International Journal of Retina and Vitreous最新文献

Purpose: To evaluate self-reported visual function in retinitis pigmentosa (RP) patients with and without cystoid macular edema (CME) and to explore associations between cystoid spaces (CS), retinal morphometric parameters, and clinical data using swept-source optical coherence tomography (SS-OCT).

Methods: In this cross-sectional case-control study (1:3) conducted at an Inherited Retinal Degenerations referral center in Portugal, RP patients with and without CME (matched for age and gender) completed the Michigan Retinal Degeneration Questionnaire (MRDQ) and underwent SS-OCT. Morphometric analysis, including ellipsoid zone area (EZA), was performed by two independent graders. In the CME group, detailed CS analysis was conducted. Correlations between clinical data - age, gender, best-corrected visual acuity (BCVA) - and MRDQ domains were evaluated.

Results: The study included 23 RP patients with CME (60.87% male, mean age 44.65 ± 13.58 years) and 69 without CME (49.28% male, mean age 47.94 ± 14.39 years). No significant differences were found between groups in almost all MRDQ domains, BCVA, or EZA. Age positively correlated with 4 MRDQ domains in both groups. BCVA negatively correlated with nearly all MRDQ domains. While EZA showed a negative correlation in both groups, it was significant only in RP without CME. In the CME group, centrally located, outer nuclear layer-involving and large CS were associated with worse BCVA but better EZA.

Conclusion: MRDQ responses strongly correlated with clinical parameters. CME does not seem to affect self-reported visual function in RP patients, and CS may not worsen visual function. Thus, aggressive treatment of CME in RP may not be necessary.

Background: The purpose of this study is to evaluate the retinal and choroidal microvascular state in children with congenital isolated growth hormone deficiency (IGHD) and determine the effect of recombinant human growth hormone treatment on these structures compared with healthy controls.

Methods: The study included children with IGHD under recombinant human GH treatment as group one and another group of healthy controls. Both groups were examined using optical coherence tomography angiography (OCTA). Data concerning superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), and retinal thickness were recorded.

Results: The study included two equal groups of 30 individuals. Both groups had no statistically significant differences in age, gender, weight, or spherical equivalent. However, subjects of group II were taller than those of group I (p = 0.011). OCTA images of the SCP, DCP, and CC vessel density revealed statistically non-significant differences between the two groups.

Conclusion: Children receiving recombinant growth hormone therapy showed no changes in the retinal and choroidal microvasculature or macular thickness.

Trial registration number: 1094/03/2024 by Minia University Faculty of Medicine Institutional Review Board. Another registration number is UMIN000055654.

Background: Patients who had successful rhegmatogenous retinal detachment (RRD) surgery often complained of metamorphopsia due to postoperative fovea displacement and alteration of the foveal microstructure. The papillo-foveal distance (PFD) is correlated bilaterally. Therefore, PFD from the fellow healthy eye could be used to determine the change of foveal position in eyes with successful RRD repair. Ultra-high-resolution optical coherence tomography (UHR-OCT) could explain incomplete visual recovery by demonstrating foveal misalignment and changes in foveal microstructure. The rationale of the study is to assess the changes in the foveal location and microstructural layers after successful retinal reattachment and correlate them with visual dysfunction.

Patients and methods: A prospective interventional cross-sectional controlled study included patients who had successful retinal reattachment and complained of defective vision or metamorphopsia. The primary outcome measure is to evaluate the post-operative foveal location. The secondary outcome measures are the assessment of metamorphopsia, the evaluation of the foveal microstructural changes, and the correlation between foveal shift, metamorphopsia, foveal microstructure, and visual function. We used a standard Amsler chart to detect subjective metamorphopsia and a modified Amsler chart to quantify metamorphopsia. We used the enhanced-depth imaging optical coherence tomography (EDI-OCT) to detect changes in PFD and the foveal microstructure. p < 0.05.

Results: The study included 50 study eyes and 50 control eyes. The male gender constituted 70%. The mean age was 53 years. The mean baseline BCVA was 0.001. The incidence of foveal displacement was 70%. Disorganized retinal inner layers (DRIL) occurred in 56% of eyes, and disorganized retinal outer layers (DROL) occurred in 72% of eyes. The mean postoperative BCVA was 0.3. The subjective metamorphopsia was mild in 39%, moderate in 24%, severe in 33%, and very severe in 3% of eyes. The mean quantitative metamorphopsia was 587 mm. PVR correlated significantly with the foveal shift. DROL correlated significantly with subjective metamorphopsia. There was a statistically significant difference between subjective metamorphopsia and quantitative metamorphopsia.

Conclusion: Foveal displacement and metamorphopsia after successful retinal reattachment pose significant morbidity. UHR-OCT is pivotal in evaluating the anatomical outcome after successful retinal re-attachment surgery and its relation to visual function.

Background: The choroid, a highly vascular structure within the eye, is significantly influenced by various systemic conditions. The advent of enhanced depth optical coherence tomography has improved our ability to evaluate choroidal pathophysiology. The choroidal vascularity index (CVI), a noninvasive and reliable tool, serves as an effective means of assessing the choroidal vascular structure. Recent studies have increasingly focused on exploring CVI alterations under different systemic conditions. This study aims to provide a comprehensive summary of the latest research findings in this area.

Methods: A systematic literature review was conducted on October 1, 2023, using two databases, MEDLINE (via PubMed) and Scopus. Search terms were tailored specifically for each database to ensure a thorough exploration of relevant literature. The studies identified were qualitatively assessed, with particular emphasis on outcomes related to CVI and choroidal thickness.

Results: A total of 48 studies were included in the review, encompassing a diverse range of systemic conditions such as diabetes, central nervous system disorders, cardiovascular diseases, autoimmune disorders, and infectious diseases. Notable reductions in CVI were observed in diabetic retinopathy, autoimmune diseases, and neurodegenerative disorders. Additionally, the review highlighted variations in CVI values related to the severity of systemic diseases, indicating its potential use as a biomarker for disease progression.

Conclusion: This review highlights the significant correlation between variations in the choroidal vascularity index and diverse systemic conditions affecting hemodynamics. An enhanced understanding of CVI provides deeper insights into the pathophysiological mechanisms underlying these disorders and positions CVI as a promising biomarker for early detection and monitoring. Nevertheless, its clinical utility warrants careful assessment. Future research should address the potential limitations of CVI to fully capitalize on its diagnostic and prognostic potential.

Background and objective: Retinal vein occlusion (RVO) and acute myocardial infarction (MI) are significant vascular events that impact patient health and mortality. Both conditions share common risk factors, such as hypertension, diabetes, and atherosclerosis. This study investigated the potential connection between RVO and MI, particularly among younger individuals, to improve preventive measures and management protocols.

Method: A systematic review and meta-analysis were conducted, adhering to the PRISMA and MOOSE guidelines. Multiple databases, including PubMed, Scopus, MEDLINE, ScienceDirect, and ClinicalTrials.gov, were exhaustively searched until August 24, 2024. Studies were selected based on their reports of the association between RVO and MI risk. Quality assessment was performed using the Newcastle-Ottawa Quality Assessment Scale, and data were pooled using a random-effects model with hazard ratios and 95% confidence intervals.

Result: Twelve studies comprising 371,817 participants were included. Meta-analysis revealed a pooled hazard ratio of 1.324 (95% CI, 1.238-1.415), indicating a significant association between RVO and increased MI risk (p = 0.0001). Subgroup analysis for central retinal vein occlusion (CRVO) showed a hazard ratio of 1.691 (95% confidence interval [CI] 1.142, 2.502, p = 0.009) with moderate heterogeneity (I² = 36%), whereas branch retinal vein occlusion (BRVO) yielded a non-significant hazard ratio of 1.167 (95% CI 0.843, 2.106, p = 0.444; I² = 33%). Publication bias was identified (Egger's test, p = 0.036) and addressed through trim-and-fill adjustment, maintaining statistical significance.

Conclusion: Our meta-analysis shows a strong association between CRVO and a 69.1% increased risk of MI, while BRVO shows no significant correlation. Overall, RVO is linked to a 32.4% elevated risk of MI. Despite slight publication bias, adjusted analyses confirm reliability, indicating that improved cardiovascular monitoring for RVO patients, especially those with CRVO, is essential to mitigate MI risk.

Clinical trial number: Not applicable.

Background: Diabetic macular edema (DME) is the main cause of visual loss in individuals with diabetic retinopathy (DR). This study aims to investigate the effects of central macular intraretinal cysts on the underlying outer retinal layer (ORL) in patients with diabetic macular edema (DME).

Methods: In this retrospective and cross-sectional study, diabetic patients with or without DR were categorized into three groups: without DME (group 1), with DME but without any cyst featuring a plateau in the lower region (group 2), and patients with cyst featuring an inferior cyst plateau (group 3), defined as a flat conformation at its posterior aspect. Variables such as central macular intraretinal cyst height, inferior cyst plateau, and ORL thickness were measured, and ellipsoid zone (EZ) disruption was assessed via Spectral-domain optical coherence tomography (SD-OCT) and compared between groups. Correlations between OCT-measured variables and best-corrected visual acuity (BCVA) were investigated.

Results: A total of 164 eyes were included: 48 in group 1, 47 in group 2 and 69 in group 3. Compared with Groups 1 and 2, Group 3 presented a greater intraretinal cyst height (p < 0.001), a thinner mean ORL beneath the cysts (p < 0.0001) and more frequent EZ disruption (p < 0.0001), which was associated with lower BCVA values. Cyst height, cyst plateau and ORL thickness were significantly correlated with BCVA (p < 0.0001). EZ disruption was associated with the cyst height, the cyst plateau and the underlying ORL thickness. Correlations were observed between cyst height and ORL thickness (r = - 0.32, p < 0.001), between cyst height and cyst plateau (r = 0.60, p < 0.001), and between cyst plateau and ORL thickness (r = - 0.56, p < 0.001). Every increase of 10 μm in plateau width and in cyst height results in reductions of 0.16 μm and 0.29 μm in ORL thickness, respectively, independent of the other parameters. The optimal cutoff point for cyst height that best discriminates plateau formation was determined to be 130.5 μm, with a sensitivity of 89.9% and specificity of 83%.

Conclusions: In patients with DME, large central intraretinal cysts may assume a flat configuration in their lower region, termed a plateau, and are associated with photoreceptor damage due to compression, which can result in visual impairment. These findings can be understood based on modified Hertz's mechanical contact theory.

Design: A retrospective, cross-sectional image analysis using a convenience sample.

Subjects: Five cases selected based on the availability of comprehensive imaging data.

Methods: This study involved a retrospective review of images from five cases, focusing on the use of retinal monochromatic blue light reflectance (BLR) imaging to detect non-perfusion areas. Two cases of sickle-cell retinopathy demonstrated peripheral retinal non-perfusion identified through widefield fluorescein angiography. Three other cases-one with branch retinal vein occlusion, one with branch retinal artery occlusion, and one presenting paracentral acute middle maculopathy showed focal macular non-perfusion detected by structural OCT and OCTA. The areas of nonperfused retinal tissue, confirmed by fluorescein angiography, OCT, and OCTA, were then correlated with findings from the BLR image. This correlation aimed to identify any potential associations between these imaging modalities.

Main outcome measures: Enhance understanding of the utilization of retinal monochromatic BLR images as a non-perfusion biomarker.

Results: The perfusion defects identified through fluorescein angiography were qualitatively correlated with hypo-reflective regions observed in the BLR images. A notable correlation was also observed between the OCTA deep capillary plexus findings and the BLR images. Additionally, areas of retinal thinning identified on structural OCT thickness maps corresponded with the hypo-reflective regions in the BLR images. This indicates the potential of BLR in identifying non-perfused retinal areas.

Conclusions: This study reinforces the evidence, through OCT, OCTA, and angiographic correlation, that the BLR can effectively identify areas of retinal non-perfusion in a non-invasive manner. Further research is warranted to assess the method's sensitivity, specificity, and limitations. While the interaction of blue light with the retina, leading to specular reflections and scattering, is established, this research represents a pioneering effort in suggesting which specific retinal structures may be implicated in this phenomenon. This novel insight opens avenues for deeper exploration into the underlying mechanisms and potential clinical applications of utilizing the BLR imaging technique for assessing retinal vascular abnormalities.

One of the most common health concerns disturbing people within working years globally is diabetes mellitus (DM). One well-known consequence of DM is vascular damage, which can manifest as macro- and microangiopathy affecting the ocular retina. Therefore, Diabetic macular edema (DME) is a major sight-threatening complication of diabetic retinopathy (DR) worldwide. It is the most prevalent cause of significant vision impairment in diabetic patients. Long-term vision loss can be avoided by following early DME treatment guidelines in everyday life. Hence, there are various therapeutic approaches for DME management. Currently, the first-line treatment for DME is anti-VEGF family drugs, such as ranibizumab, brolucizumab, bevacizumab, and aflibercept. Nevertheless, relapses of the disease, inadequate response, and resistance during anti-VEGF therapy are still seen because of the intricate pathophysiological foundation of the disease. Consequently, there is an excellent requirement for therapeutic approaches to advance and become better at controlling diseases more satisfactorily and require fewer treatments overall. We conducted a thorough literature search in the current review to present a comprehensive overview of the primary data about the current DME therapeutic agents. We also covered the novel advances in DME management and probable future treatments being investigated and developed. This review recommended that Large clinical trials should afford sufficient evidence to support these innovative treatment modalities.

Background: Recently, there has been a surge of literature utilizing the human amniotic membrane (hAM) to manage cases of macular holes. In this scoping review, we aimed to systematically narrate the literature to identify cases of macular holes that are managed using hAM and explore the visual and anatomical outcomes to inform future research questions.

Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A detailed database search strategy (Scopus, Embase, Medline, and Cochrane Central) was developed to identify English-language published articles that reported using hAM to manage macular holes. All human clinical studies were included for a narrative data synthesis divided across study types.

Results: The database search identified 82 articles, of which 34 were eligible for full-text review (0 randomized controlled trials (RCTs), 12 non-RCTs, 10 retrospective reviews, ten published case reports, and two clinical trial registries). The non-RCTs included patients with macular holes related to a wide range of retinal diseases, including retinal detachment, recurrent holes, and high myopia. Only two non-RCTs reported comparative data with a control group, but the study characteristics differed, and quantitative synthesis was impossible. Most retrospective interventional series and individual case reports reported a success rate of 93 -100% in hole closure and improvement in best-corrected visual acuity. None of the studies reported adverse effects after a hAM transplantation.

Conclusion: The hAM effectively seals macular holes without any safety concerns, improving anatomical and visual outcomes in all macular holes.

Background: The aim of this study was to compare functional and anatomical changes in patients with small full thickness macular holes (FTMHs) who underwent pars plana vitrectomy (PPV) with or without Internal limiting membrane (ILM) peeling.

Methods: 42 eyes of 42 patients diagnosed for FTMHs (< 250 micron) were included in our prospective interventional study. Main outcome measures were: Best Corrected Visual Acuity (BCVA), Macular hole closure rate, Ellipsoid Zone (EZ) and External Limiting Membrane (ELM) recover, Vessel Density in both Superficial (VDSCP) and deep (VDDCP) capillary plexus, Macular pigment Optical density (MPOD) and mean Central Macular Sensitivity (CMS).Patients were randomly divided into "peeling group" (21 patients), in which the ILM peeling maneuver was performed and "no-peeling group" (21 patients) in which the ILM was not peeled off. Examinations were repeated one month (T1), three months (T2) and six months (T3) after surgery.

Results: Although significant improvements in terms of MPOD, CMS, VDSCP and VDDCP over time (p < 0.001) no significant differences were found between the peeling and no peeling group. Conversely, FTMHs closure was achieved in all cases (100%) in the peeling group, whereas 10% of cases in the no peeling group experienced the hole re-opening at T3, with reported different rates of ELM/EZ recover between the two groups. Nevertheless, BCVA improved significantly (p < 0.001) but without significant differences between the two groups.

Conclusions: No significant differences were found in terms of anatomical and functional outcomes between the peeling or not the ILM in small FTMHs at 6 months follow-up.