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The aim of this study was to compare the axial lengths (ALs) using a new biometer with swept-source optical coherence tomography (Argos) versus ALs using a conventional biometer with partial coherence interferometry (IOL Master, version 5). The ALs in 48 eyes of 48 cataract patients were measured with Argos using refractive indexes that correspond to the particular tissue and with IOL Master using a single refractive index. The eyes were divided into three subgroups by AL length: short-AL group (n = 16), <23.27 mm; intermediate-AL group (n = 16), 23.27-24.03 mm; long-AL group (n = 16), ≥24.04 mm. The ALs (mm) measured with the Argos and IOL Master biometers, respectively, were 22.77 ± 0.43 and 22.74 ± 0.44, 23.63 ± 0.21 and 23.62 ± 0.21, and 26.00 ± 1.61 and 26.05 ± 1.64 in the short-, intermediate-, and long-AL groups, respectively. The mean ALs with the Argos biometer were longer than those with the IOL Master biometer in the short-AL group (P = 0.002) There was no significant difference in the intermediate-AL groups (P = 0.14). In contrast, the mean ALs with the Argos biometer were shorter than those with the IOL Master biometer in the long-AL group (P < 0.001). Differences between the ALs measured with the two biometers were statistically significant in short- and long-AL subgroups. However, the differences might not be clinically significant.

To investigate the incidence of macular hole (MH) during pars plana vitrectomy (PPV) for submacular hemorrhage (SMH) due to either retinal arterial macroaneurysm (RAM) rupture or age-related macular degeneration (AMD). We retrospectively evaluated 47 eyes of 47 patients with SMH due to RAM rupture or AMD who underwent PPV. The presence or development of MHs was confirmed intraoperatively by the surgeon. We compared the incidence of MH between the RAM and AMD groups. In the RAM group, a MH was found in five of 28 (17.9%) eyes, and a MH was developed in three eyes by the surgical procedure. In the AMD group, there was no MH. All MHs were identified intraoperatively and closed by the same surgical procedure. In the RAM group, subretinal tissue plasminogen activator (t-PA) injection was performed in 12 eyes. Of the 12 eyes, two developed an MH before t-PA subretinal injection. Of the remaining 10 eyes, four (40%) developed an MH intraoperatively or postoperatively. MHs are complications of PPV for SMH that occur more frequently in patients with SMH due to RAM rupture than in patients with SMH due to AMD.

PurposeTo create a model for prediction of postoperative visual acuity (VA) after vitrectomy for macular hole (MH) treatment using preoperative optical coherence tomography (OCT) images, using deep learning (DL)–based artificial intelligence.MethodsThis was a retrospective single-center study. We evaluated 259 eyes that underwent vitrectomy for MHs. We divided the eyes into four groups, based on their 6-month postoperative Snellen VA values: (A) ≥ 20/20; (B) 20/25–20/32; (C) 20/32–20/63; and (D) ≤ 20/100. Training data were randomly selected, comprising 20 eyes in each group. Test data were also randomly selected, comprising 52 total eyes in the same proportions as those of each group in the total database. Preoperative OCT images with corresponding postoperative VA values were used to train the original DL network. The final prediction of postoperative VA was subjected to regression analysis based on inferences made with DL network output. We created a model for predicting postoperative VA from preoperative VA, MH size, and age using multivariate linear regression. Precision values were determined, and correlation coefficients between predicted and actual postoperative VA values were calculated in two models.ResultsThe DL and multivariate models had precision values of 46% and 40%, respectively. The predicted postoperative VA values on the basis of DL and on preoperative VA and MH size were correlated with actual postoperative VA at 6 months postoperatively (P < .0001 and P < .0001, r = .62 and r = .55, respectively).ConclusionPostoperative VA after MH treatment could be predicted via DL using preoperative OCT images with greater accuracy than multivariate linear regression using preoperative VA, MH size, and age.

This retrospective observational multicentre cohort study compared the rate of postoperative cystoid macular oedema (CME) between two intraocular lens (IOL) scleral fixation (SFIOL) techniques: a flanged IOL fixation technique (Yamane technique) and a suture IOL transscleral fixation technique (conventional technique). The study included 207 eyes with postoperative CME that had undergone SFIOL and were observed for > 12 weeks between January 2019 and January 2021. The primary endpoint was a comparison of the rate of postoperative CME at 3 months between groups. Secondary endpoints were a comparison of postoperative best-corrected visual acuity (BCVA) at 3 months between groups and an analysis of characteristics associated with postoperative CME in the Yamane technique group. The Yamane technique group developed postoperative CME in 13.0% of eyes at 3 months, compared with 1.9% in the conventional technique group (odds ratio: 7.99, P  = 0.045). Postoperative BCVA was consistently significantly higher in the Yamane technique group. Although many retinal surgeons have performed the Yamane technique because of its convenience for SFIOL, our findings suggest that the Yamane technique carries an increased risk of postoperative CME compared with the conventional suture method. Therefore, careful management of postoperative CME is needed after SFIOL.

PurposeThe MERCURY study aimed to evaluate the effects on visual acuity and psychological symptoms, and safety, of ranibizumab and subsequent treatment in patients with diabetic macular oedema (DME) and impaired visual acuity (VA). We report data from the prespecified 12-month interim analysis.MethodsThis was a 24-month, phase 4, open-label, single-arm, prospective, observational study conducted at 20 specialised retinal centres in Japan. Participants were 209 patients with DME and impaired VA, not previously treated with either intravitreal or systemic anti-vascular endothelial growth factor (anti-VEGF) agents, who initiated ranibizumab 0.5 mg per investigator discretion. Following ranibizumab administration, patients were treated per routine clinical practice. Other treatments were allowed. The main outcome measure was the mean change in best-corrected VA (BCVA) in logarithmic minimum angle of resolution (logMAR) from baseline to month 12. An exploratory objective was to assess patients’ psychological status using the Hospital Anxiety and Depression Scale (HADS).ResultsThe mean ± standard deviation BCVA at baseline was 0.43 ± 0.39 logMAR. The mean number of injections of ranibizumab and anti-VEGF agents from baseline to month 11 was 3.2 ± 2.0 and 3.6 ± 2.4, respectively. The BCVA change from baseline to 12 months was − 0.08 ± 0.34 logMAR (p = 0.011), showing a significant improvement; the HADS-anxiety score also decreased significantly (p = 0.001) and the depression score decreased numerically (p = 0.080).ConclusionMERCURY study data confirm the effectiveness of real-world treatment initiated with ranibizumab in Japanese patients with DME. In addition, treatment was able to positively influence anxiety via VA improvement.

PurposeTo explore the relationship between retinal fluid status and best-corrected visual acuity (BCVA) in patients treated with intravitreal aflibercept (IVT-AFL) treat-and-extend (T&E) in the ALTAIR study.MethodsOutcomes were investigated according to overall fluid status at week 16 (predefined) and the relationship between any fluid, intraretinal fluid (IRF), subretinal fluid (SRF), or pigment epithelial detachment with BCVA at baseline, and weeks 16, 52, and 96 (post-hoc). The analyses involved treatment-naïve patients (N = 246) with exudative age-related macular degeneration (AMD), aged ≥ 50 years with BCVA of 73–25 Early Treatment Diabetic Retinopathy Study letters, who participated in the ALTAIR study.ResultsThe mean (standard deviation) change in BCVA from baseline to week 52 was + 10.6 (10.9) and + 6.5 (16.0) letters in patients without and with fluid at week 16, respectively; and to week 96 was + 9.1 (14.3) and + 4.3 (16.1) letters in patients without and with fluid at week 16, respectively. The last injection interval was 16 weeks in 33.6% and 2.0% (week 52), and 62.9% and 17.6% (week 96) of patients without or with fluid at week 16, respectively. At baseline, 35.7% of patients had IRF and 85.2% of patients had SRF, which decreased to 11.8% (IRF) and 31.7% (SRF) of patients, 8.5% (IRF) and 18.7% (SRF), and 6.5% (IRF) and 20.7% (SRF) at weeks 16, 52, and 96, respectively. Presence of IRF at all timepoints was associated with poorer BCVA than if IRF was absent, while the presence of SRF was not associated with poorer BCVA compared with the absence of SRF.ConclusionIVT-AFL T&E dosing was effective at clearing fluid regardless of fluid type in ~ 80% of patients with exudative AMD. Patients without fluid at week 16 had numerically better BCVA than those with fluid at week 16. Over 60% of patients without fluid at week 16 achieved the maximum treatment interval of 16 weeks by study end, compared with < 20% of patients with fluid at week 16. IRF (weeks 16, 52, 96), although evident in a small number of patients, was associated with poorer BCVA, whereas SRF was not.Trial registrationClinicalTrials.gov Identifier: NCT02305238

Acute submacular hemorrhage (SMH) can be caused by various diseases including age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), and retinal arterial microaneurysm (RAM). The natural course of submacular hemorrhage is generally poor. Animal studies have suggested that the removal of subretinal hemorrhage may effectively reduce retinal damage caused by hemorrhage in humans and removal of submacular hemorrhage have been performed with limited visual outcomes. Pneumatic displacement involving intravitreal expansile gas with or without adjunctive intravitreal injection of tissue plasminogen activator (tPA) has demonstrated effective displacement of SMH and improvement in visual acuity in the majority of cases. Although tPA may not be indispensable, its use may facilitate displacement. Combining pneumatic displacement with vitrectomy and subretinal injection of tPA may achieve superior displacement of SMH compared to pneumatic displacement of SMH, implying that pneumatic displacement of SMH with vitrectomy and subretinal injection may offer enhanced effectiveness in SMH displacement, while no obvious different was found in visual outcomes between the two treatments. Complications associated with these procedures encompass breakthrough hemorrhage, retinal detachment and macular hole formation. Breakthrough hemorrhage is more commonly observed following pneumatic displacement whereas retinal detachment appears to be more prevalent following vitrectomy. Macular hole formation subsequent to vitrectomy represents a significant complication, particularly in eyes with SMH attributed to ruptured retinal arterial microaneurysm. Both pneumatic displacement and vitrectomy present advantages and disadvantages, and the superiority between the two remains undetermined. Sequential strategy for the treatment of submacular hemorrhage is another option. As the initial step, pneumatic displacement of SMH should be attempted, and if displacement is insufficient, pneumatic displacement following vitrectomy with subretinal injection of tPA may be pursued. Further investigations are warranted to ascertain optimal management strategies for SMH leading to improved outcomes. Key messages What is known • Pneumatic displacement with/without intravitreal tPA injection, and vitrectomy with subretinal tPA injection and gas are the two major treatments for submacular hemorrhage. What is new • No obvious different was found in visual outcomes between vitrectomy, subretinal tPA injection and gas, and intravitreal tPA injection and gas while vitrectomy with subretinal tPA injection and gas may achieve better displacement of submacular hemorrhage. • Macular hole formation is a specific complication for submacular hemorrhage due to ruptured retinal arterial macroaneurysm.

PurposeTo investigate acquired color vision deficiency (CVD) using the Rabin cone contrast test (RCCT) in patients with retinal vein occlusion (RVO).MethodsWe retrospectively evaluated 39 patients with macular edema due to RVO who were treated with intravitreal injections of anti-VEGF agents and demonstrated improvement of best-corrected visual acuity to 20/20 Snellen VA or better. The acquired CVD was evaluated by the RCCT and standard pseudo-isochromatic plates-part 2 (SPP-2).ResultsMean L, M, and S color contrast test (CCT) scores were significantly lower in RVO eyes than in the fellow eyes (L CCTs, 70.0 ± 13.3 vs. 90.0 ± 8.0, respectively, P < 0.01; M CCTs, 85.0 ± 16.6 vs. 95.0 ± 5.7, respectively, P < 0.01; S CCTs, 80.0 ± 21.5 vs. 95.0 ± 7.1, respectively, P < 0.01). Acquired CVD was diagnosed in 25 eyes of 39 patients by the RCCT and in 15 eyes of 39 patients by SPP-2. The RCCT was performed on two different days in 21 patients. It revealed acquired CVD in 17 eyes on the first day and in 10 eyes on the second day. Acquired CVD was improved in 9 eyes, unchanged in 8 eyes, and worsened in 2 eyes.ConclusionsThe RCCT revealed eyes with RVO had acquired CVD. Acquired CVD caused by RVO can be improved further in some cases even after recovery of vision to 20/20. The RCCT may be able to quantitatively diagnose acquired CVD status.

Nivolumab is an anti-programmed cell death protein 1 monoclonal antibody that is used to treat metastatic cutaneous malignant melanoma. Although bilateral uveitis has been reported as a side effect of nivolumab administration, there are few reports of Vogt-Koyanagi-Harada disease (VKH)-like uveitis. We report such a case. A 63-year-old woman with metastatic cutaneous malignant melanoma experienced visual loss in both eyes 10 days after her second nivolumab injection. Her decimal best-corrected visual acuity (BCVA) was 0.7 in the right eye and 0.4 in the left eye. Examination revealed bilateral granulomatous keratic precipitates and posterior synechiae in the left eye. Optical coherence tomography showed multiple sites of serous retinal detachment (SRD) in the left eye and wavy retinal pigment epithelium in both eyes. Fluorescein angiography revealed multiple pinpoint-sized areas of leakage in both eyes and active leakage from the disc in her right eye. Indocyanine green angiography (IA) showed choroidal hyperfluorescence due to choroidal vascular leakage, with hypofluorescent dark spots during the late phase. These findings supported a diagnosis of VKH-like uveitis following nivolumab injections. Nivolumab was discontinued because of headache. Anterior chamber inflammation disappeared 3 weeks after starting topical corticosteroid treatment, and the SRD disappeared within 3 months. Her decimal BCVA recovered to 1.0 in the right eye and to 0.9 in the left eye. Also, the fluorescein angiography and IA findings had improved by 4 months. We concluded that careful follow-up is required after nivolumab treatment because VKH-like panuveitis might develop.