachment (AUC, 0.86; 95% CI, 0.80-0.92), and a hyperreflective ring (AUC, 0.86; 95% CI, 0.80-0.92). When at least 2 of these 4 signs were present, the AUC was 0.93 (95% CI, 0.89-0.98), with a sensitivity of 0.95 (95% CI, 0.87-0.99), a specificity of 0.95 (95% CI, 0.82-0.97), a positive predictive value of 0.92 (95% CI, 0.83-0.97), and a negative predictive value of 0.95 (95% CI, 0.86-0.99). CONCLUSIONS AND RELEVANCE These data suggest that the potential diagnostic features detected using FP and OCT provide high sensitivity and specificity for a diagnosis of PCV, especially when at least 2 of 4 highly suggestive signs are present.

To describe the epidemiology, mechanism of injury, and final visual and anatomical outcomes of pediatric patients with open globe injury. The medical records of patients aged ≤ 16 years diagnosed with open globe injury between January 2006 and December 2010 were retrospectively reviewed. Forty-nine pediatric patients were diagnosed with open globe injury during the study period. Forty-one of the 49 patients (83.7 %) were male. The mean age of the patients was 9.3 ± 4.6 years, with 49 % of the injuries occurring in patients between the ages of 11 and 16 years. Ocular penetration was the most common type of injury (63.3 %), occurring most frequently in the cornea (63.3 %). Wooden objects were the most common cause of injury. Following surgical intervention, 40.8 % of the patients obtained a final visual acuity (VA) of ≥ 6/60. Pars plana vitrectomy was performed in 51 % of cases, with only 36 % of these patients having a final VA of ≥ 6/60. The presence of retinal detachment was the only statistically significant factor (odds ratio 0.05, p < 0.001) that affected VA improvement of more than one line. Corneal penetration was frequently observed in pediatric patients with ocular trauma. Pediatric patients with a retinal detachment were significantly more likely to have a poor final visual outcome than open globe patients whose retina remained attached. Despite prompt surgical intervention, useful vision was preserved in less than half of the patients requiring pars plana vitrectomy.

Purpose To identify the predictive factors for anatomical and visual outcomes in posterior segment intraocular foreign body (IOFB) patients managed by pars plana vitrectomy (PPV). Methods A retrospective chart review was performed for 77 patients, who had PPV for IOFBs removal between January 2001 and July 2007. Univariate and multivariate analyses were conducted to evaluate the predictive factors.Results The mean age of the patients was 33.4 years. The nature of IOFBs was mainly metal, with injuries most commonly caused by an electric grass trimmer. The mean time interval between injury and IOFBs removal was 30.7 days. The mean preoperative visual acuity (VA) was 1.82 logarithm of the minimal angle of resolution (logMAR), and mean final was VA 1.10 logMAR. From multivariate analysis, good visual outcome was correlated with the corneoscleral entry site, and poor visual outcome was correlated with the presence of relative afferent pupillary defect. Conclusions In noncombat IOFBs, most cases were work-related. Delayed IOFBs removal was acceptable when primary wounds were repaired appropriately and extensive antibiotics administered. Even though advancement in vitreoretinal surgery can reduce the frequency of blindness, further promotion and education on eye protection during work are needed.

Introduction: To explore visual and anatomical outcomes in patients who underwent intravitreal anti-vascular endothelial growth factor injection for visual impairment from center-involved diabetic macular edema (CI-DME) in clinical practice. Methods: Medical records of consecutive CI-DME patients who initiated treatment with intravitreal bevacizumab injection between Jan 2012 and Dec 2016 and were followed for at least 12 months were retrospectively reviewed. Visual and anatomical changes after treatment over a 36-month period were evaluated. Results: There were 286 patients (423 eyes) with a mean (SD) age of 56.8 (8.5) years included in this study. One hundred and forty-six (51%) patients were female and 137 (47.9%) patients received bilateral-eye treatment. Mean (SD) presenting visual acuity (VA) of overall eyes was 50.2 (19.6) letter scores. Stratified by baseline vision, eyes with initial VA worse than 20/40 achieved a statistically significant VA improvement, compared to baseline, by +8.4, +6.9, and +5.4 letters at 12, 24, and 36 months, respectively with all p values < 0.001. However, when initial VA was 20/40 and better, a non-statistically significant change in mean VA by +2.0, -3.5, and -3.6 letters were noted at the same time-point (p value between 0.078 to 0.273). Unlike visual changes, a statistically significant decline in central subfield thickness compared to baseline was noted at the end of month 12, 24, and 36 in both initial VA subgroups (all p values < 0.001). Nevertheless, even though the median number of given injections considerably decreased from 6 in the first 12 months to 2 in the second 12-month period and 1 in the final 12-month interval. Required ophthalmic clinic visits decreased in frequency with median numbers of 10, 7 and 6 appointments in each consecutive 12-month duration. Conclusion: This study supports the benefits of practical intravitreal anti-VEGF utilization to manage CI-DME in real-world settings. The improvement of vision in eyes presenting with poor baseline VA and a maintenance of vision in eyes with better baseline VA were demonstrated through the 3-year review of each case. However, the burden of frequent monitoring warrants further evaluation of long-term compliance and efficacy.

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