Introduction: To explore visual and anatomical outcomes in patients who underwent intravitreal anti-vascular endothelial growth factor injection for visual impairment from center-involved diabetic macular edema (CI-DME) in clinical practice. Methods: Medical records of consecutive CI-DME patients who initiated treatment with intravitreal bevacizumab injection between Jan 2012 and Dec 2016 and were followed for at least 12 months were retrospectively reviewed. Visual and anatomical changes after treatment over a 36-month period were evaluated. Results: There were 286 patients (423 eyes) with a mean (SD) age of 56.8 (8.5) years included in this study. One hundred and forty-six (51%) patients were female and 137 (47.9%) patients received bilateral-eye treatment. Mean (SD) presenting visual acuity (VA) of overall eyes was 50.2 (19.6) letter scores. Stratified by baseline vision, eyes with initial VA worse than 20/40 achieved a statistically significant VA improvement, compared to baseline, by +8.4, +6.9, and +5.4 letters at 12, 24, and 36 months, respectively with all p values < 0.001. However, when initial VA was 20/40 and better, a non-statistically significant change in mean VA by +2.0, -3.5, and -3.6 letters were noted at the same time-point (p value between 0.078 to 0.273). Unlike visual changes, a statistically significant decline in central subfield thickness compared to baseline was noted at the end of month 12, 24, and 36 in both initial VA subgroups (all p values < 0.001). Nevertheless, even though the median number of given injections considerably decreased from 6 in the first 12 months to 2 in the second 12-month period and 1 in the final 12-month interval. Required ophthalmic clinic visits decreased in frequency with median numbers of 10, 7 and 6 appointments in each consecutive 12-month duration. Conclusion: This study supports the benefits of practical intravitreal anti-VEGF utilization to manage CI-DME in real-world settings. The improvement of vision in eyes presenting with poor baseline VA and a maintenance of vision in eyes with better baseline VA were demonstrated through the 3-year review of each case. However, the burden of frequent monitoring warrants further evaluation of long-term compliance and efficacy.

Background To explore the association of clinical characteristics and retinal microstructural features on optical coherence tomography in predicting 1-year visual response following intravitreal bevacizumab injections in eyes with visual impairment from center-involved diabetic macular edema (CI-DME). Methods Medical records of patients with visual impairment from CI-DME, who initiated intravitreal bevacizumab injections between Jan 2012 and Dec 2016 and were followed for a minimum of 12 months were retrospectively reviewed. Results The study included 226 eyes with a mean (SD) baseline visual acuity (VA) of 51.8 (19.1) letters. At week 12, following the three initial treatments, a mean (SD) VA improved to 61.7 (17.8) letters. Visual gain ≥ 10 letters was observed in 109 eyes (48.2%), while a limited early visual gain < 5 letters was noted in 80 eyes (35.4%). At one year, 110 eyes (48.7%) achieved a good VA gain ≥ 10 letters. In addition, eyes with poor baseline VA had a higher proportion of eyes that obtained limited early VA gained at week 12 (< 5 letters) and maintained in this visual response category at moth 12 compared to eyes with better baseline VA (74.1% versus 59.1%). In the multivariable logistic regression, the following factors reduced the probability of 1-year visual gain ≥ 10 letters: elderly (p = 0.040), better baseline vision (p = 0.001), and limited early visual gain < 5 letters at week 12 (p < 0.001). In multivariable linear regression, male (p = 0.010) and eyes with the presence of hyperreflective foci on baseline OCT (p = 0.010) were likely to have higher VA improvement. However, eyes with better baseline VA (p = 0.002), limited early VA gain at week 12 (p < 0.001), and a presence of EZ disruption at week 12 (p = 0.002) were likely to have less VA improvement. Conclusions Although bevacizumab is considered as effective management for CI-DME, variability in treatment responses is expected. This study revealed that baseline characteristics and visual responses at week 12 might help predict the long-term treatment response. Eyes with characteristics at risk of limited long-term visual outcome may require attention in optimizing their individual treatment strategies.

Aims To investigate susceptible human leukocyte antigen (HLA) alleles and their associations with clinical features in Thai patients with Behçet's disease (BD). Method Eighteen HLA‐A and 36 HLA‐B alleles were determined in 42 Thai BD patients and 99 healthy controls (HCs) by reverse line blot assay, and reconfirmed by MICRO SSP assay. Results The BD patients had significantly higher allele frequency (AF) of HLA‐B*51 than the HCs (13.10% vs 5.05%, P = .025). The AF of HLA‐A*26, ‐A*26:01 and ‐B*51:01 also was higher and almost reached statistical significance (5.59% vs 1.52%, P = .054, 5.95% vs 1.52%, P = .054 and 10.71% vs 4.04%, P = .051, respectively). However, the BD patients had significantly higher AF of either HLA‐A*26:01 or ‐B*51:01 (16.67% vs 5.56%, P = .005), or ‐A*26:01 or ‐B*51X (19.05% vs 6.56%, P = .003). The AF of HLA‐B*51:01 and ‐B*51X increased significantly in ‐A*26:01 non‐carrier BD patients (12.16% vs 4.17%, P = .024 and 14.86% vs 5.21%, P = .019, respectively); and that of HLA‐A*26:01 was significantly higher in ‐B*51X non‐carrier BD patients (7.58% vs 1.67%, P = .034). HLA‐B*51:01 associated significantly with the presence of posterior uveitis and visual impairment (18.18% vs 2.50%, P = .031 for both conditions). HLA‐B*51:01 was not observed in BD patients with gastrointestinal involvement or arthritis. Furthermore, the AF of HLA‐B*51:01 was significantly higher in HLA‐A*26:01 non‐carrier BD patients without arthritis (17.30% vs 0%, P = .050). Conclusion HLA‐B*51:01 was a susceptible allele for Thai BD patients, and associated with posterior uveitis and visual impairment. HLA‐A*26:01 was another susceptible allele in HLA‐B*51X non‐carrier patients. The protective effect of HLA‐B*51:01 on arthritis needs further investigation.

Purpose: To determine the prevalence of viral infections in patients with hypertensive anterior uveitis in Thailand from polymerase chain reaction (PCR) of aqueous humor. Methods: Thirty-one patients with anterior uveitis with intraocular pressure (IOP) above 25 mmHg were included for PCR analysis for cytomegalovirus (CMV), herpes simplex (HSV), varicella-zoster (VZV), rubella, chikungunya and Zika virus. Results: The prevalence of PCR-positive results was 32%, including 19% for CMV, 10% for HSV, and 3% for VZV; PCR for other tested viruses demonstrated negative results. PCR-positive patients exhibited satisfactory IOP control with antiviral and anti-glaucomatous treatment compared to PCR-negative patients, and more than half of PCR-negative patients required glaucoma surgery within 12 months (P = .01). Conclusion: PCR evidence of infection with herpes group viruses was found in one-third of patients with hypertensive anterior uveitis; CMV being the most common pathogen. The PCR-positive group generally responded well to a combination of antiviral and anti-glaucoma treatment.

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