International Journal of Retina and Vitreous最新文献

Objective: This study aims to characterize the baseline profile and clinical outcomes of pneumatic retinopexy (PR) in patients fulfilling the Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) eligibility criteria at a tertiary referral center in Colombia.

Methods: This retrospective consecutive case series included patients with primary rhegmatogenous retinal detachment (RRD) meeting PIVOT criteria between January 2021 and April 2024. The primary outcome was single-operation success (SOS) at 3 months, defined as complete retinal reattachment after one PR procedure, allowing for a supplementary gas injection within 21 days.

Results: 563 newly diagnosed primary RRD cases were reported, 143 (25.4%) were PIVOT-eligible and 105 underwent PR. The SOS rate was 85.7% (90/105). Baseline age, sex, lens status, and macular status were comparable between success and failure groups. Detachment extent > 2 quadrants correlated with an increased risk of failure (p = 0.045); however, this association should be interpreted cautiously given the limited number of events.

Conclusions: Approximately one-quarter of primary RRD cases at our center met PIVOT criteria. In this cohort, PR yielded a high SOS rate and remains a valuable first-line surgical option in appropriately selected patients, particularly in settings with constrained resources.

Corneal collagen cross-linking (CXL) is widely used to halt the progression of keratoconus by biomechanically strengthening the corneal stroma; however, its potential effects on retina and choroid remain unclear. This systematic review and meta-analysis synthesized current evidence on structural and microvascular changes in the posterior segment following CXL in patients with keratoconus, assessed by optical coherence tomography (OCT) and OCT angiography (OCTA). A comprehensive search of PubMed, EMBASE, and Web of Science was performed up to May 24, 2025. Random-effects meta-analysis using Hedges' g was applied to pool quantitative data. In addition, studies that met the eligibility criteria but lacked sufficient data for quantitative synthesis were qualitatively assessed and included in the descriptive analysis. Ten studies involving 233 eyes from 215 keratoconus patients were included. Meta-analysis demonstrated no significant change in central macular thickness at 1 month (Hedges's g = -0.15; 95% confidence interval [CI]: -0.44 to 0.13; p = 0.30) or 6 months (Hedges's g = -0.12; 95% CI: -0.47 to 0.22; p = 0.48). Subfoveal choroidal thickness also remained unchanged at 1 month (Hedges's g = -0.14; 95% CI: -0.45 to 0.17; p = 0.37). Sensitivity analyses confirmed the robustness of these results. In the qualitative synthesis, parameters demonstrated overall stability, aside from a few exceptions. In conclusion, current evidence suggests that CXL does not result in clinically meaningful changes in posterior segment structure or microvasculature in keratoconus patients. These findings support the posterior segment safety of CXL.

Purpose: To estimate the amount of eliminated vitreous after ultrasound-guided pars plana vitrectomy and complete the safety profile of the technique.

Methods: We enrolled patients with vitreous hemorrhage and clear media who had an ultrasound-guided pars plana vitrectomy. The amount of eliminated vitreous was calculated by digital analysis (ImageJ) of before and after photos, obtained intraoperatively. All cases were completed under direct visualization for safety evaluation. All patients had a comprehensive ophthalmological examination at baseline and at day 1, and 1 month follow-up. Adverse events were reported in proportions ± 95%CI. A learning curve was plotted via the formula y = ax^b. Interobserver agreement was assessed with a Cohen-Kappa test.

Results: We enrolled 62 patients. Mean age: 64.3 ± 13.3 years. Digital image analysis showed that there was a significant reduction in the number of pixels representing vitreous hemorrhage (≈ 70%, p < 0.01). The minimum number of cases needed to achieve a 70% or greater elimination of vitreous was 18. The proportion of potentially related adverse events to the surgical technique was 1.6%, 95%CI: 0.04-8.66).

Conclusion: Ultrasound-guided pars plana vitrectomy is feasible and has an acceptable safety profile for cases with minimal to no visibility of the posterior pole.

Background: Visual recovery after macula-off rhegmatogenous retinal detachment (RRD) remains limited in many cases, largely due to photoreceptor damage. This study aimed to assess the predictive value of early outer retinal findings on optical coherence tomography (OCT) for visual acuity outcomes.

Methods: A retrospective, longitudinal study was conducted on 106 eyes with macula-off RRD treated with vitrectomy and gas tamponade. The primary outcome was best-corrected visual acuity (BCVA) at six months postoperatively. Predictive variables included ellipsoid zone (EZ) and external limiting membrane (ELM) integrity, relative EZ reflectivity (rEZR) at one month, as well as age, time to surgery, macular status, baseline BCVA, and RRD extension. Associations were analyzed using linear regression models.

Results: One-month ELM and EZ integrity were independent predictors of six-month BCVA after adjusting for rEZR and baseline LogMAR BCVA (ELM absence: ß=0.33; EZ absence: ß=0.20; both p < 0.04). rEZR increased significantly between one and six months (p < 0.05), stabilizing thereafter, and moderately correlated with BCVA (r=-0.6). Other variables were not significant in univariate analysis and were excluded from the multivariate model.

Conclusions: Absence of the ELM at one month indicates poor visual prognosis, corresponding to an estimated four-line visual loss. rEZR may serve as a sensitive marker of photoreceptor metabolic recovery. These findings support the development of imaging-based deep learning models for visual outcome prediction in macula-off RRD.

Purpose: To evaluate the incidence and risk factors for cataract following pediatric pars plana vitrectomy (PPV).

Setting: Tertiary referral center.

Design: Retrospective consecutive case series.

Methods: We included 242 eyes of 218 patients (< 18 years) that underwent lens-sparring PPV with a minimum follow-up of 6 months. Information regarding demographic and ophthalmic features, surgical history and procedures were gathered and analyzed. Eyes were evaluated for the development of cataract requiring surgery.

Results: Mean age at surgery was 6.8 ± 5.0 years and mean follow-up was 31.9 ± 37.5 months. After a mean interval of 17.0 ± 22.0 months, 80 eyes (33.1%) required lensectomy with posterior subcapsular cataract being the most common cataract type (76.3%). Overall, the risk of developing cataract after PPV increased from 21% at 1 year to 47% at 5 years The factor associated with the development of postoperative cataract were the need for multiple surgeries (58.8% vs. 13.6%, p < 0.001), the type of tamponade used p < 0.001), older age at surgery (101.9 ± 53.1 months vs. 71.0 ± 60.8 months, p < 0.001), and retinal detachment (78.8% vs. 19.1%, p < 0.001). Multivariate analysis including the aforementioned variables identified the need for multiple surgeries [OR: 2.7 (CI: 1.2-6.2), p = 0.02)] as a risk factor for the development post-PPV cataract while the use of air or no tamponade as protective (p = 0.001).

Conclusions: Post-PPV cataract is a common complication occurring in about one-third of children. Risk factors include silicone oil tamponade, gas tamponade and multiple surgeries. Follow-up should be started early and continued for an extended duration after PPV especially in young children at risk of developing amblyopia.

Background: The aim of the study is to investigate the short- and long-term effects of delayed intravitreal anti-VEGF injections (IVI) for macular edema (ME) in retinal vein occlusion (RVO) patients during the first wave of the COVID-19 pandemic.

Methods: This is a retrospective observational study analyzing a cohort of patients followed at the medical retina department of the Jules Gonin Eye Hospital. During the COVID-19 lockdown, treatment for patients with ME secondary to RVO was deferred due to emergency federal dispositions. The impact on best corrected visual acuity (BCVA) and on OCT changes (i.e. central subfield thickness (CST), intraretinal fluid (IRF), and subretinal fluid (SRF)) were assessed at several time points before and after the lockdown over a 2-year period. The OCT parameters were assessed by the mean of an artificial intelligence (AI) software (Discovery, RetinAI).

Results: A total of 64 patients were included in the study. BCVA significantly decreased following a mean treatment delay of 10 weeks. However, BCVA returned to baseline levels after 6 months, with no significant differences observed after 2-years of follow-up. OCT analysis revealed an increase in CST, IRF and SRF following the treatment delay, which decreased and return to pre-lockdown values after 3 months. No significant differences in OCT parameters were observed at the two-year follow-up.

Conclusion: The results of our study suggest that delaying IVI for RVO patients during the COVID-19 lockdown resulted in a temporary decline in BCVA and a recurrence of ME. However, these effects were not sustained long term, as both BCVA and ME control returned to baseline levels by 6 months, with no significant changes observed at the two-year follow-up.

Background: Carotid endarterectomy is a well-established procedure for enhancing cerebral perfusion in patients with internal carotid artery stenosis. As a multifactorial disease, carotid stenosis can have ocular implications, potentially affecting retinal and choroidal perfusion and contributing to visual dysfunction. This systematic review aims to evaluate changes in choroidal and retinal thickness after unilateral carotid endarterectomy, providing insight into the impact of the procedure on ocular perfusion.

Methods: A comprehensive search was performed across PubMed, Scopus, and Web of Science up to July 2024, without restrictions on language or publication date. The inclusion criteria included original studies assessing retinal or choroidal thickness via optical coherence tomography before and after carotid endarterectomy in adults. Additional manual searches of reference lists and citation tracking were employed to ensure completeness. Study quality was appraised via the NHLBI tool for observational studies.

Results: Six prospective observational studies involving 269 patients were included. Findings on choroidal thickness changes after carotid endarterectomy are heterogeneous. While two studies reported significant postoperative Choroidal Thickness increases-one within a week and another at three months-other studies reported no significant changes. One study suggested that higher degrees of carotid stenosis may blunt early Choroidal Thickness response. Retinal measurements were less consistently assessed; among the three studies that evaluated retinal nerve fibre layer and ganglion cell complex thickness, no consistent postoperative changes were observed. Overall, variability in study designs, Optical Coherence Tomography protocols, and follow-up durations limits comparability, precluding meta-analysis.

Conclusions: This review highlights a potential association between carotid endarterectomy and improved ocular perfusion, as reflected by changes in choroidal thickness. However, inconsistencies across studies and limited data on retinal structural outcomes underscore the complexity of this relationship. These findings emphasize the need for larger, standardized studies to clarify the impact of carotid revascularization on the ocular microvasculature and guide future clinical practice.

Background: Diabetic macular edema (DME) is a leading cause of vision impairment. This study evaluated the effects of multiple anti-VEGF intravitreal injections, including a novel anti-VEGF PRO-169, on best-corrected visual acuity (BCVA) and central macular thickness (CMT) in Latino patients with DME.

Methods: This is a multicenter, drug-agnostic interim analysis. Patients were randomized 1:1 to receive monthly injections for four months after a pro re nata intravitreal injection of either PRO-169 or ranibizumab over a one-year period.

Results: A total of 278 eyes with DME were analyzed. The average age of the participants was 62.1 ± 7.4 years, with diabetes diagnosed at an average of 16.7 ± 8.4 years and DME detected 1.2 ± 1.6 years later. By week 48, patients with an initial BCVA letter score of < 69 experienced a gain of 13.1 ± 10.4 letters, with an injection frequency of 34.5 ± 6.9 days per injection. The group showed a reduction in CMT of -127 ± 153 μm, compared to a -82.2 ± 82.1 μm reduction in those with an initial BCVA between 69 and 78 letters (p = 0.016). Additionally, 49% of patients with an initial score < 69 letters improved their visual acuity to 20/40 or better, and 41.5% gained 15 or more letters.

Conclusions: This interim analysis indicates the potential effectiveness of the anti-VEGF agents PRO-169 and ranibizumab, especially for patients with initial visual acuity < 69 letters. The final analysis will be essential for verifying the efficacy and safety of PRO-169. This study provides solid evidence to support ophthalmologists treating Latino patients with DME and likely improves patient care.

Trial registration: NCT05217680 (clinicaltrials.gov).