Japanese investigators sought to determine the relationship between the levels of intraocular inflammatory cytokines and polypoidal choroidal vasculopathy (PCV) in the following prospective cohort study.

They studied 62 patients with PCV and 36 control subjects assessed the levels of cytokines, chemokines and growth factors in the aqueous humor samples from PCV patients and control subjects for significant associations with PCV. The investigators also used logistic regression analysis to compute the odds ratios (ORs) and 95% confidence intervals (CIs) after the study populations were divided into quartiles.

In PCV patients, IL-4, IL-10 and IL-23 were significantly higher than in the controls. The investigators noted that logistic analyses showed a significantly high risk for IL-23 (OR for the highest quartile compared with the lowest quartile: 16.3; 95% CI: 3.5—75.2), VEGF (5.7; 1.2—26.1), and IL-4 (4.0; 1.3—12.7). They also reported that IL-10 and IL-4, but not IL-23, were significantly correlated with the VEGF levels in PCV patients (IL-10: p = 0.477, IL-4: p = 0.281). Furthermore, they found the elevated levels of IL-5, IL-10, IL-4, IL-23, and IL-1α to be significantly associated with exudative lesion(s) in the fluorescein angiograms.

To conclude, the significant associations between elevated levels of IL-23 with PCV and its activity strongly suggest an involvement of inflammatory processes in the etiology of PCV, presumably independent of VEGF.

To examine the use of the retinal nerve fiber layer (RNFL) thickness map generated by a spectral-domain optical coherence tomography (SD-OCT) to detect RNFL progression and identify the pattern of progressive changes of RNFL defects in glaucoma, this prospective, longitudinal study included 186 eyes of 103 glaucoma patients.

Patients were followed at 4-month intervals for ≥36 months for RNFL imaging and visual field examination. Both eyes were imaged by the Cirrus HD-OCT (Carl Zeiss Meditec Inc.) and had visual field testing at the same visits. RNFL progression was defined by Guided Progression Analysis (Carl Zeiss Meditec) of serial RNFL thickness maps and the pattern of RNFL progression was evaluated by comparing the baseline RNFL thickness deviation map and the RNFL thickness change map. Additionally, visual field progression was defined by trend analysis of visual field index and event analysis based on the Early Manifest Glaucoma Trial criteria. Main outcome measures were the presence and the pattern of RNFL progression.

A total of 2,135 OCT images were reviewed and 28 eyes (15.1%) from 24 patients (23.3%) had RNFL progression detected by RNFL thickness map analysis. Three RNFL progression patterns were observed: (1) widening of RNFL defects (24 eyes, 85.7%), (2) deepening of RNFL defects (2 eyes, 7.1%, both had concomitant widening of RNFL defects), and (3) development of new RNFL defects (5 eyes, 17.9%). The inferotemporal meridian (324°—336°) 2.0 mm away from the optic disc center was the most frequent location where RNFL progression was detected. It was reported that 13 eyes (46.4%) had concomitant visual field progression; 61.5% (n = 8) of these had RNFL progression that preceded or occurred concurrently with visual field progression. It was also observed that 42 eyes from 37 patients (22.6%) had visual field progression by trend and/or event analyses without progression in the RNFL thickness map.

Analysis of serial RNFL thickness maps generated by the spectral-domain OCT facilitates the detection of RNFL progression in glaucoma.

The authors of this study aimed to describe the pathoanatomy of diabetic macular edema (DME) in optical coherence tomography (OCT) and its correlation with fluorescein angiography patterns. Based on the concept of the fluid conductivity barrier, they revealed a correlation between the intraretinal location of the leakage source and where the fluid accumulated within the retinal layers.

They analyzed 60 eyes of 56 patients and classified DME into typical focal leakage (from microaneurysm), typical diffuse leakage (the capillary plexus) or combined/questionable leakage using fluorescein angiography and retinal thickness profiles. They also matched leakage and pooling patterns in fluorescein angiography to the corresponding OCT images and analyzed their findings.

The study authors reported that focal leakage shows swelling predominantly in the outer plexiform layer (OPL) and that deeply located microaneurysms directly leak into the loose fiber portion of OPL (Henle layer) through the “fluid conductivity barrier” (synaptic portion of OPL). They also noted that diffuse leakage caused swelling predominantly in the inner nuclear layer and secondarily in the OPL. The deep capillary plexus is located between the two “fluid barriers” (inner plexiform layer and OPL); thus, diffuse leakage is primarily related with swelling in the inner nuclear layer. In the combined/questionable leakage, partial sections consisting of inner nuclear layer swelling and much larger areas of OPL/outer nuclear layer swelling are noticed.

In the following prospective, interventional case series, researchers reported refractive, topographic, aberrometric and tomographic outcomes 24 months after corneal cross-linking (CXL) in patients up to 18 years of age with progressive keratoconus.

A total of 40 eyes underwent riboflavin-ultraviolet A-induced CXL. Researchers evaluated uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), sphere and cylinder, topography, aberrometry, tomography, and endothelial cell counts at baseline and at 1, 3, 6, 12 and 24 months.

Mean logarithm of the minimum angle of resolution (logMAR) baseline UCVA and BSCVA were 0.79 ± 0.21 and 0.39 ± 0.10, respectively. According to the researchers, mean UCVA and BSCVA at 2 years were 0.58 ± 0.18 and 0.20 ± 0.09, respectively. They noted that the improvement in UCVA and BSCVA was significant throughout the postoperative follow-up (p < .05) and that mean spherical equivalent refraction showed a significant decrease of 1.57 D at 24 months (p = .02). They also determined that mean baseline simulated keratometry was 46.32 D in the flattest meridian and 51.48 D in the steepest meridian; at 2 years, the values were 45.30 D (p = .04) and 50.21 D (p = .07), respectively. For a 3-mm pupil, researchers found that there was a significant reduction (p < .05) in whole eye (total), corneal, higher-order, and astigmatic wavefront aberrations at 24 months. They observed a significant difference (p < .05) in total coma and total spherical aberration 2 years after CXL. Moreover, mean baseline pupil center pachymetry decreased significantly (p = .04) at 6 months, but recovered by 12 months and remained stable thereafter through the 2-year follow-up. Endothelial cell counts did not change significantly (p = .32).

In conclusion, CXL improved UCVA and BSCVA in the study patients, most likely by significantly reducing corneal asymmetry and corneal as well as total wavefront aberrations.