Graefe’s Archive for Clinical and Experimental Ophthalmology最新文献

Purpose: To evaluate the efficacy of vitrectomy, with and without cataract surgery, for diabetic macular edema (DME) in Japan.

Method: This retrospective study was conducted at 22 sites in Japan and enrolled patients who underwent vitrectomy either without (VIT group) or with (VIT + CS group) cataract surgery. Central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were measured before surgery and at 1, 3, 6, and 12 months after surgery.

Results: A total of 722 patients with DME (482 in the VIT + CS group and 240 in the VIT group) were enrolled. CRT significantly decreased after 1 month and continued thereafter in both groups. BCVA significantly improved at 1 month in the VIT + CS group and at 6 months in the VIT group. In both groups, regardless of epiretinal membrane removal, CRT and BCVA significantly improved, with no additional benefit from concomitant internal limiting membrane peeling. The change in BCVA was significantly correlated with the change in CRT during 6 months postoperatively in all patients and in the VIT group. Patients with worse preoperative visual acuity had a higher likelihood of improved BCVA at 6 and 12 months after surgery. No significant difference in BCVA was observed before and after surgery in patients with a preoperative visual acuity of 20/40 or better. However, in patients with a visual acuity of 20/50 or worse, BCVA significantly improved 1 month after surgery.

Conclusion: Vitrectomy is anatomically and functionally effective for DME, and combined cataract surgery is beneficial in DME cases with cataracts. Patients with poor preoperative BCVA improved, while those with good vision maintained it. However, better preoperative vision increased the risk of postoperative deterioration, underscoring the need for careful evaluation of surgical indications.

Key messages: What is known In vitrectomy for diabetic macular edema (DME), DRCR.net showed that 13-31% of patients experience decreased vision despite reduced edema, leaving the efficacy of vitrectomy uncertain. What is new Our multicenter study demonstrated that vitrectomy with and without cataract surgery was effective in improving central retinal thickness and visual acuity in the patients with DME. Better preoperative visual acuity increased the risk of postoperative decline, and thus the need for careful evaluation of surgical indications.

Purpose: Intracellular dark endothelial spots (IDES) on specular microscopy indicate corneal endothelial stress, and can be an imaging biomarker for subsequent endothelial cell density (ECD) loss after endothelial keratoplasty. This study evaluated the risk factors for the development of bullous keratopathy (BK) by comparing low ECD patients with or without IDES before cataract surgery.

Methods: This retrospective study included 106 consecutive patients who underwent cataract surgery with a preoperative ECD of less than 1000 cells/mm². The patients were divided into 2 groups according to presence of IDES. The medical charts were retrospectively reviewed for preoperative central corneal thickness (CCT), ECD, anterior chamber depth (ACD), presence of IDES, presence of guttae, grade of nuclear sclerosis, intraoperative posterior capsule rupture (PCR) and development of BK after cataract surgery. The clinical factors were compared in patients with or without IDES and the risk factors for BK after cataract surgery were evaluated.

Results: The mean preoperative ECD was 687 ± 124 cells/mm². IDES were observed in 41 eyes (38.7%). IDES were significantly more common in eyes with shallow ACD than in those with deep ACD (P = 0.033). Twenty-two eyes (20.8%) developed BK after cataract surgery. IDES were significantly associated with the development of BK (31.7%) compared to those without BK (13.9%, P = 0.03). CCT, nuclear sclerosis, PCR, and IDES were identified as significant risk factors for postoperative BK (P < 0.0083).

Conclusion: IDES can be used as a new imaging biomarker that suggests a potential risk for development of BK in patients with shallow anterior chamber who are to undergo cataract surgery.

Retinal oximetry, which refers to the measurement of the oxygen saturation of haemoglobin in retinal blood, has emerged as a promising tool for understanding ocular and systemic diseases over the past few decades. Advances in traditional dual-wavelength measurement techniques, as well as their integration with more advanced technologies, have driven significant progress in the field. Researchers have utilised commercially available devices to explore the applications of retinal oximetry in both healthy individuals and various disease states. To provide a comprehensive overview of the current status and development trends of retinal oximetry in ophthalmology, this review analyses relevant studies on retinal oximetry, including its principles, techniques, instrumentation, and applications in healthy individuals, ocular diseases, and systemic disorders. As a biomarker, retinal oximetry provides reliable insights into the retinal and systemic microcirculation in a noninvasive, rapid, and convenient manner. It has demonstrated potential value in the measurement of standardised data and in contributing to the understanding of disease mechanisms. However, its measurement accuracy is influenced by factors such as vessel diameter, retinal pigmentation, and optical media transparency. Future advancements, including wide-field imaging technology, nonmydriatic technology, integration with blood flow measurement techniques, and artificial intelligence, are expected to further improve the accuracy and clinical application potential of retinal oximetry.

Background: The aim of the study was to assess the outcomes of pars plana vitrectomy and macular peeling for vitreomacular interface disorders in eyes with coexisting nonexudative age-related macular degeneration (AMD), and to compare the rate of AMD progression in operated and fellow eyes.

Methods: This retrospective comparative study included patients with bilateral nonexudative AMD and unilateral vitreomacular interface disorder who underwent pars plana vitrectomy with internal limiting membrane peeling. Controlateral unoperated eyes were used as a control group. Cox proportional hazards regression analysis was used to compare the incidence of macular neovascularization, geographic atrophy and progression to late AMD in operated eyes and fellow eyes.

Results: 142 eyes of 71 patients were included. The mean follow-up duration was 17.5 ± 15.5 months. Best corrected visual acuity significantly improved in operated eyes (from 0.47 ± 0.25 to 0.21 ± 0.18 logMAR; p < 0.001), while no significant difference was observed in fellow eyes (from 0.18 ± 0.22 to 0.33 ± 0.56 logMAR; p = 0.055). Central retinal thickness improved in operated eyes (from 0402.9 ± 79.9 to 296.1 ± 48.4 µm; p < 0.001), while no change in fellow eyes was observed (from 296.1 ± 48.4 to 312.7 ± 110.6 µm; p = 0.205). Vitrectomy was not associated with the risk of developing macular neovascularization (hazard ratio [HR] = 0.30; 95% confidence intervals (CI) = 0.08-1.09; p = 0.068); geographic atrophy (HR = 1.01, 95% CI = 0.32-3.12; p = 0.990) nor progression to late AMD (HR = 0.64, 95% CI = 0.28-1.49; p = 0.307).

Conclusions: Pars plana vitrectomy with macular peeling for vitreomacular interface disorders in eyes with coexisting nonexudative AMD is associated with positive visual and functional outcomes, with no shot-term increased risk of AMD progression.

Purpose: To explore the 1-year functional and anatomic outcomes of treatment-naïve neovascular age-related macular degeneration (nAMD) eyes undergoing a treat and extend (TAE) regimen with faricimab, METHODS: Prospective interventional study on 33 eyes with treatment-naïve nAMD undergoing a loading phase of 4 monthly faricimab followed by a TAE regimen. Participants underwent functional assessment and retinal imaging with optical coherence tomography and angiography (OCT/OCTA), at baseline and follow-up visits (V0-V5). Primary outcomes were safety, changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST). Secondary outcomes included changes in OCT biomarkers (intraretinal and subretinal fluid [IRF and SRF], maximum pigment epithelium detachment [PED] height) and vascular densities (VD) in the superficial (SCP) and deep capillary plexuses (DCP).

Results: Mean follow-up was 14.1 ± 2.7 months. At the final visit, 36.4% eyes were on a q16w regimen, and 36.4% on q12w. Results showed significant reductions in CST (V0: 334 ± 102 μm, V5: 227 ± 47 μm, p < 0.001), presence of IRF/SRF and PED height. BCVA improved significantly from 0.51 ± 0.23 to 0.36 ± 0.26 LogMAR (p = 0.03). A dry macula after the loading phase was achieved in 63.7% of cases and correlated with longer inter-injections intervals during TAE. SCP's VD showed a transient decrease in V1-V3 but returned to baseline values at V5, while no significant changes were observed in DCP VD. No cases of intraocular inflammation or adverse events were observed.

Conclusion: Faricimab showed favorable results in treatment-naive nAMD, leading to structural and functional improvements and allowing for extended treatment intervals even in real-world setting.

Purpose: Geographic atrophy (GA) is a late-stage manifestation of age-related macular degeneration associated with vision loss. Differences between Asian and non-Asian populations with GA have been reported. It is essential to understand these differences because they may reflect variations in the natural history of the disease and its underlying pathophysiology, impacting resultant future treatment strategies and clinical trial designs.

Methods: A non-systematic search for articles published up to November 22, 2023 was performed using PubMed. Reference lists from included articles were reviewed and relevant articles manually selected and included, as well as read for background information about the topic. Only articles in English were considered for inclusion in this narrative review.

Results: Although the overall prevalence of GA appears to be low across Asia and shows a male predominance, regional variability is evident. Compared with White and other non-Asian populations, Asian populations typically have more distinct but fewer drusen overall (regardless of type), smaller GA lesion size at presentation, a thicker choroid, and lower rates of bilaterality. In both Asian and non-Asian populations, certain characteristics of GA may be associated with an increased risk of fast disease progression.

Conclusion: The characteristics of GA in Asian populations show some similarities as well as relevant differences compared with those in White and other non-Asian populations. A better understanding of the characteristics associated with GA subphenotypes and predictors of progression will help to optimize management strategies for Asian patients with GA and improve study designs for future interventional trials.

Background: Teprotumumab is the only FDA-approved medication for thyroid eye disease (TED), showing benefits in reducing proptosis, diplopia, clinical activity score (CAS), and improving quality of life. This study describes the clinical outcomes of TED patients treated with Teprotumumab across 5 medical centers in Israel and evaluates time-to-improvement.

Methods: A retrospective cohort study of electronic medical records for Israeli patients treated with Teprotumumab between 2021 and 2024 in five medical centers. The main outcome included changes in proptosis and diplopia.

Results: Thirty-two TED patients (mean age 53.3, 19 females) received partial or complete treatment with Teprotumumab. All had previously failed IV glucocorticoids, and some also failed other biologics. Four patients had decompression surgery prior; 3 with optic neuropathy and 1 with proptosis improved after 1-7 doses. Proptosis decreased by 2.4mm (right) and 2.0mm (left) (p < 0.001, p = 0.002, paired sample t-test), with significant reductions in primary gaze diplopia (p = 0.015, chi-square test). Four patients (12.5%) had symptom recurrence 8-12 months post-treatment; one improved with additional treatment. Thirteen patients (40.6%) had significant improvement within 3 infusions. Adverse events included myalgia (n = 4), hyperglycemia (n = 3), diarrhea (n = 3), and hearing issues (n = 4). One patient developed encephalopathy, successfully treated with plasmapheresis.

Conclusions: Teprotumumab was effective in reducing diplopia and proptosis among Israeli TED patients, with rapid improvement in nearly half of the cases. Further studies are warranted to confirm these findings in real-world settings.

Purpose: To investigate distribution differences of parafoveal cone photoreceptors between dominant and non-dominant eyes using the adaptive optics scanning laser ophthalmoscope (AO-SLO) system.

Methods: This retrospective study included 156 eyes from 78 healthy subjects, all of whom had best-corrected visual acuity of 20/20 or better in both eyes and underwent ophthalmological examinations. The dominant eye was determined using the hole-in-the-card test. Retinal cone photoreceptor observations were performed at an eccentricity of 3.0° from the foveal center using the AO-SLO system. Quantitative distribution parameters, including cone density, spacing, regularity, and dispersion of both dominant and non-dominant eyes, were analyzed and compared.

Results: Dominant eyes exhibited higher cone photoreceptors density at a 3.0° horizontal eccentricity from the fovea [22,896 (20,954, 25,179) cells/mm²] than non-dominant eyes [22,621 (20,147, 24,253) cells/mm²] (p = 0.03). Correspondingly, the spacing of cone photoreceptors in dominant eyes [5.41 (5.09, 5.68) µm] was smaller than that in non-dominant eyes [5.47 (5.23, 5.72) µm] (p = 0.041). The interocular difference in cone regularity between dominant [96.53 (95.07, 97.46)%] and non-dominant [96.68 (95.49, 97.57)%] eyes was statistically significant (p = 0.04). However, there was no significant interocular difference in cone dispersion, which could reflect distribution uniformity (p = 0.795).

Conclusion: Our findings reveal that the dominant eye exhibits higher cone density in the parafoveal region with narrower spacing but a less regular arrangement than the non-dominant eye. These cytological features provide new evidence linking cone photoreceptor distribution to ocular dominance, which may account for the electrophysiological asymmetry observed between the two eyes.

Key messages: What is known? • The adaptive optics scanning laser ophthalmoscope can correct aberrations caused by irregularities in the eye's optics, allowing for the direct and noninvasive observation of retinal microstructures in vivo. What is new? • Our study reveals that parafoveal cone photoreceptors in dominant eyes exhibit significantly higher density, narrower spacing, and a less regular arrangement compared to those in non-dominant eyes in vivo. • The cytological asymmetry between photoreceptor cells in dominant and non-dominant eyes may serve as a potential basis for the electrophysiological differences observed between the two.