PURPOSE:To evaluate differences in the presentation patterns of Type 3 macular neovascularization (T3 MNV) secondary to age-related macular degeneration in Caucasian and Asian populations. METHODS:This retrospective, multicenter, comparative case series included treatment-naïve T3 MNV patients from Switzerland, Italy, and South Korea. All patients underwent comprehensive multimodal imaging. The topography of T3 MNV foci was mapped relative to the Early Treatment Diabetic Retinopathy Study(ETDRS) grid. Demographic and clinical variables were analyzed with respect to ethnicity, and discriminant score performance was assessed for differentiating Caucasian and Asian populations. RESULTS:A total of 301 eyes (181 European and 120 Korean) from 248 patients were included. Asian patients were significantly younger at presentation(76.1±6.9 vs. 81.1±6.1 years, p<0.001), with T3 MNV lesions located closer to the foveal center (mean distance: 810.7±329.0 vs. 1061.4±300.8 μm, p<0.001). Central ETDRS circle involvement was observed in Asians (17.5% vs 4.4%; p<0.001). Subfoveal choroidal thickness was similar between groups (154.1±72.1 vs. 153.3±71.0 μm, p=0.904). The prevalence of reticular pseudodrusen was higher in Caucasians than in Asians(89.0% vs. 74.2%; p=0.001). Multivariable analysis demonstrated that age(β=0.128, p<0.001), mean foveal distance (β=0.003, p<0.001) and RPD (β=1.150, p=0.003) had the strongest associations with ethnicity. In the discriminant model analysis, age and foveal distance emerged as significant discriminant features (Δ-C-index decreases=0.03 and 0.04, respectively). CONCLUSION:The presentation patterns of T3 MNV in the Caucasian and Asian populations demonstrated both shared and distinct characteristics. These findings suggest that while T3 MNV may involve common pathophysiological mechanisms across ethnicities, certain contributing factors may vary between populations.

Intraretinal hyperreflective foci (IHRF) are a common but pathologically diverse optical coherence tomography (OCT) finding, increasingly recognized as a hallmark of retinal disease activity. IHRF have been described in age-related macular degeneration (AMD), where they may represent migrating retinal pigment epithelium cells, in diabetic retinopathy, retinal vein and artery occlusions, pachychoroid spectrum disorders, inherited retinal dystrophies, and ocular inflammatory diseases. Their appearance reflects a spectrum of underlying processes, including inflammatory cell recruitment, lipid or proteinaceous material deposition, and degenerative tissue remodeling. Advances in OCT technology and multimodal imaging have refined the characterization of IHRF, enabling correlations with histopathology, cytokine profiles, and genetic risk variants. Across diseases, their presence, number, distribution, and temporal evolution have been linked to structural progression, functional decline, and treatment response—serving as early indicators of atrophy or neovascularization in AMD, markers of inflammation and therapeutic responsiveness in vascular retinopathies, and predictors of recurrence or complication in pachychoroid disease. This review provides a comprehensive synthesis of the current literature on IHRF, summarizing their proposed histopathological correlates, multimodal imaging features, molecular associations, prognostic significance, and potential role as biomarkers in a wide range of retinal disorders.

Aims Evaluate the efficacy and safety of faricimab for treatment-naïve and pre-treated diabetic macular oedema (DME) in a real-world setting.Methods This multicentre, retrospective cohort study examined consecutive DME patients treated with faricimab for ≥1 year. Data were collected at predefined time points. Primary outcomes were mean changes in corrected visual acuity (VA), centre-point retinal thickness (CRT) and central subfield thickness (CST) and treatment intervals and adverse events (AEs).Results 184 eyes with DME were included: 61 (33.2%) were treatment-naïve, and 123 (66.8%) were pretreated. In treatment-naïve eyes, VA improved from 69.7±15 Early Treatment of Diabetic Retinopathy Study letters at baseline to 73.9±14.1 after 12 months (p=0.014), while it remained stable in pretreated eyes (71.2±14.2 vs 73.0±12.9; p=0.14). CST decreased significantly in both groups (treatment-naïve (366.1±108.3 µm to 316.4±113.5 µm, p<0.001); pretreated (339.1±93.1 µm to 298.3±65.8 µm, p<0.001)). Thirty-one percent of naïve eyes and 21.1% of pretreated eyes were completely dry after 12 months. In treatment-naïve eyes, the mean treatment interval was 12.7±6.4 weeks at 12 months. In pretreated eyes, the interval increased from 6.0±3.0 to 7.8±3.6 weeks (p<0.001). Over 12 months, 8.1±2.1 and 9.4±2.5 injections were administered to naïve and pretreated eyes, respectively (p<0.001). Of the five recorded AEs, two cases of non-infectious intraocular inflammation and one cerebrovascular event were reported.Conclusion Over 12 months, faricimab demonstrated good efficacy and safety in both treatment-naïve and pretreated eyes with DME. There was a reduction in CST and improved VA in treatment-naïve eyes and stable VA in pretreated eyes. The low number of AEs supports a favourable risk-benefit profile of faricimab in a real-world setting.

Schlaegel lines (SL) represent distinctive curvilinear patterns of chorioretinal atrophy that have emerged as a distinctive, yet non-pathognomonic, funduscopic sign across diverse ocular disorders. First described as related to presumed ocular histoplasmosis syndrome in the early 1980s in Histoplasma-endemic regions, these peripheral fundus lesions have since been documented across numerous other etiologies. The majority of SL arise in the context of inflammatory chorioretinal disorders, with idiopathic multifocal choroiditis and punctate inner choroiditis constituting the most frequent underlying causes. SL can also occur in a subset of inherited retinal diseases, where they may represent a secondary acquired sign of outer retinal damage. SL demonstrate a predilection for young to middle-aged myopic women. On fundus examination, SL appear as linear atrophic spots or streaks with variable pigmentation. Optical coherence tomography demonstrates retinal pigment epithelium-Bruch membrane-choriocapillaris complex disruption or, when SL are detected during the active inflammatory phase, hump-like hyperreflective RPE elevations. The differential diagnosis of SL requires recognition of the characteristic multimodal imaging patterns to distinguish them from mimicking conditions, such as Verhoeff lines and West Nile chorioretinitis. A comprehensive understanding of the diverse etiologies of SL is essential for accurate diagnosis and appropriate clinical management.

PURPOSE:To characterize early outer retinal changes at the site of origin of subretinal fluid (SRF) in central serous chorioretinopathy (CSCR). To investigate their pathophysiologic and clinical significance. DESIGN:Retrospective, nonconcurrent, multicenter cohort study. SUBJECTS:A total of 87 eyes of 87 patients with primary or recurrent CSCR (episode duration <4 months) and one or more fluorescein angiographic leaks. METHODS:In a series of cases of recently active CSCR, we analyzed changes occurring in the retina and subretinal space at the site of fluorescein leaks, taking into account similar finding already reported in the literature. Following the distinction of two basic findings definable as outer retinal erosion (ORE) and outer retinal pinching (ORP), we investigated associated clinical and morphological patterns. Volumetric quantification of SRF and pigment epithelial detachment (PED) was performed using artificial intelligence-enhanced algorithms (Discovery, RetinAI). Three-dimensional configurations of SRF volumes performed using custom scripts (MATLAB, MathWorks) provided complementary visualization of the retinal changes. Sixty patients had available follow-up of median 19 months. In these patients, time-to-event analysis with stratified log-rank test was performed to evaluate the development of foveal atrophy and posterior cystoid retinal degeneration (PCRD). MAIN OUTCOME MEASURES:SRF and PED volume. Development of foveal atrophy and PCRD. RESULTS:The cohort was divided according to the presence of ORE (43/87) and ORP (44/87) findings. ORP cases showed more frequent history of steroid use (40.9% vs 18.6%, P = .011), significantly higher SRF volumes (median 1763 vs 720 nL, P = .0005), more frequent PEDs (77.3% vs 46.9%, P = .027), and higher PED volumes (median 14.5 vs 0 nL, P = .0002). PCRD developed exclusively in ORP+ cases (7/28 eyes), with a median time to occurrence of 225 days, with no event in the ORE+ group (0/32 eyes). PCRD had an incidence of 0 versus 15.4 events per 100 person-years in ORE+ and ORP+ groups, and was associated with lower best-corrected visual acuity at the event (median = 0.3 vs 0.1 logMAR). No case developed foveal atrophy during the follow-up. CONCLUSIONS:ORE and ORP are two distinct disease pathways in CSCR. ORP cases, characterized by focal retinal pigment epithelium photoreceptor adherence and high-volume SRF, show significant risk of transition toward PCRD and limited visual loss.

To investigate the influence of macular drusen phenotypes on dark adaptation (DA) in intermediate age-related macular degeneration (iAMD). This cross-sectional, multicentric study enrolled 57 eyes of 43 iAMD patients. Drusen were subclassified as cuticular, soft, reticular pseudodrusen (RPD), or combined soft + RPD based on multimodal imaging. Dark adaptometry (AdaptDx; 20-minute test-time) assessed DA function through rod intercept time (RIT), last measured log sensitivity (LMLS; primary outcome) and area under the DA curve (AUDAC; secondary outcome). OCT volumes (30°x20° field) were analyzed using an AI-enhanced algorithm providing a quantification of chorioretinal layers and pigment epithelium detachments (PED) volumes. Multivariable tobit and linear regression analyzed associations between drusen phenotypes and DA outcomes. Drusen phenotype distribution was: cuticular 13 eyes (22.8

Purpose:To characterize structural phenotypes in intermediate and advanced non-neovascular age-related macular degeneration (AMD) using flood-illumination adaptive optics (FIAO) and to explore their relationship with established multimodal imaging biomarkers, including OCT-based atrophy classifications. Design:Prospective, cross-sectional observational study. Subjects:A total of 208 eyes from 117 patients (mean age 74 years; 63% female) with intermediate AMD (iAMD) or geographic atrophy (GA) were enrolled. Eligible participants had visual acuity ≥20/63, refractive error between -6 and +2 diopters, and sufficient media clarity for high-quality imaging. Methods:Participants underwent multimodal imaging, including color fundus photography, spectral-domain OCT, infrared reflectance, fundus autofluorescence, and FIAO. Structural phenotypes (drusen, subretinal drusenoid deposits, pigmentary changes, and GA margins) were assessed qualitatively across modalities. Flood-illumination adaptive optics features were compared with OCT-based atrophy classifications (incomplete and complete retinal pigment epithelium and outer retinal atrophy [iRORA and cRORA]) using descriptive analyses and cross-tabulation. Main Outcome Measures:Prevalence and multimodal characteristics of AMD structural phenotypes, and their correspondence with FIAO features. Results:Drusen and pigmentary abnormalities were detected in the majority of eyes across modalities, with variability in prevalence depending on imaging technique. Flood-illumination adaptive optics identified drusen in 70% of eyes revealing a consistent reflectivity pattern of hyperreflective borders and hyporeflective centers. Hyporeflective clumps corresponding to pigmentary changes were always observed on FIAO, frequently localizing to areas of atrophy or transition zones. Distinct FIAO-defined GA border phenotypes were observed, including well-demarcated and indistinct margins. In descriptive cross-tabulation, well-demarcated FIAO borders were more frequently associated with OCT-defined cRORA, whereas indistinct or hyporeflective margins were with iRORA. Conclusions:Flood-illumination adaptive optics provides high-resolution visualization of structural features in iAMD and GA, revealing distinct patterns of drusen, pigmentary changes, and atrophic margins. While certain FIAO features show qualitative correspondence with OCT-defined atrophy stages, these relationships remain descriptive. Further quantitative and longitudinal studies are needed to determine their clinical relevance and role in disease characterization. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

This study was conducted as a retrospective, exploratory analysis to assess early anatomical and functional effects of intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (nAMD) in a small cohort of patients. This retrospective study was conducted at the Jules Gonin Eye Hospital in Lausanne, Switzerland, and included treatment-naïve patients with nAMD. Patients received a minimum of two intravitreal injections (IVT) of aflibercept 8 mg over a 3-month period. Key outcomes assessed were changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), mean retinal thickness (RT), total fluid (TF) volume which was calculated as the sum of intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) volumes. These parameters were evaluated at baseline, month 1, and month 3 using the RetinAI Discovery® platform, an artificial intelligence-based analysis system. 10 eyes of 10 patients were enrolled. Mean age was 77.7 ± 12.5 years. Comparative analysis between baseline, month 1, and month 3 revealed statistically significant reduction in CST, RT and TF volume, indicating a positive early response to treatment. One adverse event of intraocular inflammation (IOI) occurred in one patient (10

PURPOSE:To evaluate whether intraocular and ocular perfusion pressure (IOP and OPP, respectively) are significantly associated with central serous chorioretinopathy (CSCR) and compare their degree of disease prediction with that of anterior scleral thickness (AST). DESIGN:Cross-sectional study comparing cases and controls. SUBJECTS:Eighty patients with CSCR and 80 healthy controls. METHODS:Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected with an automatic electronic sphygmomanometer, and IOP was determined using Goldman tonometry. Mean OPP was calculated as MOPP = ⅔ [DBP + ⅓ (SBP-DBP)] - IOP. AST was obtained at nasal and temporal gaze positions. Logistic regression models were computed to determine the correlation between risk factors and the presence of the disease. The ROC curve was used to compare the disease probability across different classifier models and determine the best cut-off values ​to distinguish patient subgroups. MAIN OUTCOME MEASURES:IOP, blood pressure measurements, and AST. RESULTS:Patients with CSCR showed greater AST (498 ± 55 vs 455 ± 40 μm, P = .03) and choroidal thickness (435 ± 106 vs 321 ± 76 μm, p < .001), higher blood pressure (SBP: 130.6 ± 13.4 vs 124.8 ± 5.6 mm Hg, P = .001; DBP: 82.8 ± 9.6 vs 77.0 ± 7.1 mm Hg, p < .001), and lower IOP (12.7 ± 1.8 vs 16.1 ± 1.6 mm Hg, P < .001) than the controls, resulting in higher MOPP (57.3 ± 6.6 vs 51.2 ± 3.9 mm Hg, p < .001). ROC curve analysis revealed IOP as the strongest disease predictor (AUC = 0.914), significantly superior to MOPP (AUC = 0.813, P = 0.0096) and AST (AUC = 0.737, P = 0.0001). Using best cut-offs (IOP ≤ 14 mm Hg; AST > 454.5 μm), we identified two distinct CSCR subgroups: 13 eyes with low IOP and 12 with high AST. Both groups displayed similar structural chorioretinal biomarkers and systemic hemodynamic findings. CONCLUSIONS:This study demonstrates a significant association of low IOP, high MOPP, and high AST values with CSCR. IOP was a more significant predictor of CSCR than the other two factors, indicating its major role in the pathogenesis of the disease. Low IOP can promote CSCR pathogenesis by increasing the OPP, which favors choroidal overperfusion and exudation, and reducing the interstitial fluid clearance across the sclera.

Abstract Background This study evaluates the efficacy of intravitreal Faricimab in reducing pigment epithelium detachment (PED) and fluid volumes in both treatment-naïve eyes and eyes unresponsive to anti-VEGF mono-therapies, all diagnosed with type 1 macular neovascularization (T1 MNV) over a period of 12-month. Methods A retrospective, single-center cohort study was conducted at the Jules Gonin Eye Hospital, Lausanne, Switzerland. Clinical records of treatment-naïve and non-responder switch patients presenting T1 MNV secondary to neovascular age-related macular degeneration (nAMD) from September 2022 to March 2023 were reviewed. Patients received a loading dose of three monthly Faricimab injections followed by a treat-and-extend (T&E) regimen. Multimodal imaging, including structural OCT and AI-assisted analysis, was used to quantify PED volumes and related fluid biomarkers at baseline, 3-month, 6-month, and 12-month follow-up. Statistical analyses included linear mixed models to evaluate differences and trends in intraretinal (IRF), subretinal fluid (SRF) and PED volumes. Results 65 eyes of 65 patients were enrolled (female: 70.7%; mean age = 80.7yrs, SD = 6.9yrs). 80% had received anti-VEGF treatment (Switch group) and 20% were treatment-Naïve at baseline. At 12 months, intravitreal treatments were more frequent in the Switch group (mean number = 8.3 vs. 6.0; p = 0.009). BCVA improved at the 12-month follow-up in Naïve eyes (+ 6.9 ETDRS letters from baseline, p = 0.053) and was maintained in Switch eyes. No cases of intraocular inflammation were observed. Significant reduction in SRF and IRF volumes were noted in both groups. A significant reduction in PED volume was observed over the follow-up period in both groups (mean slope = -206 nL, 95%CL = -273/-138; p-value < 0.001). Conclusions Intravitreal Faricimab significantly reduced PED volumes in both treatment-Naïve and non-responder Switch patients over 12 months. The study highlights Faricimab’s potential as an effective treatment option for T1 MNV in nAMD, offering significant improvements in PED volume and related fluid biomarkers.

Purpose: To investigate the incidence, timing, dimensional features, and spatial characteristics of telangiectatic capillaries (TelCaps) in retinal vein occlusion (RVO) patients treated with anti-VEGF monotherapy. Design: Prospective nonconcurrent cohort study. Participants: One hundred thirty-eight eyes of 138 patients with treatment-naive RVO treated with anti-VEGF monotherapy for a minimum of 24 months. Methods: Telangiectatic capillaries were identified using multimodal imaging, including indocyanine green angiography (ICGA), OCT, and color fundus photography. Recurrence of venous occlusive events was defined by new onset of retinal hemorrhages accompanied by worsening of macular edema. Cox regression modeling was used to assess risk factors for TelCap development. Main Outcome Measures: Telangiectatic capillaries' incidence, dimensional features, spatial distribution, and association with RVO recurrence events. Results: Over 4.4 +/- 2.6 years of follow-up, TelCaps developed in 15/138 eyes (10.9%) after 26 +/- 16 months. Telangiectatic capillaries in hemispheric and central RVO showed larger diameters compared with branch RVO (277 +/- 44 mm vs. 196 +/- 43 mm, P-0.005) and preferential localization along the temporal horizontal raphe (y-axis coordinates: 0.4 +/- 0.6 mm vs. 0.9 +/- 0.7 mm, P-0.017). The recurrence of RVO during follow-up was significantly associated with TelCap development (hazard ratio-8.74, 95% confidence limit-2.92-26.2, P < 0.001). At 5-year follow-up, the risk of developing TelCaps was-9% in patients without recurrence and-55% in those patients with recurrence. Conclusions: Telangiectatic capillaries occur in approximately 10% of RVO cases undergoing intravitreal anti-VEGF monotherapy, with distinct characteristics based on RVO subtype. The strong association with disease recurrence suggests episodes of increased venous obstruction contribute to TelCap formation. Extended follow-up and vigilant screening are recommended; when TelCaps are suspected, ICGA can confirm the diagnosis and guide adjunctive targeted treatment. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. Ophthalmology Science 2025;5:100754 (c) 2025 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Focal capillary ectasia in the macular region can manifest in distinct clinical scenarios, which can be categorized into two main entities: perifoveal vascular anomalous complex (PVAC) and telangiectatic capillaries (TelCaps). PVAC represents a primary, idiopathic condition, whereas TelCaps occur secondary to underlying vascular disorders, including diabetic macular edema and retinal vein occlusion. We provide a comprehensive analysis of these two entities, encompassing their clinical presentations, multimodal imaging findings, histological evidence, and differential diagnosis from other retinal microvascular abnormalities, such as Type 1 macular telangiectasia, adult-onset Coats disease, Type 3 macular neovascularization in age-related macular degeneration, and retinal arterial macroaneurysms. Although PVAC and TelCaps are distinct entities, they may share common pathogenic mechanisms, including progressive endothelial dysfunction, pericyte loss, and intraluminal deposition of blood components. Selective laser photocoagulation has emerged as a promising therapeutic approach for both conditions. The proposed standardization of nomenclature for accurate reporting and meaningful cross-study comparisons is expected to facilitate future advancements in this field, ultimately leading to improved patient outcomes.

Bacillary layer detachment (BALAD) refers to the distinctive splitting at the level of the photoreceptor inner segment myoid and accumulation of intraretinal fluid, as seen on optical coherence tomography (OCT). BALAD is an increasingly recognized OCT biomarker of numerous heterogeneous chorioretinal diseases, including posterior uveitis, age-related macular degeneration and macular neovascularization, neoplastic and paraneoplastic retinal disorders, rhegmatogenous retinal detachment, blunt ocular trauma, and miscellaneous conditions. The recognition of BALAD is clinically relevant because, based on the specific etiology, BALAD may require simple observation, ocular or systemic medical treatment, or even surgical intervention, with subsequent different prognosis. We discuss and summarize the clinical and prognostic significance of BALAD in the different chorioretinal disorders in which it has been described.

Background The aim of our study is to describe clinical features, therapy, and outcome of children with inflammatory choroidal neovascularization (CNV). Methods Retrospective case series of children seen at the Jules-Gonin Eye Hospital between 2000 and 2024 with macular choroidal neovascularisation secondary to ocular inflammation. Results Four children (one male, three females) developed a retro-foveolar neovascular membrane after a median time of 2.5 months (range 1 - 16 months) following uveitis onset. The median age at presentation was 12 years (range 5 - 12 years). The CNV presentation was unilateral in all four cases, with three patients having posterior uveitis and one panuveitis. Two patients had idiopathic bilateral granulomatous uveitis while the other two had suspected toxoplasmosis chorioretinitis. Idiopathic cases were treated with oral steroids, with one patient being additionally treated with adalimumab. Toxoplasmosis cases were managed with antibiotics and oral steroids. CNV treatment involved a single anti-VEGF injection in two cases, six injections in one case, and no injection in one case due to CNV inactivity. Median follow-up period was 4.25 years (range 0.75 to 11 years) and the median final best-corrected visual acuity was 0.9 (range 0.6 - 1.25). No recurrence of CNV was observed, despite uveitis reactivation in two cases. Conclusion Anti-VEGF therapy is safe even in young children with minimal injections required to control the disease. Treating the underlying cause of uveitis with appropriate therapy is also crucial.

PURPOSE:To assess the reliability of en face swept-source OCT (SS-OCT) imaging for quantifying macular atrophy in patients with neovascular age-related macular degeneration (AMD) and evaluate its limitations compared to green autofluorescence (GAF) imaging. METHODS:This prospective observational study included 30 patients with macular atrophy associated with neovascular AMD previously treated with anti-VEGF therapy. Multimodal imaging included GAF and en face SS-OCT. Macular atrophy was quantified as regions of hypoautofluorescence on GAF and hypertransmission defects (hyperTDs) on en face SS-OCT. Two masked graders measured atrophy size, followed by qualitative analysis of inter-modality discrepancies. Statistical comparisons were conducted using the Wilcoxon test and Spearman correlation. RESULTS:Mean macular atrophy size was 5.96 ± 4.48 mm² on SS-OCT and 7.10 ± 5.47 mm² on GAF, with a significant difference (p < 0.001) but strong correlation (ρ = 0.998, p < 0.001). Discrepancies arose due to hyperpigmentation obscuring hyperTDs and macular haemorrhages on SS-OCT underestimations of atrophy. Additionally, fibrosis also reduced choroidal hypertransmission, complicating hyperTD detection on SS-OCT. Border delineation inconsistencies were also observed, with diminished autofluorescence on GAF not always corresponding to hyperTDs on SS-OCT. CONCLUSIONS:En face SS-OCT is a reliable imaging modality for quantifying macular atrophy in neovascular AMD, with strong correlation to GAF measurements. However, hyperpigmentation, fibrosis, haemorrhages, and variability in border delineation introduce significant challenges. These findings underscore the need for careful interpretation of atrophy metrics and highlight the importance of addressing inter-modality discrepancies in clinical and research applications.

PURPOSE:To report the efficacy and safety of switching to faricimab in a real-world, Swiss cohort of patients with pretreated neovascular age-related macular degeneration (nAMD). DESIGN:Retrospective, multicenter, longitudinal observational study conducted at 11 centers of the Swiss Retina Research Network. SUBJECTS:We included 353 eyes of 325 patients who were switched to intravitreal faricimab after prior anti-VEGF therapy and followed for a minimum of 12 months between May 1, 2022, and October 30, 2024. METHODS:Demographic characteristics, baseline functional and OCT findings, treatment history, and outcomes at 12 months after switch to faricimab were extracted from the patients' electronic case report forms. MAIN OUTCOME MEASURES:Change in best-corrected visual acuity (BCVA), central subfield thickness (CST), presence of retinal fluid (RF) and pigment epithelial detachment, treatment intervals, and safety signals. RESULTS:Twelve months after switch, mean BCVA remained unchanged, whereas mean CST decreased from 315.3 to 263.9 μm (P < 0.01). Fast drying (absence of RF) after 1 faricimab injection was observed in 134 eyes (38%) and correlated positively with the treatment interval at 12 months (r(301) = 0.24; P < 0.01). After 12 months, 169 (47.9%) eyes demonstrated the absence of RF compared with 10.2% at switch. Mean treatment interval increased from 5.8 ± 2.5 weeks at switch to 8.3 ± 4.2 weeks at 12 months, and extended treatment intervals (≥12 week) were achieved in 20% of patients. Mild intraocular inflammation was reported in 1.7% of cases. CONCLUSIONS:Switching to faricimab in pretreated nAMD led to sustained anatomic improvements and stabilization of BCVA, with a substantial reduction in RF compared with baseline. Our results suggest the potential benefits of this switching strategy based on real-world data. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: To characterize, using clustering analysis, the OCT morphological and clinical phenotypes of diabetic macular edema (DME) in a very large population (>2000 DME eyes) using standardized and validated OCT-based biomarkers. Methods: A cross-sectional study was conducted on OCT scans collected from 2355 eyes of 1688 patients with DME and performed during real-world clinical practice. OCT scans were automatically analyzed by a software able to automatically quantify OCT key biomarkers: intraretinal fluid (IRF), subretinal fluid (SRF), hyperreflective retinal foci (I-HRF), and external limiting membrane (ELM) and ellipsoid zone (EZ) interruption. Clustering analysis was performed using the above-mentioned biomarkers, including the distribution of IRF across the three ETDRS rings. Results: The overall population was predominantly composed of type 2 diabetes patients (89%), with a mean diabetes duration of 15.6 ± 10.7 years and mean best corrected visual acuity (BCVA) of 63 ± 18 ETDRS letters. Multivariate clustering identified four morphological phenotypes with distinct patterns of fluid distribution associated with different I-HRF counts, SRF volume, and percentages of ELM/EZ integrity (p < 0.0001). Conclusions: This large OCT analysis identified distinct morphological subtypes of DME, confirming the clinical relevance of key imaging biomarkers. The distribution and severity of DME features differ among clusters, supporting the importance of OCT-based phenotyping in tailoring treatment strategies and understanding disease evolution.

BACKGROUND:The aim of the study is to investigate the short- and long-term effects of delayed intravitreal anti-VEGF injections (IVI) for macular edema (ME) in retinal vein occlusion (RVO) patients during the first wave of the COVID-19 pandemic. METHODS:This is a retrospective observational study analyzing a cohort of patients followed at the medical retina department of the Jules Gonin Eye Hospital. During the COVID-19 lockdown, treatment for patients with ME secondary to RVO was deferred due to emergency federal dispositions. The impact on best corrected visual acuity (BCVA) and on OCT changes (i.e. central subfield thickness (CST), intraretinal fluid (IRF), and subretinal fluid (SRF)) were assessed at several time points before and after the lockdown over a 2-year period. The OCT parameters were assessed by the mean of an artificial intelligence (AI) software (Discovery, RetinAI). RESULTS:A total of 64 patients were included in the study. BCVA significantly decreased following a mean treatment delay of 10 weeks. However, BCVA returned to baseline levels after 6 months, with no significant differences observed after 2-years of follow-up. OCT analysis revealed an increase in CST, IRF and SRF following the treatment delay, which decreased and return to pre-lockdown values after 3 months. No significant differences in OCT parameters were observed at the two-year follow-up. CONCLUSION:The results of our study suggest that delaying IVI for RVO patients during the COVID-19 lockdown resulted in a temporary decline in BCVA and a recurrence of ME. However, these effects were not sustained long term, as both BCVA and ME control returned to baseline levels by 6 months, with no significant changes observed at the two-year follow-up.

Central serous chorioretinopathy (CSCR) is a retinal disease characterised by the accumulation of subretinal fluid, which often resolves spontaneously in acute cases. However, approximately one-third of patients experience recurrences that may cause severe and irreversible vision. This study aimed to identify parameters derived from optical coherence tomography (OCT) that are associated with CSCR recurrence. Our dataset included 5211 OCT scans from 344 eyes of 255 patients diagnosed with CSCR. 178 eyes were identified as recurrent, 109 as non-recurrent, and 57 were excluded. We extracted parameters using artificial intelligence algorithms based on U-Nets, convolutional kernels, and morphological operators. We applied inferential statistics to evaluate differences between the recurrent and non-recurrent groups, and we used a logistic regression predictive model, reporting the coefficients as a measure of biomarker importance. We identified nine predictive biomarkers for CSCR recurrence: age, intraretinal fluid, subretinal fluid, pigment epithelial detachments, choroidal vascularity index, integrity of photoreceptors and retinal pigment epithelium layer, choriocapillaris and choroidal stroma thickness, and thinning of the outer nuclear layer, and of the inner nuclear layer combined with the outer plexiform layer. These results could enable future developments in the automatic detection of CSCR recurrence, paving the way for translational medical applications.