International Journal of Retina and Vitreous最新文献

Background: Postoperative endophthalmitis (PSE) is a severe ocular complication that can lead to irreversible vision loss or even globe atrophy. The Endophthalmitis Vitrectomy Study (EVS) historically guided PSE management but is increasingly questioned due to advances in pars plana vitrectomy (PPV) techniques and its narrow focus on cataract surgery. This study aimed to compare PPV followed by intravitreal antibiotic injection at the end of surgery (PPV + IVAIES) with intravitreal antibiotic injection alone (IVAI) in managing PSE.

Methods: This randomized clinical trial included 35 pseudophakic patients with PSE following cataract extraction, anti-vascular endothelial growth factor (anti-VEGF) injections, or glaucoma surgeries. Participants were randomized to receive either PPV + IVAIES (n = 12) or IVAI (n = 23). Best-corrected visual acuity (BCVA) was assessed at baseline and days 7, 30, 60, and 90 post-intervention. Clinical worsening, defined as lack of improvement or progression of symptoms within 48-72 h, guided retreatment protocols. Group A (PPV + IVAIES) received repeat IVAI if required, while Group B (IVAI) underwent delayed PPV with repeat IVAI. Statistical significance was assessed using repeated measures ANOVA and logistic regression.

Results: Both groups showed significant BCVA improvement (p < 0.001). PPV + IVAIES resulted in faster recovery, with superior BCVA at day 7 (p = 0.019) and day 30 (p = 0.041). Retreatment was required in 39.1% of the IVAI group but not in the PPV + IVAIES group (p = 0.015). Subgroup analysis indicated a trend toward better early outcomes with early PPV (p = 0.029).

Conclusions: Early PPV + IVAIES provides faster visual recovery and reduces retreatment rates compared to IVAI alone. Multicenter studies are warranted to confirm these findings and refine clinical guidelines. Trial registration ClinicalTrials.gov identifier: NCT04192994.

Introduction: Hypertensive retinopathy refers to changes in the retinal microvasculature resulting from elevated blood pressure, and the global burden ranges from 2 to 85%. However, there was no evidence on prevalence and associated factors of hypertensive retinopathy among adult hypertensive patients in the study area even in Ethiopia.

Objective: The aim of this study was to investigate prevalence of hypertensive retinopathy and associated factors in adult hypertensive patients attending at Comprehensive Specialized Hospitals in Northwest Ethiopia in 2024.

Methods: Multicenter hospital-based cross-sectional study was conducted in Northwest Ethiopia Comprehensive specialized hospitals from June, 07 to August, 07, 2024. A multistage sampling technique with an interval of 3 was applied to select 696 study participants. Data were collected through personal interviews, review of medical records and eye examinations. Data were entered into the Kobo Toolbox and then transferred to STATA version 17 for analysis. Bivariable and then multivariable binary logistic regression models were fitted to determine factors associated with hypertensive retinopathy. Variables with a P-value of less than 0.05 at multivariable analysis were considered statistically significant.

Result: A total of 696 (95.34%) participants were included in the study. The prevalence of hypertensive retinopathy was 57.47%(95%CI: 53.75, 61.10). Age > 74 years (AOR = 4.24, 95%CI = 1.54,11.64), heart disease(AOR = 5.38, 95%CI = 1.86,15.58), duration of hypertension > 5years (AOR = 12.66, 95%CI = 3.88,41.29), dyslipidemia (AOR = 3.44,95%CI = 1.59-7.45), uncontrolled current levels of hypertension (AOR = 40.03, 95%CI = 17.19,93.18), poor adherence of hypertensive medications (AOR = 1.84, 95%CI = 1.12,3.03) and diabetes (AOR = 3.56, 95%CI = 1.49,5.99) were positively associated with hypertensive retinopathy.

Conclusion: -The prevalence of hypertensive retinopathy is high among systemic hypertensive patients seen in Northwest Ethiopia comprehensive specialized hospitals and independently associated with older age, longer duration of hypertension, heart disease, diabetes, dyslipidemia, poor adherence of hypertension medications and uncontrolled hypertension. Early diagnosis and treatment of hypertension was recommended to prevent target organ complications.

Purpose: To investigate the association between oxidative stress (OS) and both the risk of neovascular age-related macular degeneration (nAMD) and the treatment response to intravitreal anti-vascular endothelial growth factor injections (anti-VEGF IVIs).

Methods: This retrospective study included 46 treatment-naïve nAMD eyes of 46 patients (26 male and 20 female) who received anti-VEGF IVIs with a "treat-and-extend" regimen following an initial loading phase for one year. The patients were divided into two groups according to the total number of anti-VEGF IVIs administered during the year: the "effective" group and the "resistant" group. OS was evaluated by diacron reactive oxygen metabolites (d-ROMs), biological antioxidant potential (BAP), and skin autofluorescence (SAF) at baseline. For comparison, 54 control subjects were recruited.

Results: There were no significant differences in d-ROM or BAP levels between control subjects and nAMD patients, regardless of sex, whereas SAF levels were higher in nAMD patients overall and in male nAMD patients than in controls (P < 0.001 for both). The effective and resistant groups included 30 and 16 eyes, respectively. Among the male nAMD patients, the effective and resistant groups had similar baseline characteristics, including age, smoking history, visual acuity, and central macular thickness; however, the resistant group had higher SAF levels (effective vs. resistant: 2.3 vs. 2.6 arbitrary units [AU]; P = 0.02). This finding was further supported by a multiple logistic regression analysis, which showed that the odds ratio for SAF was 1.57 per 0.1 AU increase (P = 0.01).

Conclusion: SAF levels were significantly higher in nAMD patients than in controls. The total number of anti-VEGF IVIs required over one year in male nAMD patients depended on SAF levels, suggesting that the SAF levels may serve as a potential biomarker for the response to anti-VEGF IVIs in nAMD.

Background: Vitreous biopsy is a common technique used to guide management of acute endophthalmitis and help differentiate between infectious and inflammatory conditions. Currently, in-clinic vitreous biopsy is performed with a 25-gauge needle, without the ability to cut vitreous, potentially leading to reduced diagnostic yield. Recent work demonstrated the ability to perform vitreous biopsy with an off-the-shelf vitreous cutter. However, this was limited by complexity of assembly. Here, a technique using a single peel pack vitrectomy cutter is demonstrated for in-clinic vitreous biopsy.

Methods: A 25-gauge vitreous cutter is opened from a peel pack. The drive line is identified, cut to length, and attached to a 10 mL syringe. A 1 mL syringe is attached to the aspiration line. After a trocar is used to place a cannula in the pars plana, the vitreous cutter is introduced into the eye. Cutting is performed by an assistant actuating the 10 mL syringe while the surgeon aspirates from the 1 mL syringe. After sample is collected, antimicrobials are injected if required and the cannula is removed.

Results: A peel pack technique simplifies assembly for an in-clinic vitreous biopsy using a manually actuated cutter.

Conclusion: We present a novel, improved, and simplified technique for vitreous tap using a vitreous cutter provided in a single peel pack, actuated by a single syringe with minimal assembly prior to use. This technique may be more accessible for clinicians than prior techniques and does not require a surgical console.

Background: To illustrate the treatment effect of Pegcetacoplan for atrophy secondary to age-related macular degeneration (AMD), on an individualized topographic progression prediction basis, using a deep learning model.

Methods: Patients (N = 99) with atrophy secondary to AMD with longitudinal optical coherence tomography (OCT) data were retrospectively analyzed. We used a previously published deep-learning-based atrophy progression prediction algorithm to predict the 2-year atrophy progression, including the topographic likelihood of future retinal pigment epithelial and outer retinal atrophy (RORA), according to the baseline OCT input. The algorithm output was a step-less individualized topographic modeling of the RORA growth, allowing for illustrating the progression line corresponding to an 80% growth compared to the natural course of 100% growth.

Results: The treatment effect of Pegcetacoplan was illustrated as the line when 80% of the growth is reached in this continuous model. Besides the well-known variability of atrophy growth rate, our results showed unequal growth according to the fundus location. It became evident that this difference is of potential functional interest for patient outcomes.

Conclusions: This model based on an 80% growth of RORA after two years illustrates the variable effect of treatment with Pegcetacoplan according to the individual situation, supporting personalized medical care.

Purpose: To examine the association between tear glucose (TG) and the presence and severity of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

Methods: A cross-sectional study. TG was examined by rapid qualitative test strip in 160 patients. The severity of DR was graded as mild DR and severe DR. The presence and severity of DR were compared between patients with positive and negative TG. The association of TG with the presence and the severity of DR was estimated by multivariable regression analysis and spearman's rank correlation test, respectively. The performance of TG to detect DR was evaluated by the receiver operating characteristic (ROC) curve.

Results: In this study, 160 patients were included, with a median age of 64.0 years, and 88 (55.0%) patients were males. A total of 91 (56.9%) patients had positive TG, and 69 (43.1%) patients had negative TG. In TG-positive group, 41 (45.1%) patients were diagnosed with DR, among them, 8 (19.5%) patients had mild DR, and 33 (80.5%) patients were afflicted with severe DR. Multivariable logistic regression indicated that the presence of DR positively correlated with the presence of positive TG (odds ratio [OR], 3.62; 95% confidence interval [CI], 1.56-8.40; p < 0.01), longer duration of diabetes (OR, 1.11; 95% CI 1.06-1.17; p < 0.01) and higher HbA1c (OR, 1.25; 95% CI 1.01-1.54; p = 0.03). Moreover, Spearman's correlation analysis suggested that the grading of TG increased with the severity of DR (r_s = 0.28, p < 0.01). The area under the curve (AUC) of the model integrating TG, the duration of diabetes and HbA1c was 0.76 (95% CI 0.69-0.84), indicating a fair discriminative ability of DR.

Conclusion: TG level was associated with the presence and the severity of DR. TG might be an easy-to-use, non-invasive parameter to the screening and monitoring of DR among patients with diabetes.

Background: To evaluate baseline optical coherence tomography (OCT) biomarkers in treatment-naïve patients with neovascular age-related macular degeneration (nAMD) and their correlation with visual acuity changes following intravitreal aflibercept injections.

Methods: A retrospective analysis was conducted on treatment-naïve nAMD patients. Baseline OCT biomarkers, including shallow irregular pigment epithelial detachment (SIPED), subretinal hyperreflective material, subretinal fluid, intraretinal fluid (IRF), hyperreflective foci, and subretinal drusenoid deposits, were assessed. Patients received bimonthly aflibercept injections after three loading doses. Visual acuity changes were evaluated at 3 and 12 months. The maximum height and width of the largest pigment epithelial detachment (PED) were also measured.

Results: Among 89 eyes with nAMD, mean best-corrected visual acuity (BCVA) improved by 6 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from baseline to month 3, with sustained improvement through month 12. Baseline IRF was associated with poorer visual acuity improvement at month 12, with patients showing a mean improvement of 1.6 ± 18.2 ETDRS letters versus 11.1 ± 10 ETDRS letters in those without IRF (P = 0.002). Multivariable analysis indicated SIPED was linked to lower visual gains at month 3 (P = 0.025). The largest PED width correlated significantly with lower BCVA gains at months 3 (P = 0.021) and 12 (P = 0.043), suggesting its potential as a prognostic factor.

Conclusion: Baseline OCT biomarkers, including SIPED, IRF, and PED width, may predict visual acuity changes in nAMD patients treated with aflibercept, highlighting the need for individualized monitoring.

Clinical trial number: Not applicable.

Background: This study aimed to evaluate the effect of metformin and sulfonylurea (SUs) medication time on Diabetic retinopathy (DR) among newly diagnosed patients with type 2 diabetes (T2DM) using a pooled analysis. This study aimed to evaluate the effect of metformin and SUs' medication time on DR among newly diagnosed T2DM using a pooled analysis.

Methods: The data of 4,068 newly diagnosed DM individuals(mean age, 60.2 ± 0.85 years) from three prospective cohorts of Tehran Sugar and Lipid Study (TLGS), Multi-Ethnic Study of Atherosclerosis (MESA), and Atherosclerosis Risk in Communities (ARIC) with a mean age of 59.6 ± 08 years were pooled. The cumulative exposure to metformin, SUs, aspirin, statin, and anti-hypertensive medication was also determined using the same approach. The Cox proportional hazards (CPH) model was used to calculate the hazard ratio (HR) (95% CI) for the outcomes while adjusting for confounding factors such as fasting Blood Sugar (FBS), age, statin, aspirin, and anti-hypertensive medications.

Results: During follow-up, DR occurred in 519 DM. Metformin alone, SUs alone, and the combination of both reduced the hazard of DR by 10%, 7%, and 11% for each year of use, respectively (p < 0.05). The protective effect of metformin and SUs, individually or in combination, on DR started approximately five years after the initial treatment and continued until approximately 15 years after the initial treatment and then reached a plato.

Conclusion: Long-term treatment with metformin and SUs, individually and in combination, was associated with a reduced risk of DR in people with newly diagnosed diabetes for up to a decade compared with no treatment. These findings highlight the protective role of metformin and sulfonylureas as inexpensive and readily available drugs to prevent DR in people with newly diagnosed diabetes.

Background: Diabetic retinopathy (DR) and macular edema (DME) are critical causes of vision loss in patients with diabetes. In many communities, access to ophthalmologists and retinal imaging equipment is limited, making screening for diabetic retinal complications difficult in primary health care centers. We investigated whether ChatGPT-4, an advanced large-language-model chatbot, can develop risk calculators for DR and DME using health check-up tabular data without the need for retinal imaging or coding experience.

Methods: Data-driven prediction models were developed using medical history and laboratory blood test data from diabetic patients in the Korea National Health and Nutrition Examination Surveys (KNHANES). The dataset was divided into training (KNHANES 2017-2020) and validation (KNHANES 2021) datasets. ChatGPT-4 was used to build prediction formulas for DR and DME and developed a web-based risk calculator tool. Logistic regression analysis was performed by ChatGPT-4 to predict DR and DME, followed by the automatic generation of Hypertext Markup Language (HTML) code for the web-based tool. The performance of the models was evaluated using areas under the curves of receiver operating characteristic curve (ROC-AUCs).

Results: ChatGPT-4 successfully developed a risk calculator for DR and DME, operational on a web browser without any coding experience. The validation set showed ROC-AUCs of 0.786 and 0.835 for predicting DR and DME, respectively. The performance of the ChatGPT-4 developed models was comparable to those created using various machine-learning tools.

Conclusion: By utilizing ChatGPT-4 with code-free prompts, we overcame the technical barriers associated with using coding skills for developing prediction models, making it feasible to build a risk calculator for DR and DME prediction. Our approach offers an easily accessible tool for the risk prediction of DM and DME in diabetic patients during health check-ups, without the need for retinal imaging. Based on this automatically developed risk calculator using ChatGPT-4, health care workers will be able to effectively screen patients who require retinal examinations using only medical history and laboratory data. Future research should focus on validating this approach in diverse populations and exploring the integration of more comprehensive clinical data to enhance predictive performance.

Background: Diabetic retinopathy (DR) is a leading cause of vision impairment worldwide, affecting both retinal and choroidal vasculature. While advances in imaging technology, particularly optical coherence tomography angiography (OCTA), provide new opportunities to assess choroidal changes in diabetic patients, the role of OCTA in early diagnosis and monitoring of diabetic choroidopathy remains unclear.

Objective: This review aims to evaluate the potential role of OCTA in diagnosing and monitoring diabetic choroidopathy.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Databases including PubMed, Embase, Cochrane Library, Google Scholar, ISI, and Scopus were searched for studies on diabetic choroidopathy assessed by OCTA. Studies included were peer-reviewed, published in English, and excluded case reports, conference proceedings, and studies on treated DR patients. Two independent reviewers screened articles for eligibility based on predefined criteria.

Results: OCTA allows for non-invasive, high-resolution visualization of retinal and choroidal microvasculature, providing both qualitative and quantitative data. The majority of studies indicate a significant decrease in choroidal perfusion parameters in diabetic patients without DR compared to healthy controls. Conflicting evidence exists regarding the correlation between choriocapillaris flow reduction and DR severity. OCTA may also predict changes in visual function related to choroidal perfusion, though it cannot fully replace clinical examinations.

Conclusions: OCTA is a valuable tool for early detection and monitoring of diabetic choroidopathy. However, its role is limited by variability in findings and its inability to detect certain features of diabetic microangiopathy. Further studies are needed to clarify its clinical utility and standardize assessment methods.