Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI.

Purpose: To evaluate changes in the foveal avascular zone (FAZ) area during the postoperative period of macular hole (MH) surgery using the optical coherence tomography angiography (OCTA) and to investigate its relationship to visual acuity (VA). Methods: Consecutive unilateral MH patients who underwent successful MH closure with at least a six-month observation period were studied retrospectively. To evaluate the FAZ area, OCTA images were obtained at the preoperative visit, the first postoperative visit, and the six-month visit. Main outcome measures were postoperative FAZ change and its relationship to VA change after MH closure. Results: Fifty-one cases were studied. The FAZ area was 0.42 ± 0.11 mm² at the preoperative visit, 0.25 ± 0.091 mm² at the first postoperative visit and 0.31 ± 0.11 mm² at the six-month visit. FAZ area at the first postoperative visit was significantly smaller (P < 0.0001) than at the preoperative visit. FAZ area at the six-month visit was significantly greater (P < 0.0001) than at the first postoperative visit, but still significantly smaller (P = 0.0002) compared to the normal fellow eye. The postoperative FAZ area enlargement from the first postoperative visit to the six-month visit was significantly correlated with the postoperative VA recovery (P = 0.0322) and the postoperative photoreceptor reconstruction (P = 0.0213). Conclusions: The FAZ area once decreases along with MH closure; it thereafter increases toward the normal value over time. The postoperative FAZ change was correlated with the VA recovery. Translational Relevance: This study suggests that the postoperative FAZ area enlargement might be a potential biomarker indicating foveal reconstruction after MH closure.

We investigated whether foveal ellipsoid zone (EZ) status affects visual prognosis in eyes with subretinal fluid (SRF) associated with branch retinal vein occlusion (BRVO). We included 38 eyes retrospectively and classified those with or without a continuous EZ on the SRF of the central foveola on the vertical optical coherence tomography (OCT) image at the initial visit as intact (n = 26) and disruptive EZ (n = 12) groups, respectively. In addition, we classified the intact EZ eyes into clear (n = 15) and blurred (n = 11) EZ groups according to whether EZ on the SRF was observed distinctly or not. Multiple regression analyses showed that baseline EZ status significantly correlated (p = 0.0028) with the 12-months logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), indicating that baseline intact EZ significantly improves visual prognosis. The 12-months logMAR BCVA of the intact EZ group was significantly better (p < 0.001) than that of the disruptive EZ group, and did not differ significantly between the clear and blurred EZ groups. Thus, baseline foveal EZ status on vertical OCT images can be a novel biomarker for visual prognosis in eyes with SRF associated with BRVO.

We present a rare case of acute retinal pigment epitheliitis (ARPE) following vaccination. An 18-year-old Japanese man visited our hospital with a 5-day history of a central scotoma in the right eye. He had received the second dose of coronavirus disease 2019 vaccination (BNT162b2 mRNA, Pfizer-BioNTech) 1 month prior, following which he developed a low-grade fever of 37.3–37.5°C for 2 days accompanied by joint pain. Although he had received influenza vaccination 5 days prior to this presentation, no systemic symptoms other than injection site pain were observed. Blood test results were unremarkable. Ophthalmological examination revealed a decimal best-corrected visual acuity (BCVA) of 0.8 and 1.2 in the right and left eyes, respectively. Intraocular pressure was 15 mm Hg in both eyes. Intraocular inflammation was not observed. Fundus examination revealed a localized lesion of pigment stippling associated with yellowish hypopigmentation in the fovea. Fluorescein angiography revealed slight transmission hyperfluorescence without leakage. Optical coherence tomography (OCT) revealed disruption of the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). We diagnosed the patient with ARPE in the right eye. The patient was followed up without treatment. Five weeks after onset, the central scotoma in the right eye disappeared, and patient’s BCVA in the right eye improved to 1.5. OCT showed improvement in ELM and EZ continuity in the right eye, but IZ remained disruptive. Although the exact pathophysiology of the association between ARPE and these vaccinations is unclear, ARPE may develop after the vaccination.