Reports therapeutic effect was achieved with regard to the CME, additional studies are necessary to provide a better understanding of the pharmacodynamics of sustained-release medications from devices implanted or inserted into eyes filled with a vitreous substitute such as silicone oil.4,5

ARMIN R. AFSHAR, MD, MBA ALLISON R. LOH, MD PEAR PONGSACHAREONNONT, MD DANIEL M. SCHWARTZ, MD JAY M. STEWART, MD University of California, San Francisco, Department of Ophthalmology, San Francisco, California Financial Support: That Man May See, Inc., and Research to Prevent Blindness.

References 1. Boyer DS, Faber D, Gupta Set al; ; Ozurdex CHAMPLAIN Study Group. 2. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina 2011;31:915–23. 2. Meyer LM, Schönfeld CL. Cystoid macular edema after complicated cataract surgery resolved by an intravitreal dexamethasone 0.7-mg implant. Case Rep Ophthalmol 2011;2:319–22. 3. Srour M, Querques G, Leveziel N, et al. Intravitreal dexamethasone implant (Ozurdex) for macular edema secondary to retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 2013;251: 1501–6. 4. Kim JT, Yoon YH, Lee DH, et al. Dexamethasone intravitreal implant in the silicone oil-filled eye for the treatment for recurrent macular oedema associated with ankylosing spondylitis: a case report. Acta Ophthalmol 2013;91:331–2. 5. Spitzer MS, Kaczmarek RT, Yoeruek E, et al. The distribution, release kinetics, and biocompatibility of triamcinolone injected and dispersed in silicone oil. Invest Ophthalmol Vis Sci 2009;50:2337–43.

Subfoveal Choroidal Thickness in Retinal Vein Occlusion Since Spaide et al1 described the enhanced depth imaging mode of optical coherence tomography to visualize the choroid, an increasing number of studies have examined choroidal thickness and its associated factors in normal eyes and eyes with various retinal and retinochoroidal disorders. The studies revealed that the mean subfoveal choroidal thickness (SFCT) in normal eyes is approximately 250 mm at age 65 years; that SFCT shows a marked interindividual variability with values as low as 8 mm and values as great as 854 mm; that SFCT decreases by about 4 mm per year of age and by 15 mm per diopter of myopia; and that SFCT is additionally associated with male gender, a deeper anterior chamber, and thicker lens.2 Clinical studies showed that eyes affected by central serous chorioretinopathy and their contralateral eyes as well as eyes with polypoidal vascular choroidopathy have an abnormally thick subfoveal choroid.3 Because retinal vein occlusions (RVOs) as retinal vascular diseases may have an association with abnormalities of the choroidal vasculature, we conducted this study to assess the choroidal thickness in patients with RVOs.

The Beijing Eye Study 2011 is a population-based, cross-sectional study in Northern China.2 The Medical Ethics Committee of the Beijing Tongren Hospital approved the study protocol and all participants gave informed consent. Out of 4403 individuals aged 50 years, 3468 (78.8%) participated. The RVOs defined were defined as described previously.4 Their presence and locations were examined on fundus photographs. We measured SFCT using a spectral domain optical coherence tomography (OCT; Spectralis, Heidelberg Engineering Co., Heidelberg, Germany) with enhanced depth imaging (OCT) modality after pupil dilation. The technique was described in detail recently.1,2 Measurements of SFCT and assessments of RVOs were available for 3222 (92.9%) subjects (1811 women [56.2%]) with a mean age of 64.29.6 years (range, 50e93). The RVOs were detected in 85 eyes (48 right eyes) of 81 subjects (45 women). Ophthalmoscopically, all these RVOs did not seem to have a recent onset. There was no marked cystoid macular edema, neither upon ophthalmoscopy nor detected on the macular OCT images. On univariate analysis, SFCT was significantly (P ¼ 0.002) thinner in the RVO study group than in the remaining study population of subjects without RVOs (218104 mm; range, 55e513) versus 255107 mm (range, 8e854). After adjustment for age, gender, axial length, anterior chamber depth, and lens thickness, SFCT was no longer associated with the presence of an RVO (P ¼ 0.22; standardized coefficient beta, 0.02; correlation coefficient B, 17.2; 95% confidence interval, 44.7 to 10.1). In binary regression analysis with RVO presence as dependent variable, and age, systolic blood pressure, and SFCT as independent variables, RVO presence was not associated with SFCT (P ¼ 0.25). The SFCT did not vary significantly between 59 eyes contralateral to eyes affected by RVOs and the ipsilateral eyes with RVOs (22399 mm [range, 65e517] vs 223110 mm [range, 55e513]; P ¼ 0.98) nor did refractive error (P ¼ 0.59) or axial length (P ¼ 0.41). Eyes with a branch RVO (75 eyes) and eyes with a central RVO (10 eyes) did not differ significantly in SFCT (218105 mm [range, 55e513] vs 220105 mm [range, 65e431]; P ¼ 0.96) nor in age (P ¼ 0.28) and axial length (P ¼ 0.79). On multivariate analysis, with adjustment for age, gender, axial length, anterior chamber depth, and lens thickness, SFCT was not associated with the presence of branch RVOs (P ¼ 0.15; beta, 0.02; B, 21.4; 95% confidence interval, 50.7 to 7.8) nor presence of central RVOs (P ¼ 0.76; beta, 0.01; B, 12.0; 95% confidence interval, 65.8 to 89.8). In our population-based study on a relatively large study population, we found that that there was no association of SFCT with either longstanding branch or central RVO after adjustment for age, axial length, gender, anterior chamber depth, and lens thickness. Correspondingly, affected eyes and contralateral unaffected eyes in patients with unilateral RVOs did not differ in SFCT, nor varied the contralateral unaffected eyes from eyes of subjects without RVOs. Our findings seem to be in contrast with the results of a recent, retrospective, hospital-based study by Tsuiki et al,5 who examined 36 patients with unilateral central RVO.5 They found that SFCT was significantly thicker in eyes affected by central RVO than in the fellow unaffected eyes (25783 mm vs 22368 mm; P < 0.01). Tsuiki et al additionally detected that after treatment with intravitreal bevacizumab, SFCT significantly decreased to 22865 mm (P < 0.01). The discrepancy between Tsuiki’s study and our investigation may be explained by the difference in the study design; Tsuiki et al examined patients with a recently developed central RVO, whereas our population-based study

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Ophthalmology Volume 120, Number 12, December 2013 included subjects with longstanding RVOs without recent onset and without marked cystoid macular edema. It fits with the observation of Tsuiki et al that, after an intravitreal medical treatment of the RVOs, choroidal thickness returned to similar values as measured in the contralateral unaffected eyes. Tsuiki’s study and our investigation agree in the finding that eyes with central RVOs after treatment as in Tsuiki’s study or longtime after onset as in our study do not markedly differ in SFCT compared with their fellow eyes. If one combines the results of Tsuiki’s study and our study, one may infer that in the acute stage of central RVOs, the subfoveal choroid may be primarily or secondarily thickened, whereas at a later stage of the disease after resorption of the macular edema, the subfoveal choroid resumed its normal thickness. Because Tsuiki’s investigation did not include eyes with branch RVOs, our results on SFCT in eyes with branch RVOs cannot be compared with the findings of any other investigation. In conclusion, SFCT as measured by enhanced depth imaging OCT was not associated with either longstanding central or branch RVOs.

KUI FANG DU, MD1 LIANG XU, MD2 LEI SHAO, MD1 CHANG XI CHEN, MD2 JIN QIONG ZHOU, MD2 YA XING WANG, MD2 QI SHENG YOU, MD2

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JOST B. JONAS, MD2,3 WEN BIN WEI, MD1 1

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; 2Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; 3 Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany Financial Disclosures: Supported by State Natural Sciences Fund (81170890) and the Natural Sciences Fund of Beijing government (7092021; 7112031).

References 1. Spaide RF, Koizumi H, Pozonni MC. Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol 2008;146:496–500. 2. Wei WB, Xu L, Jonas JB, et al. Subfoveal choroidal thickness: the Beijing Eye Study. Ophthalmology 2013;120:175–80. 3. Kim SW, Oh J, Kwon SS, et al. Comparison of choroidal thickness among patients with healthy eyes, early age-related maculopathy, neovascular age-related macular degeneration, central serous chorioretinopathy, and polypoidal choroidal vasculopathy. Retina 2011;31:1904–11. 4. Liu W, Xu L, Jonas JB. Vein occlusions in Chinese subjects. Ophthalmology 2007;114:1795–6. 5. Tsuiki E, Suzuma K, Ueki R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central retinal vein occlusion. Am J Ophthalmol 2013;156:543–7.

Subfoveal choroidal thickness in retinal vein occlusion.

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