For detecting RPD, IR and SD-OCT had the highest sensitivity. Although SD-OCT had the highest sensitivity and specificity, RPD detection should be confirmed using more than one modality for increased accuracy.

Pachychoroid neovasculopathy is a recently proposed clinical entity of choroidal neovascularization (CNV). As it often masquerades as neovascular age-related macular degeneration (AMD), it is currently controversial whether pachychoroid neovasculopathy should be distinguished from neovascular AMD. This is because its characteristics have yet to be well described. To estimate the relative prevalence of pachychoroid neovasculopathy in comparison with neovascular AMD and to investigate the phenotypic/genetic differences of the two diseases, we evaluated 200 consecutive Japanese patients who agreed to participate in the genetic study and diagnosed with pachychoroid neovasculopathy or neovascular AMD. Pachychoroid neovasculopathy was observed in 39 individuals (19.5%), which corresponds to one fourth of neovascular AMD. Patients with pachychoroid neovasculopathy were significantly younger (p = 5.1 × 10−5) and showed a greater subfoveal choroidal thickness (p = 3.4 × 10−14). Their genetic susceptibility to AMD was significantly lower than that of neovascular AMD; ARMS2 rs10490924 (p = 0.029), CFH rs800292 (p = 0.013) and genetic risk score calculated from 11 AMD susceptibility genes (p = 3.8 × 10−3). Current results implicate that the etiologies of the two conditions must be different. Thus, it will be necessary to distinguish these two conditions in future studies.

Focal choroidal excavations were present in 7.8% of eyes with CSC. In these eyes, focal choroidal excavations may have formed from RPE retraction caused by focal scarring of choroidal connective tissue.

PURPOSE.To investigate the relationship between the cystoid spaces in the outer plexiform layer (OPL) and the characteristics of the photoreceptors beneath the cystoid spaces in patients with diabetic macular edema (DME). METHODS. In this observational cross-sectional study, 123 eyes of 96 consecutive patients with clinically significant macular edema were retrospectively reviewed. The characteristics of the photoreceptors on optical coherence tomography (OCT) images represented by the external limiting membrane (ELM) and the junction between inner and outer segments (IS/OS), and their association with the overlying cystoid spaces were investigated. RESULTS. The areas beneath the cystoid spaces in the OPL had a longer transverse length of disrupted or faint IS/OS and disrupted ELM lines than those without cystoid spaces (P Ͻ 0.001, P Ͻ 0.001, and P ϭ 0.009). The IS/OS lines beneath the cystoid spaces had higher reflectivity than those in areas without cystoid spaces (P Ͻ 0.001). Enlarged cystoid spaces extending from the inner nuclear layer to the OPL were associated with disrupted IS/OS or ELM but not faint IS/OS (P Ͻ 0.001, P Ͻ 0.001, and P ϭ 0.467). The transverse length of disrupted IS/OS at the fovea was correlated with the logarithm of the minimum angle of resolution (logMAR) more than the association between foveal thickness and logMAR (r ϭ 0.49, P Ͻ 0.001 vs. r ϭ 0.28, P ϭ 0.002). The ELM descended to the RPE more frequently in eyes with single-lobulated fluorescein pooling in the foveal avascular zone than those with multilobulated pooling (P Ͻ 0.001). CONCLUSIONS. OCT showed that the cystoid spaces in the OPL were accompanied by photoreceptor damage beneath the cystoid spaces in DME. (Invest Ophthalmol Vis Sci. 2012;53: 1506 -1511) DOI:10.1167/iovs.11-9231 D iabetic retinopathy (DR) often leads to severe visual impairments especially in patients of working age. Diabetic macular edema (DME), which is caused by the breakdown of blood-retinal barrier (BRB), deteriorates the neuroglial function in the macula and concomitantly the visual acuity (VA). 1-4Despite intensive effort, complete resolution of DME has not been achieved, and research into the pathogenesis and treatments must continue. 5-9Although DME was diagnosed originally as macular thickening based on the biomicroscopic examination, optical coherence tomography (OCT) has enabled quantification of the retinal thickness and evaluation of the pathohistologic findings of the neuroglial components. The macular thickness is correlated modestly with poor VA in DME, suggesting that, despite its clinical relevance, mechanisms other than retinal thickening remain to be elucidated.10 Several pathomorphologic findings have been seen on OCT images (i.e., cystoid macular edema; CME), serous retinal detachments (SRDs), and sponge-like retinal swelling, all which contribute to macular thickening. 11Cystoid spaces especially are seen often in the inner nuclear layer (INL) and the outer plexiform layer (OPL) on OCT images.12-16 Those investigators have speculated...

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Citation: Hata M, Yamashiro K, Ooto S, et al. Intraocular vascular endothelial growth factor levels in pachychoroid neovasculopathy and neovascular agerelated macular degeneration. Invest Ophthalmol Vis Sci. 2017;58:292-298. DOI:10.1167/iovs.16-20967 PURPOSE. To investigate the difference in intraocular vascular endothelial growth factor (VEGF) concentration between pachychoroid neovasculopathy and neovascular age-related macular degeneration (nAMD) and its associations with responses to three monthly anti-VEGF injections as an initial treatment for the two conditions.METHODS. This study included nine eyes with treatment-naïve pachychoroid neovasculopathy and 21 eyes with treatment-naïve nAMD. Before the initial intravitreal anti-VEGF injection, aqueous humor samples were collected and the concentration of VEGF was measured using enzyme-linked immunosorbent assay. The concentration was compared between the two conditions, and its associations with responses to anti-VEGF therapy were investigated. RESULTS.The mean VEGF concentration in pachychoroid neovasculopathy was significantly lower than that in nAMD (63.4 6 17.8 pg/ml and 89.8 6 45.0 pg/ml, respectively; P ¼ 0.035). The VEGF concentration was associated with the presence or absence of drusen (b ¼ 0.503, P ¼ 0.004). After anti-VEGF therapy, 6 (66.7%) of 9 eyes with pachychoroid neovasculopathy and 17 (81.0%) of 21 eyes with nAMD achieved dry macula (P ¼ 0.640). Dry macula at 3 months and 12 months was significantly associated with a low VEGF concentration in pachychoroid neovasculopathy (P ¼ 0.013 and P ¼ 0.042, respectively), but not in nAMD (P ¼ 0.108 and P ¼ 0.219). CONCLUSIONS.The mean VEGF concentration in pachychoroid neovasculopathy was lower than that in nAMD, suggesting that the way in which VEGF is involved in angiogenesis may differ between pachychoroid neovasculopathy and nAMD.

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