European Journal of Ophthalmology最新文献

PurposeTo compare the effectiveness of 3 × 3 mm versus 6 × 6 mm swept source optical coherence tomography angiography (SS-OCTA) scan patterns in detecting and characterizing pachychoroid-associated macular neovascularization (MNV).MethodsWe retrospectively analyzed 79 eyes from 79 treatment-naïve patients with pachychoroid-associated MNV using SS-OCTA. Both 3 × 3 mm and 6 × 6 mm scans were obtained on the same day. Two masked graders independently evaluated neovascular network area and presence of anastomoses.ResultsMean lesion areas were significantly larger in 6 × 6 mm scans compared to 3 × 3 mm scans (0.869 ± 0.868 mm² vs 0.699 ± 0.697 mm²; p = 0.005). However, analysis of anastomoses revealed superior detection with 3 × 3 mm scans, with 12 eyes (15.2%) showing anastomoses only in 3 × 3 mm scans compared to 4 eyes (5.1%) visible only in 6 × 6 mm scans (p = 0.021). Interobserver agreement was excellent for area measurements (ICC = 0.92).ConclusionsWhile 6 × 6 mm SS-OCTA scans demonstrate larger overall neovascular area measurements, the 3 × 3 mm scan pattern provides superior visualization of anastomoses and fine vascular details in pachychoroid-associated MNV. These findings suggest that 3 × 3 mm scans should be considered the preferred protocol for detailed evaluation of these lesions.

PurposeTo present the first case of multifocal vitelliform paravascular retinopathy (MVPR) identified in Turkey and to describe its multimodal imaging features and clinical course.MethodsA 59-year-old woman underwent a routine ophthalmic examination during evaluation for a chalazion. Comprehensive multimodal imaging, including fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), and fluorescein angiography (FA), was performed.ResultsBest-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed multiple, small, round, yellow-white lesions distributed along the vascular arcades and surrounding the macula bilaterally. FAF showed predominantly hypoautofluorescent lesions with areas of mixed hypo- and hyperautofluorescence. OCT sections through the lesions demonstrated disruption of the ellipsoid zone and dome-shaped hyporeflective cavities in the outer retina, while FA revealed hyperfluorescent lesions ( Figure 1). The patient had a history of diabetes and hypertension but no other systemic or ocular disease. Laboratory and systemic imaging findings were unremarkable. Full-field ERG and EOG were within normal limits.ConclusionThis case represents the first reported instance of MVPR in Turkey. The imaging features and benign, asymptomatic clinical course were consistent with those of previously reported MVPR cases. Further studies are required to clarify the underlying pathophysiology and long-term prognosis of this newly described condition.

ObjectiveTo evaluate the efficacy of switching from anti-vascular endothelial growth factor (VEGF) to faricimab in reducing exudative signs in age-related macular degeneration (AMD) patients receiving regular injections (every 8 weeks or less) without restarting a standard induction regimen.MethodsThis retrospective, observational, multicenter study included patients with exudative AMD previously treated with aflibercept 2 mg or ranibizumab every ≤8 weeks and switched to faricimab while maintaining their previous injection interval. The first follow-up visit occured after switching to faricimab, with a single injection, and corresponded to the pre-existing injection interval. Primary outcomes included changes in subretinal (SRF) and intraretinal fluid (IRF).ResultsAmong 39 patients (47 eyes), the proportion of eyes with SRF decreased from 43.1% to 23.5% (p < 0.01) and IRF from 43.8% to 19.6% (p < 0.01). SRF height significantly reduced from 75.3 μm to 60 μm (p = 0.04). Pigment epithelial detachment (PED) height decreased from 223 μm to 164μm (p < 0.01), and central retinal thickness (CRT) declined from 273.7 μm to 268 μm (p < 0.01). Injection intervals extended by an average of 7 days (40 to 47 days, p < 0.01). No significant changes in BCVA (p = 0.14) were observed. No adverse events were reported.ConclusionsSwitching to faricimab without restarting an induction phase effectively reduces SRF and IRF while modestly extending injection intervals in patients requiring frequent anti-VEGF injections. These findings suggest a potential benefit in treatment burden reduction. Further studies are needed to assess long-term visual outcomes and safety.

PurposeTo describe the population characteristics, prevalence, and causes of visual impairment in Maltese adults aged 50-80 years.MethodsThe Malta Eye Study invited 4,006 random adults aged 50-80 for eye exams and interviews at the Malta and Gozo state hospitals (September 2021-July 2024). Tests included visual acuity, refraction, anthropometry, clinical measurements, tonometry, slit-lamp and dilated fundus exams, retinal imaging, and cognitive screening. Interviews covered sociodemographic, medical, ocular, and medication histories.ResultsA representative sample of 1,794 individuals (44.8% turnout) were assessed. Visual impairment in either eye was found in 23.9% (95%CI 21.9%-25.9%), and bilateral impairment in 6.0% (95%CI 4.9%-7.2%). The most common causes in either eye were uncorrected/undercorrected refractive error (12.3%), amblyopia (5.0%), cataract (3.8%), pathological myopia (1.3%), diabetic retinopathy (0.8%), age-related macular degeneration (0.6%), and glaucoma (0.4%). Predictors of visual impairment included older age, lower education, diabetes requiring insulin and tablets, and dementia. Protective factors were sunglasses use and angiotensin receptor blocker therapy.ConclusionsAlthough overall visual impairment rates are favourable, this study highlights the need to strengthen screening and treatment services for avoidable causes, particularly by improving public optometry access, among older adults, socioeconomically vulnerable groups, and those with poorly controlled diabetes.

PurposeTo assess the effect of anti-VEGF intravitreal injection (IVI) on vascularity and size of retinal angiomas using quantitative analysis of color fundus images.MethodsColor fundus images of retinal angiomas underwent RGB analysis with ImageJ software. White intensity (mean RGB values) and red ratio (red value/sum of green and blue values) were calibrated to obtain the white intensity and red indices, respectively. The lesion-disc area ratio was assessed for size changes.ResultsSeventeen image sets of 10 angiomatous lesions were analyzed: 6 retinal hemangiomas from 4 eyes (4 patients) with Von Hippel-Lindau disease (VHL) and 4 retinal vasoproliferative tumors (VPT) from 4 eyes (4 patients). Overall, the white intensity index increased from 1.34 to 1.5 (P = 0.001), and the red index decreased from 1.14 to 0.85 (P < 0.001) post-IVI. In the VHL group, white intensity increased from 1.41 to 1.58 (P = 0.013), and the red index decreased from 1.04 to 0.84 (P < 0.001). In the VPT group, white intensity increased from 1.17 to 1.36 (P = 0.031) and red index decreased from 1.39 to 0.87 (P = 0.156) after IVI. Lesion-disc area ratio decreased significantly in both groups.ConclusionAnti-VEGF induces whitening and reduces the red component of angiomas, diminishing vascularity and facilitating subsequent invasive treatments.

PurposeTo define the clinical characteristics and to analyse the factors predicting visual acuity in eyes with central serous chorioretinopathy (CSCR) with subfoveal leak.MethodsThis was a multicentric, retrospective, observational comparison of CSCR eyes with subfoveal versus extrafoveal leak, with secondary analysis identifying predictors of 12-month best corrected visual acuity (BCVA) within the subfoveal group.ResultsA total of 134 eyes of 134 patients (113 males and 21 females) with a mean age of 49.6 ± 11.1 years, were included. The median duration of symptoms before presentation was two months. The leak was subfoveal in 50 eyes and extrafoveal in 84 eyes. The duration of symptoms was significantly higher in eyes with extrafoveal leak, than subfoveal leak group (p = 0.01). Eyes with subfoveal leak had higher Haller vessel/choroidal thickness ratio at fovea at baseline. BCVA at one year was similar in both cohorts. On linear regression analysis, factors affecting poor visual acuity at 1 year in eyes with subfoveal leak were greater duration of symptoms, complex CSCR at presentation, history of persistence/recurrences, higher number of leaks, focal retinal pigment epithelium (RPE) atrophy areas, and more months waited before treatment initiation.ConclusionsPatients with CSCR and subfoveal leaks presented earlier and showed a higher baseline Haller to choroidal thickness ratio at the fovea than those without. Although 1-year visual outcomes were similar to extrafoveal leaks, worse BCVA in the subfoveal leak group was associated with complex, persistent or recurrent disease, focal RPE atrophy, longer symptom duration, multiple leaks, and delayed treatment initiation.

PurposeTo evaluate the proportion of patients with choroidal nevus in an ocular oncology practice who would be suitable candidates for monitoring via a virtual photoscreening model, wherein imaging is asynchronously reviewed and longitudinally managed by an ocular oncologist.MethodsData were abstracted from the Prospective Ocular Tumor Study Database for all patients diagnosed with choroidal nevus from July 2019-October 2024. A stratification model for identification of virtual pathway candidates was defined and implemented as follows: good virtual pathway candidates included those with posteriorly located lesions for adequate photographic capture and no more than two high-risk features. Risk factors, outlined by the TFSOM-DIM acronym, included thickness >2 mm, presence of subretinal fluid, visual acuity 20/50 or worse, presence of orange pigment, low internal reflectivity, and basal diameter >5 mm. Of posteriorly located lesions, those with 0-2 risk factors were defined as good virtual pathway candidates, 3 risk factors as acceptable in select cases, and 4 or more as poor candidates.ResultsThere were 614 choroidal nevi in 586 patients diagnosed during the study period. Mean patient age at initial visit was 63.5 years old (median 66.1, range 5.8-94.8), with 59.4% female and 98.8% white. Analysis identified 436 (71%) nevi in 408 (69.6%) patients as good virtual pathway candidates, 53 (8.6%) nevi in 53 (9%) patients as potential candidates in select cases, and 125 (20.4%) nevi in 125 (21.3%) patients as poor candidates.ConclusionNearly 70% of patients with choroidal nevi followed by Mayo Clinic Ocular Oncology were identified as good candidates for follow-up via virtual photoscreening. This highlights the potential for improved clinical efficiency through virtual frameworks in ocular oncology.

PurposeThis systematic review and meta-analysis evaluated the pooled diagnostic accuracy of the ISNT rule non-compliance in detecting glaucoma, considering diverse technique approaches.MethodsA comprehensive literature search was conducted. The primary outcome was the pooled diagnostic accuracy of ISNT rule non-compliance, quantified through various tools. Secondary outcomes included subgroup comparisons based on approach type (neuroretinal rim [NRR] width versus recently described approaches), analysis method (original versus modified), measuring tool, anatomical site evaluated, ISNT rule definition, and the continent where the study was conducted. Risk of bias was assessed using the modified Quality Assessment of Diagnostic Accuracy Studies 2 tool.ResultsA total of twenty-two results derived from six distinct measurement approaches across eighteen studies were included. The pooled diagnostic accuracy estimates were for sensitivity, 0.83 (confidence interval [CI]:0.77-0.88); specificity, 0.49 (CI:0.35-0.63); positive likelihood ratio, 1.60 (CI:1.30-2.15); negative likelihood ratio, 0.37 (CI:0.27-0.49); and diagnostic odds ratio, 4.55 (CI:2.76-7.50). No statistically significant differences were found between subgroup comparisons, except for the specificity of the original method (0.72 [CI:0.67-0.77]), sensitivity of the modified method (0.85 [CI:0.78-0.90]), and sensitivity of the NRR (0.86 [CI:0.79-0.91]).ConclusionsThe ISNT rule presented a low specificity but a high sensitivity for glaucoma diagnosis and may be a useful tool for screening.

ObjectiveThe aim of this systematic review and meta-analysis was to assess the clinical, humanistic, and economic evidence of the OMNI^® Surgical System (OMNI), Visco360 and Trab360 for open-angle glaucoma (OAG).MethodsSearch strategies were applied across MEDLINE^®, Web of Science™, Cochrane (January 2016-April 2024) on 16th April 2024. Congress proceedings (2021-2024) were searched in July 2024. Studies containing ≥15 patients that reported clinical, humanistic or economic outcomes associated with the use of OMNI, Visco360 or Trab360 for the treatment of adults with OAG were included. Structured summaries were used to summarize findings and a meta-analysis synthesized the data. Risk of bias was assessed using the Newcastle-Ottawa and CHEERS checklists. The protocol was registered on PROSPERO (CRD42024536680).ResultsAmong 29 included publications, 27 reported clinical and 2 reported economic outcomes. OMNI significantly reduced intraocular pressure (IOP) with mean IOP <18 mmHg (11.5-17.2 mmHg) at 12 months when used standalone or combined with cataract surgery. The meta-analysis confirmed statistically significant, comparable IOP reductions at months 6, 12 and 24. IOP-lowering medication use decreased from 0.9-3.4 at baseline to 0.1-2.2 at month 12 (standalone and combination); these continued months 24-36. Adverse events were generally mild and transient.ConclusionOMNI consistently reduced IOP and medication use demonstrating sustained effects over 24--36 months with a favorable safety profile, thus supporting its use in patients with OAG. Limitations of this review include the absence of randomized controlled trials. Six studies were assessed as good quality, the remainder showed risk of bias.