International Journal of Retina and Vitreous最新文献

Background: Uncorrected myopia is a leading cause of blindness globally, with a rising prevalence in recent decades. Pathological myopia, often seen in individuals with increased axial length (AXL), can result in severe structural changes in the posterior pole, including myopic tractional maculopathy (MTM). MTM arises from tractional forces at the vitreoretinal interface, leading to progressive macular retinoschisis, macular holes, and retinal detachment (RD). This study aims to outline preoperative evaluation and surgical indication criteria for MTM, based on the MTM staging system, and to share our Brazilian experience with three cases of macular buckle (MB) surgery, all with over a year of follow-up.

Methods: We conducted a retrospective analysis of three cases of MTM-associated RD treated with MB surgery, with or without pars plana vitrectomy. Preoperative evaluations included optical coherence tomography (OCT) and ultrasonography (USG) to assess the extent of macular involvement and retinal detachment. Surgical indications were determined based on the MTM staging system. The MB was assembled using customizable and accessible materials. Surgical procedures varied according to the specific needs of each case. An informed consent form regarding the surgical procedure was appropriately obtained for each case. The study was conducted with the proper approval of the institution's ethics committee.

Results: All three cases demonstrated successful retinal attachment during the mean follow-up of eighteen months. In the first case, combined phacoemulsification, vitrectomy, and MB were performed for MTM with macular hole and RD. The second case required MB and vitrectomy after two failed RD surgeries. In the third case, a macular detachment with an internal lamellar hole was treated with MB alone. These cases highlight the efficacy of MB surgery in managing MTM in highly myopic eyes.

Conclusions: MB surgery is an effective treatment option for MTM-associated RD in highly myopic eyes, providing long-term retinal attachment. Our experience demonstrates that with proper preoperative evaluation and surgical planning, MB can be successfully implemented using accessible materials, offering a viable solution in resource-limited settings. Further studies with larger sample sizes are warranted to validate these findings and refine surgical techniques.

Purpose: To evaluate the long-term clinical outcomes in patients with combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) to intrascleral haptic fixation (ISHF) using the Agarwal technique with fibrin glue to secure the scleral flap of a posterior chamber intraocular lens.

Methods: Retrospective, consecutive, single-center, comparative case series. 83 eyes were studied. Patients with < 8 months of follow-up were excluded. Detailed pre-, intra-, and post-operative complications were analyzed using mixed model univariate analysis and t-test. Pre- and post-operative best corrected visual acuity (BCVA) was analyzed.

Results: Twenty-five subjects met entry criteria. Mean age at time of surgery was 70.4 ± 17.7 years in the ACIOL group (n = 12) and 54.6 ± 21.1 years in the ISHF group (n = 13; p = 0.03). Mean follow-up was 38.2 months. Incidence of corneal decompensation was similar in the ACIOL and ISHF lens group (p = 0.93). There was no difference in the BCVA mean change or cystoid macular edema (CME) at the final visit between the groups (p = 0.47; p = 0.08), but there was a trend toward increased CME in the ACIOL group.

Conclusions: PPV with concomitant placement of either ACIOL or ISHF lens result in improvement in BCVA. Both procedures are well tolerated and result in favorable outcomes with long-term follow-up though varying patient populations do not allow precise comparison between the two groups.

Purpose: To verify the correlation between the full-macular and the ganglion cell complex (GCC) thickness measurements and retinal sensitivity (RS) assessed by microperimetry (MP) 6 months after surgical peeling for idiopathic epiretinal membrane (ERM).

Methods: Forty-three were submitted to pars-plana posterior vitrectomy (PPV) with concomitant peeling of internal limiting membrane (ILM) for idiopathic ERM treatment. Best-corrected visual acuity (BCVA) and 3D volumetric high-definition optical coherence tomography (OCT) imaging were preoperatively acquired. Six months after the surgery, BCVA, OCT imaging, and RS measured by MP were assessed. For the OCT parameters, we analyzed both the full-macular and the ganglion cell layer complex (GCC) thicknesses. The MP parameters tested were 44 points covering 20 central degrees (6 mm), with direct correspondence with the nine sectors of the OCT-ETDRS map. This approach enables the direct topographic correlation between the structure and functional measurements. The OCT and MP exam measurements were also performed in 43 eyes of age-matched healthy controls. Correlations between BCVA, RS, and OCT parameters were examined.

Results:  All patients exhibited a substantial improvement in visual acuity following surgery. The RS parameters were significantly lower in patients compared to the controls. The full-macular thickness measurements were thicker than controls preoperatively and significantly reduced postoperatively; however, remaining significantly higher than controls, in the 4 inner sectors, at the fovea and for the average macular thickness. Preoperative GCC measurements were higher than those in controls. There was a significant reduction in GCC thickness in all sectors postoperatively, especially in the outer sectors, as well as in the average macular thickness. A positive correlation was found between full-macular and GCC thickness and RS postoperatively in several sectors.

Conclusions: Our results demonstrate that ERM peeling can improve visual acuity in the postoperative period. However, RS may not fully restore, remaining significantly lower when compared to the controls. Both full-macular and GCC thickness measurements were reduced 6 months after surgery. However, significant thinning of the GCC thickness was observed when compared to the normal control eyes, indicating the occurrence of some degree of ganglion cell layer atrophy. We have demonstrated significant correlations among various OCT thickness parameters, particularly for GCC measurements. We believe that GCC integrity may play an important role in visual function after ERM surgery, and that MP may help better understand the correlations between structural and functional findings following ERM surgery.

Introduction: Macular holes are breaks in the retinal tissue at the center of the macula, affecting central vision. The standard treatment involves vitrectomy with membrane peeling and gas tamponade. However, for larger or chronic holes, alternative techniques like autologous retinal graft have emerged. This meta-analysis evaluates the efficacy and safety of retinal transplantation in managing large macular holes.

Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. The study was prospectively registered in PROSPERO (CRD42024504801). We searched PubMed, Web of Science, Cochrane, and Embase databases for observational studies including individuals with large macular holes with or without retinal detachments and retinal transplantation as the main therapy. We used a random-effects model to compute the mean difference with 95% confidence intervals and performed statistical analysis using R software.

Results: We conducted a comprehensive analysis of 19 studies involving 322 patients diagnosed with various types of macular holes (MHs). These included cohorts with refractory MH, high myopia associated with MH, primary MH, and MH with retinal detachment (RD). The findings were promising, revealing an overall closure rate of 94% of cases (95% CI 88-98, I² = 20%). Moreover, there was a significant improvement in postoperative visual acuity across all subgroups, averaging 0.45 (95% CI 0.33-0.58 ; I² = 72%; p < 0.01) overall. However, complications occurred with an overall incidence rate of 15% (95% CI 7-25; I² = 59%).

Conclusion: ART for large MH shows promising results, including significant improvements in visual acuity and a high rate of MH closure with low complication risks overall and for subgroups.

Purpose: To evaluate the visual outcomes and changes in the retinal microcirculation in patients with primary rhegmatogenous retinal detachment (RRD) following successful pars plana vitrectomy (PPV).

Methods: Nine macula-on RRD and 23 macula-off RRD eyes were retrospectively evaluated. Clinical data was collected at admission and 3 months after PPV. Optical coherence tomography angiography (OCTA) was performed 3 months after PPV. Superficial vascular plexus data obtained with OCTA was compared between affected and fellow eyes and according to macular involvement. Quantitative measurements of the superficial retinal capillary associated with the preoperative and intraoperative factors were analyzed.

Results: Overall RRD inner vessel densities (IVD), full vessel densities (FVD), inner perfusion densities (IPD) and full perfusion densities (FPD) were significantly and positively correlated with best corrected visual acuity (BCVA)(p = 0.002, p = 0.006, p = 0.009, p = 0.023, respectively). In the macula-off RRD, IVD and FVD were significantly decreased compared with macula-on RRD (p = 0.014 and p = 0.034, respectively) and significantly correlated with a longer duration and larger extension of detachment. Higher differences of IVD and FVD between the fellow and affected eyes were significantly correlated with worse BCVA in the macula-off subgroup.

Conclusion: Macula-off RRD presented worse OCTA superficial vascular parameters compared with the macula-on group and fellow eyes, which were correlated with a poorer visual outcome and exacerbated by a longer duration and larger extension of the detachment. Macula-off RRD causes not only retinal structural damage but also a reduction in retinal perfusion despite successful anatomical repair.

Purpose: Suprachoroidal hemorrhage (SCH) is a rare but severely feared sight-threatening complication of intraocular surgery, and its management remains debatable. We intended to summarize the existing surgical management options regarding perioperative SCH, describing different techniques and their respective visual outcomes.

Methods: A systematic literature search of articles published since 1st January 2011 until 31st December 2022 was performed using MEDLINE (PubMed) and Scopus. Eligibility criteria included the adult population with SCH related to intraocular surgery.

Results: Thirty-eight studies enrolling 393 patients/eyes were assessed after a selection process among 525 records. We included 5 retrospective cohort studies, 15 case series and 18 case reports. We documented cases of acute SCH diagnosed intraoperatively and delayed SCH, treated until a maximum of 120 days after the diagnosis. Best corrected visual acuity at diagnosis was generally poor, with variable final visual outcomes. Techniques of external drainage with or without combined pars plana vitrectomy (PPV), type of endotamponade (if PPV performed), anterior chamber maintainer and reports of the use of recombinant tissue plasminogen activator were described.

Conclusion: To the best of our knowledge, this is the first systematic review assessing perioperative SCH and its surgical management. There is no standardized surgical approach of SCH and longitudinal intervention studies are lacking. To ensure that patients achieve the best possible visual outcome, prompt diagnosis and treatment are crucial. Therefore, further clinical research is on demand to improve the management of this clinical sight-threatening entity.

Background: Age-related macular degeneration (AMD) is a leading cause of vision loss. Photobiomodulation (PBM) offers a controversial approach for managing dry AMD, aiming to halt or reverse progression through mitochondrial activity modulation. However, the efficacy and clinical relevance of PBM as a potential approach for managing dry AMD remain debated.

Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing PBM versus a sham in patients with dry AMD. We performed trial sequential analysis (TSA) and minimal clinically important difference (MCID) calculations to assess statistical and clinical significance applying a random-effects model with 95% confidence intervals (CI).

Results: We included three RCTs comprising 247 eyes. The pooled analysis showed that PBM significant improved BCVA (MD 1.76 letters; 95% CI: 0.04 to 3.48) and drusen volume (MD -0.12 mm³; 95% CI: -0.22 to -0.02) as compared with a sham control. However, the TSA indicated that the current sample sizes were insufficient for reliable conclusions. No significant differences were observed in GA area. The MCID analysis suggested that the statistically significant results did not translate into clinically significant benefits. In the quality assessment, all studies were deemed to have a high risk of bias.

Conclusion: This meta-analysis points limitations in the current evidence base for PBM in dry AMD treatment, with issues around small sample sizes. Statistically significant improvements do not translate into clinical benefits. The research underscores need for larger RCTs to validate PBM's therapeutic potential for dry AMD.

Background: To report the risk of exudation recurrence and long-term outcomes in patients with choroidal neovascularization secondary to angioid streaks, according to its morphology and characteristics by optical coherence tomography angiography.

Methods: Retrospective analysis of electronic medical records from three hospitals. We enrolled patients with a clinical diagnosis of angioid streaks choroidal neovascularization that had a minimum follow-up of 12 months. From each record, we extracted general demographic data, best corrected visual acuity (baseline, before and after each disease recurrence and last on file), type of treatment, time between last intravitreal injection and disease recurrence, and classification of the neovascular lesion morphology by optical coherence tomography, and optical coherence tomography angiography. Patients with myopic choroidal neovascularization were used as controls. Interobserver agreement was assessed with a Cohen-Kappa test. The Odds ratio was calculated with a chi2 test for significance. Visual acuity change through time was evaluated with an ANOVA for repeated measurements with an alpha value of 0.05 for statistical significance.

Results: We enrolled 30 patients in the study group and 14 in the control group. In the study group, the baseline and final BCVA were 0.861 ± 0.59 and 1.095 ± 0.61 logMAR (p = 0.1) respectively.

Control group: 1.045 ± 0.57 and 0.617 ± 0.53 logMAR (p < 0.05). In the study group, the predominant CNV type by OCTA was mixed (37%), and interlacing (57%) in the control group. Mixed and cog-wheel patterns at baseline had increased Odds for recurrence in the study group (p = 0.09). Patients in the study group required more intravitreal injections on each recurrence episode to achieve disease control (3.5 ± 1.5 vs.1.4 ± 0.2, p < 0.01).

Conclusions: The benefits of anti-VEGF treatment are lost over time in patients with angioid streaks and CNV. Lesion characteristics by optical coherence tomography angiography could help physicians predict the risk of recurrence.

Trial registration: Retrospective registered, and IRB approved.

Background: This review aims to substantiate the correlation between vitamin D and retinal vein occlusion (RVO) within the medical literature.

Method: A systematic review and meta-analysis were conducted in PubMed, SCOPUS, Web of Science, and Embase until December 10th, 2023. A meticulous literature search was undertaken to identify and analyze all observational-analytical papers reporting vitamin D levels in RVO patients. The principal outcome measures centered on the comparative assessment of vitamin D levels between patients with RVO (cases) and those devoid of RVO (controls). The protocol was registered in PROSPERO (code: CRD42024499853).

Results: A total of six relevant studies consisting of 589 participants were included in this meta-analysis. The results indicated a significant association between vitamin D deficiency and increased risk of RVO (Odds ratio = 14.51; 95% CI: [1.71, 122.59], P = 0.014); and patients with RVO exhibited a significant decrease in serum vitamin D levels by 1.91ng/mL (95% CI: [-2.29, -1.54], P < 0.001). Moreover, there was no significant difference observed in vitamin D levels between central RVO (CRVO) and branch RVO (BRVO) subtypes (P = 0.63).

Conclusion: RVO patients have more vitamin D deficiency than healthy controls. These results contribute to the growing body of evidence highlighting the intricate role of vitamin D supplementation as both a prophylactic and a treatment strategy in RVO.

Prospero registration identifier: CRD42024499853.

Background: To investigate the relationship between changes in the optic disc size and color, cup-to-disc (C/D) ratio, and axial elongation in schoolchildren.

Methods: A prospective cohort study was performed in 75 right eyes of elementary school students for six years (from 8.5 to 14.5 years old). In the first and last year, all participants underwent optical axial length measurement and color fundus photography. The optic disc color was calculated by dividing the intensity of red by the sum of the intensity of red, green, and blue. The optic disc area was calculated by modifying the number of pixels according to Bennett's formula. The C/D ratio was calculated by dividing the vertical cup diameter by vertical optic disc diameter. Wilcoxon signed rank test was used to compare these optic disc parameters and axial length in the first and last year.

Results: Mean axial length in the last year (24.82 mm) was significantly longer than that in the first year (23.34 mm). Likewise, the mean optic disc size was significantly smaller in the last year (41,946 pixels) than that in the first year (46,144 pixels). The mean optic disc color in the last year (0.49) was significantly more reddish than that in the first year (0.46), while the mean C/D ratio in last year (0.50) was significantly smaller than that in first year (0.52).

Conclusions: During the period from 8.5 years to 14.5 years of age, both the optic disc size and C/D ratio became smaller, while the color became more red.