Eye最新文献

Objectives: Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is traditionally viewed as a uniform presentation of syphilitic posterior uveitis, though recent evidence suggests broader phenotypic variability. This study aimed to characterise ASPPC heterogeneity using multimodal imaging (MMI).

Methods: Single-centre retrospective cohort study on patients presenting with syphilitic posterior uveitis or panuveitis. MMI included fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). Cases were classified as typical ASPPC when a unifocal, well-demarcated placoid lesion was present at the posterior pole, and as atypical when multifocal lesions were funduscopically occult but evident on FAF. Macular sensitivity recovery post-antibiotic treatment was evaluated in a subset of cases using microperimetry.

Results: Among 33 eyes from 21 patients (median age: 51 years, 91% male), 55% had typical ASPPC and 45% an atypical presentation. HIV co-infection was found only in patients with a typical placoid lesion (42%). Both phenotypes consistently demonstrated hyperautofluorescent lesions on FAF, which corresponded to late-phase hypofluorescence on ICGA and ellipsoid zone disruption on OCT. Atypical cases showed a higher prevalence of vitritis (53% vs. 44%, P < 0.001), uveitic macular oedema (27% vs. 0%), and peripheral vascular leakage (73% vs. 28%, P = 0.004). Macular sensitivity improved by a mean of 1.7 dB/month (P = 0.005), with no significant difference observed between typical and atypical presentations.

Conclusion: This study broadens the clinical spectrum of ASPPC by characterising atypical funduscopically occult presentations. Despite phenotypic differences, all cases share identical MMI features, although atypical forms may exhibit more pronounced posterior segment inflammation.

Objectives: To characterise diabetic macular atrophy (DMA) and identify risk factors for progression to retinal pigment epithelium (RPE) and outer retinal atrophy.

Methods: In this retrospective longitudinal cohort study, we analysed 103 eyes from 70 patients with diabetic retinopathy (DR) and DMA, identified between 2015 and 2024. DMA was defined by clear-bordered hypopigmented RPE lesions on fundus photography with corresponding choroidal hypertransmission on optical coherence tomography (OCT). Lesions were classified as focal or diffuse and staged using modified criteria from the Classification of Atrophy Meetings for the geographic atrophy. Longitudinal OCT, fundus photos, and visual acuity were evaluated using time-to-event analysis and linear mixed-effects models.

Results: Over a mean follow-up of 91.9 months, 93% of eyes progressed to complete RPE and outer retinal atrophy (cRORA). Foveal detachment from DR-related macular structural complications, including macular oedema, epiretinal membrane, vitreomacular traction, and retinal detachment, was linked to earlier onset (p < 0.001) and faster progression (p = 0.036) to cRORA. Diffuse-type DMA, more common in females and eyes post-vitrectomy with silicone oil, was associated with worse visual acuity throughout progression (p = 0.010) and at end-stage (p = 0.029). Fundus autofluorescence in DMA revealed a characteristic diffuse hypoautofluorescence surrounding atrophic patch.

Conclusion: DMA is a vision-threatening, progressive condition in advanced DR. The diffuse-type DMA predicted worse vision throughout DMA progression and end-stage DMA. Foveal detachment of any cause was associated with earlier DMA onset and faster progression to end-stage. Structural macular complications in DR may play a pivotal role in DMA pathogenesis.

Background/objectives: To examine how multiple birth status affects the incidence and severity of retinopathy of prematurity (ROP) in preterm infants. With increasing multiple births associated with assisted reproductive technology, this study seeks to clarify these risks independently of gestational age (GA) and birth weight (BW).

Subjects/methods: This retrospective observational study included 4392 preterm infants screened for ROP between 2010 and 2023. Eligibility criteria were GA ≤ 32 weeks, BW ≤ 2000 g, or unstable clinical conditions. ROP screening results, GA, BW, gender, and multiple birth status were analysed using multivariable logistic regression to assess predictors for ROP incidence and severity.

Results: Among the cohort, 1643 infants (37.4%) were from multiple births, and 780 infants (17.8%) were diagnosed with ROP. Multivariable analysis showed that lower GA (B: -0.063, OR = 0.94), lower BW (B: -0.001, OR = 0.999), and multiple birth status (B: 0.41, OR = 1.51) were independently associated with ROP incidence. For ROP severity, only lower BW (beta: -0.17, B: -0.01) and multiple birth status (beta: 0.08, B: 2.69) were significant.

Conclusions: Multiple birth status may be independently associated with an increased risk and severity of ROP in preterm infants. These findings warrant further investigation to validate the association and to explore whether infants from multiple gestations might benefit from more tailored screening strategies.

Objective: To compare the surgical outcomes of myopic foveoschisis (MF) with preoperative attached versus detached fovea.

Design: A retrospective interventional case series.

Participants: Eyes with MF that underwent vitrectomy were included and were divided into an attached fovea group (26 eyes) and a detached fovea group (54 eyes).

Methods: Preoperative and postoperative best-corrected visual acuity (BCVA) and optical coherence tomography were analysed. The impact of cataract and posterior vitreous detachment were also assessed.

Results: Surgical complications were low and comparable between the two groups (p = 0.830), and the BCVA was similar between the groups at postoperative 6 and 12 months. Ellipsoid zone (EZ) restoration at 6 months was significantly greater in the attached fovea group (12/26 eyes, 46%) than in the detached group (12/54 eyes, 22%; p = 0.037). A trend toward greater restoration was observed at 12 months in the attached group (15/26 [58%] versus 24/54 [44%]; p = 0.098). Eliminating the effect of cataract, the pseudophakic subgroup analyses showed only those with a baseline attached fovea had improved BCVA (p = 0.028). Furthermore, only the 55 eyes with attached posterior vitreous preoperatively showed significant BCVA improvement at 12 months (p < 0.001), whereas the 25 eyes with a preoperative detached vitreous did not (p = 0.390).

Conclusions: Early vitrectomy in MF before foveal detachment preserves outer retinal integrity and may result in better visual acuity outcomes. Future studies are needed to confirm this and should investigate the impact of posterior vitreous detachment on the outcomes.

Objective: To describe a series of patients who developed retinal vein occlusion (RVO) while undergoing treatment with tyrosine kinase inhibitors (TKIs) for systemic malignancy.

Methods: A retrospective chart review was performed to identify patients at an academic medical centre from 2014 to 2024 who developed an RVO while on TKI therapy. Data collected included demographics, cancer diagnosis, TKI agent and treatment duration, ocular history, and treatment outcomes. Ophthalmic imaging obtained at the time of presentation was reviewed when available to confirm the diagnosis of an RVO.

Results: Eleven patients (12 eyes) were identified with an RVO during TKI therapy. The mean age at presentation was 75.9 ± 9.8 years, and 8 patients (72.7%) were male. TKIs included imatinib (n = 3), axitinib (n = 5), ibrutinib (n = 2), and regorafenib (n = 1). RVO developed after a mean duration of 2.8 ± 2.0 years on TKI therapy (range: 0.8-6.5 years). Of the 12 RVOs, 8 were central retinal vein occlusions (CRVOs) and 4 were branch retinal vein occlusions (BRVOs). The mean Naranjo Adverse Drug Reaction Probability Score was 5.2, suggesting a probable link between TKI use and RVO. One patient developed bilateral RVO after continuing regorafenib therapy.

Conclusions: This series highlights a possible association between TKI therapy and RVO, underscoring the need for awareness in patients with vascular risk factors.

Background/objectives: Psoriasis is a systemic immune-mediated disease with ocular involvement. While biologic therapies reduce cardiovascular and musculoskeletal comorbidities, their impact on ocular health is not well characterised. We aimed to assess whether biologic therapy is associated with reduced ocular disease risk in psoriasis patients.

Subjects/methods: We performed a large-scale, retrospective cohort study using the TriNetX Global Collaborative Network (>160 million patients worldwide). Adults with psoriasis initiating biologic therapy were compared with those receiving non-biologic systemic treatments. Cohorts were matched 1:1 by propensity scoring for demographic and clinical variables. Sixty-eight ocular outcomes were assessed over 6 to 120 months. Hazard ratios (HRs) were estimated using proportional hazards models.

Results: Among 30,911 biologic-treated and 35,832 non-biologic-treated patients with psoriasis, biologic therapy was consistently associated with reduced risk of ocular surface and corneal inflammation. The strongest associations were seen for dry eye disease (mean HR = 0.55, 95% confidence interval [CI; 0.42, 0.66], p = 0.0007), conjunctivitis (mean HR = 0.71, 95% CI [0.59, 0.86], p = 0.01), and keratitis (mean HR = 0.40, 95% CI [0.3, 0.56], p = 0.0007). These lower-risk associations were evident from 6 months and remained observable in the 10-year analysis window. No consistent reduction was observed for retinal or vitreous disease.

Conclusions: Biologic therapy in psoriasis was associated with a lower risk of ocular surface disease. These observational findings may inform interdisciplinary management and consideration of ocular outcomes in treatment decisions.

Neurotrophic keratopathy (NK) is an uncommon corneal disorder caused by trigeminal nerve dysfunction, leading to loss of ocular surface sensation, impaired corneal epithelial maintenance, and possible progressive stromal lysis. NK is of added potential visual significance in children on account of the risk of amblyopia resulting from stromal opacification. Unlike acquired NK in adult-onset disease, NK in childhood is frequently congenital or inherited, linked to genetic pain insensitivity syndromes, cranial dysinnervation disorders or broader developmental anomalies. Visual function can be well preserved in affected eyes in many children with supportive management or specific medical and surgical interventions directed at modulating sensory nerve function. A modification of the existing classification of NK stages is proposed to incorporate those eyes in which there is no detectable corneal sensation but otherwise normal eye examination, a phenotype not infrequently encountered in early NK in childhood.

Purpose: To evaluate hyperreflective choroidal foci (HCF) in Sattler's and Haller's layers as predictive biomarkers for treatment response and pachychoroid macular atrophy (pMA) development in chronic central serous chorioretinopathy (CSC).

Methods: Retrospective analysis of 70 treatment-naïve patients with recurrent CSC classified according to Chhablani's criteria. HCF were quantified separately in choroidal layers using spectral-domain OCT at baseline and 12-month follow-up. Patients received photodynamic therapy (n = 20), eplerenone (n = 16), or subthreshold micropulse laser (n = 34). Primary outcomes included treatment response (complete fluid resolution) and pMA development.

Results: At baseline, no significant differences in HCF counts existed between future responders (n = 36) and non-responders (n = 34). At 12 months, responders showed significant HCF reduction in Sattler's layer (-9.17 foci, p = 0.001) and Haller's layer (-3.19 foci, p = 0.039), while non-responders demonstrated increased Sattler's foci (+4.62, p = 0.041). pMA developed in 15 patients (21.4%), more frequently in non-responders (32.4% vs 11.1%, p = 0.001). Baseline total HCF count was the strongest predictor of pMA development (β = 0.465, R² = 0.324, p < 0.001), with final HCF counts showing even stronger associations (β = 0.512, R² = 0.348, p < 0.001).

Conclusions: Layer-specific HCF quantification provides valuable prognostic information for treatment response and pMA risk in chronic CSC. These biomarkers may guide therapeutic decisions and identify patients requiring closer monitoring for atrophy development.