Purpose. Ellipsoid zone (EZ) integrity is identified as a potential biomarker for therapy surveillance and outcome prediction of visual acuity (VA). However, only a few studies report long-term results of over 1 year of clinical and anatomical changes in patients with diabetic macular edema (DME). This study is aimed at describing the long-term VA and anatomical outcomes in spectral domain optical coherence tomography (OCT) (relative ellipsoid zone reflectivity ratio, central macular thickness, and volume) in patients with DME treated with antivascular endothelial growth factor (anti-VEGF) therapy. Furthermore, we studied the correlation between EZ integrity and changes in visual acuity. Methods. 71 eyes of 71 patients were included in this retrospective study. Clinical characteristics were reviewed yearly. OCT data were assessed at baseline and after 1, 3, and 5 years. EZ parameters were quantified automatically. OCT parameters and visual outcome were correlated and analyzed in multivariable regression models. Results. EZ reflectivity ratio correlated with functional outcome in DME patients from baseline to fifth year at all time points (for all ). EZ reflectivity improved the most in the first year of treatment (0.68 to 0.75; ) and declined gradually until year 5 of therapy (0.71; compared to baseline ). Similarly, best VA was achieved after 1 year (0.40 logarithm of the minimum angle of resolution (logMAR) to 0.28 logMAR; ) and declined gradually until year 5. Final VA in year 5 was comparable to baseline (0.45 logMAR, compared to baseline ). Together with baseline VA, baseline EZ parameters did predict VA outcome after 1 year ( ). Concordantly, VA and EZ parameters from year 1 were associated with VA outcome in year 2. Conclusion. This study described the long-term course of EZ changes during anti-VEGF treatment in DME patients. In addition, our results underlined the potential of EZ parameters as novel OCT biomarkers for prediction of VA outcomes during therapy.

The efficacy of the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (ILUVIEN) in the treatment of non-infectious uveitic macular edema (UME) was assessed on twenty-six patients (34 eyes) with non-infectious UME between 2013 and 2020, in a mean follow-up of 18 ± 19.3 (mean ± SD) months. Macular edema was resolved in 24 (70.6%) cases. Five of these eyes had a relapse after 23.2 ± 14 months. Three FAc reinjections were performed and a drying of the macula was observed. After FAc implantation, 24 eyes (70.6%) were completely dry; central retinal thickness (CRT) decreased in 6 eyes (17.6%), but residual intraretinal fluid was still evident. In 20 eyes (58.5%), visual acuity (VA) improved (from +1 to +5 lines) and remained stable in 9 eyes (26.5%). Thirty eyes (88.2%) were pseudophakic at baseline and four were phakic. Three of these eyes had a cataract prior to therapy and the other developed a cataract 2.5 years after the FAc implant was administered. There was an overall increase in intraocular pressure (IOP; +4.4 ± 3.7 mmHg) and eye drops were required in three eyes. The FAc implant led to long-term improvements in mean CRT and VA, and that the side-effect profile was manageable in a clinical setting in patients with non-infectious UME.

The recently introduced term “two-photon vision” relates to the visual perception resulting from a simultaneous absorption of two photons by photoreceptors. In this study, we determined two-photon retinal sensitivity in age-related macular degeneration (AMD) and compared it that in normal aging. Microperimetry was performed with visible (white) light and infrared (IR) light, which was perceived as green in the two-photon stimulation. In total, 45 subjects were included with one (better) eye studied. Furthermore, best-corrected visual acuity (VA) and ocular straylight were assessed. AMD resulted in decreased median (interquartile range) logMAR VA, i.e., 0.15 (0.05; 0.24), which in normal eyes was −0.02 (−0.06; 0.02). The two groups showed comparable straylight levels. Sensitivity to IR light was significantly lower in the AMD group (p < 0.001): 8.3 (7.4, 9.3) dB than in controls 10.7 (9.7, 11.2) dB. AMD also significantly affected visible light sensitivity (p < 0.001): 14.0 (11.0; 15.5) dB vs. 18.0 (16.3; 18.9) dB. Notably, the two-photon approach yielded a lower data spread. In conclusion, AMD considerably impairs retinal sensitivity measured in the single- and two-photon realm. However, two-photon-vision microperimetry may improve the testing accuracy and offer an additional diagnostic parameter (beyond VA measurements) for retinal function assessment.

Preoperative and postoperative diagnostics play an important role in ensuring the safety of patients with phakic intraocular lenses (pIOLs). The risk of endothelial cell loss can be addressed by regularly measuring the endothelial cell density using specular microscopy and considering the endothelial cell loss rate and the endothelial reserve in accordance with the patient’s age when deciding whether to explant a pIOL. The anterior chamber morphometrics, including the anterior chamber depth and the distance between the pIOL and the endothelium, measured using Scheimpflug tomography and anterior segment optical coherence tomography (AS-OCT), can help to assess the risk of the endothelial cell loss. In patients undergoing posterior chamber pIOL implantation, accurate prediction of the vault and its postoperative measurements using AS-OCT or Scheimpflug tomography are important when assessing the risk of anterior subcapsular cataract and secondary glaucoma. Novel approaches based on ultrasound biomicroscopy and AS-OCT have been proposed to increase the vault prediction accuracy and to identify eyes in which prediction errors are more likely. Careful patient selection and regular postoperative follow-up visits can reduce the complication risk and enable early intervention if a complication occurs.

To compare automated customized ray-tracing-guided laser in situ keratomileusis (LASIK) with wavefront-optimized LASIK by assessing intraindividual refractive and visual acuity outcomes. Prospective, interventional, randomized, double-blinded, contralateral-eye comparison. Thirty patients (60 eyes) with myopia and myopic astigmatism. Ray-tracing-guided LASIK, termed wavelight plus (Alcon), was performed in one eye and wavefront-optimized LASIK in the fellow eye. For wavelight plus, the ablation profile was calculated automatically by ray-tracing, using only objective measurements obtained with a single diagnostic device. The manifest refraction was used for planning wavefront-optimized LASIK treatment. Manifest refraction spherical equivalent (MRSE), refractive cylinder, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, safety and efficacy indices were analyzed. The primary endpoint was the percentage of eyes with a MRSE within ±0.50D at 3 months, tested for non-inferiority of wavelight plus. At 3 months after wavelight plus and wavefront-optimized LASIK, MRSE was within ±0.50D in 100% (95%CI: 88.6-100%) and 90.0% (95%CI: 74.4-96.5%) of eyes, and within ±0.25D in 83.3% (95%CI: 66.4-92.7%) and 76.7% (95%CI: 59.1-88.2%) of eyes, respectively (wavelight plus non-inferior for ±0.50D, p0.05). The mean monocular UDVA was -0.11±0.07 logMAR and -0.09±0.09 logMAR, while the monocular CDVA was -0.14± 0.05 logMAR and -0.13±0.06 logMAR after wavelight plus and wavefront-optimized treatments, respectively (p>0.05). UDVA was ≥20/20 in 100% (95%CI: 88.6-100%) and 93.3% (95%CI: 78.7-98.2%) of eyes, and ≥20/16 in 83.3% (95%CI: 66.4-92.7%) and 73.3% (95%CI: 55.6-85.8%) of eyes after wavelight plus and wavefront-optimized LASIK, respectively. The efficacy index was 1.01±0.14 and 0.98±0.16, while the safety index was 1.08±0.13 and 1.07±0.14 for wavelight plus and wavefront-optimized LASIK, respectively (p>0.05). The automated ray-tracing-guided LASIK treatment wavelight plus had a high safety and efficacy, with comparable visual acuity outcomes to those after wavefront-optimized LASIK. Without the need of manifest refraction, wavelight plus achieved non-inferior refractive outcomes and a slightly higher accuracy in MRSE.