International Journal of Retina and Vitreous最新文献

Background: This study was conducted as a retrospective, exploratory analysis to assess early anatomical and functional effects of intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (nAMD) in a small cohort of patients.

Methods: This retrospective study was conducted at the Jules Gonin Eye Hospital in Lausanne, Switzerland, and included treatment-naïve patients with nAMD. Patients received a minimum of two intravitreal injections (IVT) of aflibercept 8 mg over a 3-month period. Key outcomes assessed were changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), mean retinal thickness (RT), total fluid (TF) volume which was calculated as the sum of intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) volumes. These parameters were evaluated at baseline, month 1, and month 3 using the RetinAI Discovery^® platform, an artificial intelligence-based analysis system.

Results: 10 eyes of 10 patients were enrolled. Mean age was 77.7 ± 12.5 years. Comparative analysis between baseline, month 1, and month 3 revealed statistically significant reduction in CST, RT and TF volume, indicating a positive early response to treatment. One adverse event of intraocular inflammation (IOI) occurred in one patient (10%) after the second IVT injection. Treatment was subsequently interrupted, and IOI resolved with topical corticosteroids therapy.

Conclusion: Intravitreal aflibercept 8 mg demonstrated early anatomical and functional improvements in nAMD treatment-naïve patients after the first 3-months. The use of the AI-based analysis allowed for detailed and automated assessment of retinal changes, providing valuable insights into early treatment effects. Given the retrospective design and small cohort, further studies are warranted to assess long-term outcomes and the potential predictive value of early changes on long-term visual prognosis and safety.

Clinical trial number: Not applicable.

The integration of artificial intelligence (AI) in healthcare has revolutionized various medical domains, including radiology, intensive care, and ophthalmology. However, the increasing reliance on AI-driven systems raises concerns about bias, particularly when models are trained on non-representative data, leading to skewed outcomes that disproportionately affect minority groups. Addressing bias is essential for ensuring equitable healthcare, necessitating the development and validation of AI models within specific populations. This viewpoint paper explores the critical role of data in AI development, emphasizing the importance of creating representative datasets to mitigate disparities. It discusses the challenges of data bias, the need for local validation of AI algorithms, and the misconceptions surrounding retinal imaging in ophthalmology. Additionally, highlights the significance of publicly available datasets in research and education, particularly the underrepresentation of low- and middle-income countries in such datasets. The Brazilian General Data Protection Law is also examined, focusing on its implications for research and data sharing, including the legal and ethical measures required to safeguard data integrity and privacy. Finally, the manuscript underscores the importance of adhering to the FAIR principles (Findability, Accessibility, Interoperability, and Reusability) to enhance data usability and support responsible AI development in healthcare.

Background: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are the standard of care in DME, a sight-threatening complication of diabetic retinopathy. However, many patients show suboptimal response to anti-VEGF agents alone. This study aimed to investigate the effect of adding interferon alpha 2b eye drops to intravitreal bevacizumab (IVB) in treating patients with DME.

Methods: In this double-blind, placebo-controlled, parallel clinical trial, eligible eyes of DME patients were randomized into two treatment arms: (1) three monthly doses of intravitreal bevacizumab (IVB) (2) three monthly doses of IVB plus interferon alpha 2b eye drops (IVB + IFN). Outcome measures were changes in central macular thickness (CMT) and best corrected visual acuity (BCVA) over four months. Intraocular pressure (IOP) and possible adverse events were also documented.

Results: A total of 87 eyes of 87 patients with DME were included (mean age: 64.1, female-to-male ratio ~ 1:1). Anatomical and visual improvements were significant in both groups (p-value < 0.001). CMT reduction and BCVA improvement were greater in the IVB + IFN compared to the IVB group (-117 μm vs. -54 μm, 0.2 vs. 0.1 LogMAR, p-values = 0.004 and < 0.001, respectively). Final IOP was lower in the IVB + IFN group (p value = 0.02), but within groups changes were not significant in either arm (p-value > 0.05). No serious side effects associated with IFN alpha 2b were observed.

Conclusions: Adjunction of topical IFN alpha 2b to standard IVB therapy may result in superior functional and structural improvements in eyes with DME in short-term follow-up.

Trial registration: Iranian Registry of Clinical Trials (irct.behdasht.gov.ir), IRCT20230103057035N1, March 18th, 2023.

Background: To evaluate methods of preoperative axial length (AL) estimation for intraocular lens (IOL) power calculation in patients with macula-off rhegmatogenous retinal detachment (RRD). These methods included optical biometry, A-scan biometry, and novel decision algorithms.

Methods: A retrospective analysis of prospectively collected data was conducted at a tertiary hospital from January 2018 to December 2023. Preoperative and postoperative AL measurements were obtained using optical biometry (IOL Master 700, Zeiss, Germany) and A-scan biometry (VuMAX, Sonomed, USA). The primary outcome was the mean absolute prediction error (MAE) between postoperative AL and preoperative estimates generated by five methods, including two novel algorithms.

Results: The study included 56 patients (56 eyes). The lowest MAE was achieved using the simple algorithm (0.31 ± 0.55 mm), followed by the AL of the fellow eye measured via IOL Master (0.34 ± 0.60 mm), and the advanced algorithm (0.36 ± 0.62 mm). A Kruskal-Wallis H test found no statistically significant difference in MAE across the five methods (P = 0.118). Bland-Altman analysis demonstrated good agreement between preoperative and postoperative AL measurements obtained with the IOL Master.

Conclusion: For patients undergoing phacovitrectomy for macula-off RRD, the simple algorithm provides accurate AL estimation for IOL power calculation. In cases where AL measurement of the affected eye is not feasible using the IOL Master, the fellow eye's AL is a reliable alternative.

Purpose: To evaluate the significance of age and gender on macular retinal and choroidal thicknesses (RT and CT) and related vascular density (VD) using optical coherence tomography angiography (OCTA) in a wide spectrum of normal participants.

Methods: This was a cross-sectional study of 435 eyes of 234 normal healthy children and adults aged 5-97 years old who performed macular 3 × 3 mm scans using Optovue RTVue OCTA.

Results: A statistically meaningful relationship was detected between age and macular layered VD and RT parameters. The middle retinal thickness (MRT) experiences minimal alterations throughout the lifespan. The mean foveal superficial capillary plexus density (SVD), deep capillary plexus density (DVD), and parafoveal SVD had the most density between the 20-40 years and tended to decrease to lowest point by the seventies. Foveal choriocapillaris vascular density (CVD), parafoveal CVD and parafoveal DVD had a decreasing course during the life course. There was no significant difference in choroidal vascular index between age groups. FAZ revealed relatively insignificant minor changes across age groups. The male participants had higher VD than the female participants in all measured parameters, except for parafoveal DVD.

Conclusion: RT of different layers as well as the whole retina is known to be influenced by age while the MRT experiences minimal alterations throughout the lifespan. The VD of male participants exceeded that of female participants across all measured parameters, except parafoveal DVD. Differential retinal and choroidal vascular plexuses have different course during a man's life.

Background: Effects of macular shape changes on the retina have been studied in pathologic myopia. However, whether there are individual differences in macular shape in non-pathologic myopia and the influence of macular shape on retinochoroidal disease in these eyes is not well known. A recently developed ultra-wide-field optical coherence tomography (UWF-OCT) has a wider imaging range and can be used to evaluate inferior posterior staphyloma (IPS). We aimed to investigate the effect of IPS on Haller vessel running patterns (HVRPs) in healthy eyes using UWF-OCT.

Methods: This single-center retrospective study included healthy subjects. UWF-OCT images of normal subjects were stretched vertically to enhance the macula's shape and classified into IPS (n = 16) and non-IPS (n = 113) groups with or without propensity score matching (PSM) for age, sex, and ocular axis length. The HVRPs were subjectively classified into symmetry, superior dominant, and inferior dominant. Differences in the proportions of the patterns between the two groups were compared using Fisher's exact test.

Results: In the non-IPS group, 65 (57.5%) individuals had a symmetric pattern of Haller's vessels, 32 (28.3%) had an upper-dominant pattern, and 16 (14.1%) had a lower-dominant pattern. In the IPS group, 14 eyes (87.5%) presented an upper dominant pattern, and 2 (12.5%) presented a symmetric pattern. There was a significant difference in vascular running patterns between the two groups (P < 0.001). After the PSM, a similar trend was confirmed.

Conclusions: The eyes with IPS are likely to have superior dominant HVRPs compared to the non-IPS group in healthy eyes. Macular shape may play a role in HVRPs, which are involved in the pathogenesis of retinochoroidal diseases.

Background: To evaluate the potential adjunctive effect of pledget anesthetic to topical proparacaine applied in a droplet form in patients undergoing intravitreal injections (IVI).

Method: This is a single-centre, prospective, randomized, double-blinded crossover study. 60 patients were included. Patients receiving IVI were given topical 0.5% proparacaine drops then randomized in a 1:1 ratio to receive 0.5% proparacaine soaked pledget or normal saline soaked pledget as placebo. The patients would later be crossed over to receive the alternative intervention. Pain was assessed with a visual analog scale (VAS) and questionnaire immediately afterwards, 10-minutes and 20-minutes after injection.

Result: Pain intensity as assessed on the visual analogue scale was lower for the placebo group compared to the pledget group immediately (2.51 cm vs. 2.8 cm), 10-minutes (1.81 cm vs. 2.13 cm) and 20-minutes (1.23 cm vs. 1.65 cm) after injection, however this was not statistically significant (p = 0.48, p = 0.43, p = 0.24 respectively). However, in a subgroup of treatment naïve patients, the addition of pledget anesthesia may lower pain and make IVI more tolerable.

Conclusion: Additional pledget soaked with proparacaine does not enhance anesthesia compared to solely using topical proparacaine for IVI, except in a subset of treatment naïve patients.

Purpose: To explore the use of perfluorocarbon liquids (PFCLs) as a short-term tamponade in a staged vitrectomy approach for managing severe open globe injuries (OGIs).

Methods: This retrospective, interventional case series included patients undergoing 23-gauge pars plana vitrectomy with PFCL tamponade for 7-14 days (mean 11.2 ± 3.36 days), followed by secondary vitrectomy and silicone oil exchange. Key outcome measures included retinal and choroidal reattachment rates, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and postoperative complications. Statistical analyses were performed using McNemar's test and Student's t-test.

Results: Five eyes from five patients (mean age 55.6 ± 10.12 years; male to female ratio 4:1) were included, with a mean follow-up of 8.4 ± 4.9 months. All patients sustained zone II and III globe ruptures secondary to blunt trauma, with baseline visual acuity ranging from light perception (LP) to no light perception (NLP). Intraoperative findings included total hyphema, funnel retinal detachment, traumatic choroidal rupture (TCR), suprachoroidal hemorrhage (SCH) and extensive intraocular hemorrhage (EIH). Following PFCL removal, SCH exhibited full or partial resolution, and the posterior retina remained attached in all cases. All eyes were salvaged, and visual acuity improved to hand motion (HM) on postoperative day 1, maintaining stability throughout follow-up (P = 0.03682). No significant IOP changes were observed postoperatively (preoperative: 9.66 ± 2.38 mmHg; postoperative: 9.48 ± 3.31 mmHg, P = 0.9063). Retinal and choroidal attachment were maintained during follow-up, with no cases of phthisis bulbi, endophthalmitis, recurrent hyphema, or ocular hypertension. One patient developed corneal degeneration three months postoperatively.

Conclusions: Short-term PFCL tamponade in a staged vitrectomy may facilitates retinal and choroidal stabilization while minimizing complications, offering a viable alternative for managing severe OGIs.

Background: A variety of different treatments have been proposed to effectively treat chronic central serous chorioretinopathy but there remains uncertainty regarding the efficacy of a number of treatment options. We aim to evaluate the efficacy of several therapeutic options for chronic central serous chorioretinopathy including photodynamic therapy, conventional laser photocoagulation, subthreshold micropulse laser, selective retina therapy, vascular endothelial growth factor (VEGF) antagonists, and mineralocorticoid receptor antagonists.

Methods: Pubmed, Embase, and Cochrane databases were searched for systematic reviews and meta-analyses evaluating treatment modalities for chronic central serous chorioretinopathy. Primary outcome measures included improvement in best corrected visual acuity (BCVA) and resolution of subretinal fluid (SRF). Conclusions regarding the efficacy of each modality were summarized and compared to findings of several key randomized controlled trials.

Results: Ten systematic reviews and meta-analyses that incorporated 58 unique randomized controlled trials and observational studies were identified. Treatments that were shown to improve BCVA and promote SRF resolution included half-fluence and half-dose photodynamic therapy, conventional laser therapy, and subthreshold micropulse laser therapy. Evidence regarding selective retina therapy was limited and inconclusive. VEGF antagonists were not effective in the absence of choroidal neovascularization and mineralocorticoid receptor antagonists were not effective.

Conclusion: The most effective therapeutic option for chronic central serous chorioretinopathy is half-dose or half-fluence photodynamic therapy, however, conventional laser therapy is an acceptable alternative in cases when photodynamic therapy is unavailable and when fluid leakage sites are not subfoveal or juxtafoveal. Subthreshold micropulse laser is less effective but can be considered when other options are unavailable.

Aim: To evaluate the therapeutic effect of a single intravitreal dexamethasone implant (Ozurdex^®) in eyes with refractory diabetic macular oedema (DME) anatomically via optical coherence tomography (OCT) and functionally via best corrected visual acuity (BCVA) and multifocal electroretinography (mfERG).

Methods: This prospective interventional study included twenty eyes with refractory DME that were treated using six intravitreal injections of anti-vascular endothelial growth factor (VEGF). The central retinal thickness (CRT) was measured via OCT exceeding 300 μm. The eyes were treated with a single dexamethasone (DEX) implant four weeks after the last injection of anti-VEGF. The outcomes included changes in CRT, BCVA and p1 amplitude of ring 1 on mfERG and intraocular pressure (IOP) recorded before injection and two, four and six months after DEX injection.

Results: The study included fifteen males (75%) and five females (25%). The mean age was 62.83 ± 6.34 years, with the mean duration of diabetes was 16.7 ± 2.21 years. During the two-month follow-up, there were statistically significant reductions in CRT and logMAR BCVA as well as an increase in p1 of ring 1 on mfERG (P = 0.046, P < 0.001 and P < 0.001, respectively). At four months, these changes were not statistically significant (P = 0.99, P < 0.56&P < 0.58), whereas at six months, all the parameters nearly reached pre-DEX injection values (p = 0.93 P = 0.99 P = 0.81). The IOP values were not significantly increased at two, four or six months (p < 0.06, P = 0.35 and P = 1.0, respectively). There were significant negative correlations between the mfERG and OCT parameters before and six months after DEX injection (p = 0.000).

Conclusion: A single intravitreal injection of DEX in refractory DME patients induced significant anatomical and functional improvements, but these improvements only lasted for short periods of up to four months. This treatment exhibited an excellent safety profile. However, at six months, the therapeutic effect was null. The utility of mfERG as a sensitive biomarker of treatment efficacy was highlighted herein.