International Journal of Retina and Vitreous最新文献

Purpose: To present a novel optical model explaining why the vast majority of patients with Asteroid Hyalosis (AH) do not perceive any floaters. This changes our understanding of floater perception and undermines the operation mode of YAG laser vitreolysis.

Methods: Relying on a previously published model of floater perception based on astronomical equations of a solar eclipse, and on ultrasound images of the vitreous in three eyes with AH, we explain why such patients do not perceive floaters in spite of opaque bodies filling their entire vitreous, to the point of, in severe cases of AH, obscuring the fundus view during ophthalmoscopy.

Main outcome measures: Developing an optical model of light rays that can quantify the maximal distance upon which a vitreous floater or opacity will cast a shadow on the retina.

Results: Calculations using the proposed model demonstrated that with a 3 mm pupil, for a floater located between 1.5 mm and 2 mm from the retina, its shortest diameter must be > 215 microns and > 286 microns, respectively, to be perceived. Since AH floaters, based on ultrasound imaging, do not exist in the most peripheral 1.5 mm of the vitreous, it becomes understandable why these patients are asymptomatic.

Conclusions: Based on the proposed model and our findings, we deduced that even large, degenerative floaters whose width is usually narrower than a large retinal vein (125 microns), must be located very close to the retina and hence are not the floaters that are aimed at when performing YAG laser vitreolysis. We speculate that in successful cases, YAG vitreolysis works by a different mechanism, most likely a shock wave that displaces floaters further away from the retina. Hence, vitreolysis might not necessarily require the laser be aimed at the floaters, as symptomatic floaters may be located in the outer 1.5-2.0 mm of the vitreous body, a very risky zone for YAG laser shots.

Purpose: This scoping review aims to explore the current applications of ChatGPT in the retina field, highlighting its potential, challenges, and limitations.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, MEDLINE, and Embase, to identify relevant articles published from 2022 onwards. The inclusion criteria focused on studies evaluating the use of ChatGPT in retinal healthcare. Data were extracted and synthesized to map the scope of ChatGPT's applications in retinal care, categorizing articles into various practical application areas such as academic research, charting, coding, diagnosis, disease management, and patient counseling.

Results: A total of 68 articles were included in the review, distributed across several categories: 8 related to academics and research, 5 to charting, 1 to coding and billing, 44 to diagnosis, 49 to disease management, 2 to literature consulting, 23 to medical education, and 33 to patient counseling. Many articles were classified into multiple categories due to overlapping topics. The findings indicate that while ChatGPT shows significant promise in areas such as medical education and diagnostic support, concerns regarding accuracy, reliability, and the potential for misinformation remain prevalent.

Conclusion: ChatGPT offers substantial potential in advancing retinal healthcare by supporting clinical decision-making, enhancing patient education, and automating administrative tasks. However, its current limitations, particularly in clinical accuracy and the risk of generating misinformation, necessitate cautious integration into practice, with continuous oversight from healthcare professionals. Future developments should focus on improving accuracy, incorporating up-to-date medical guidelines, and minimizing the risks associated with AI-driven healthcare tools.

Purpose: To assess the accuracy of High-Resolution OCT in detecting biomarkers associated with central serous chorioretinopathy (CSC) compared to standard OCT.

Methods: We conducted a cross-sectional study involving CSC patients who underwent High-Resolution and standard OCT during the same visit. Using the SPECTRALIS High-Res OCT device (Heidelberg Engineering, Heidelberg, Germany), macular B-scans were obtained and compared with those acquired using a SPECTRALIS HRA + OCT device (Heidelberg Engineering, Heidelberg, Germany). Qualitative assessments were performed, and statistical analyses compared the performance of both OCT modalities.

Results: Thirty-one patients diagnosed with CSC were included with a mean age of 56.3 years (± 10.2). Among them, 29% (n = 9) were classified as acute CSC (aCSC), while 71% (n = 22) had chronic CSC (cCSC). High-Resolution OCT outperformed standard OCT in detecting microstructural changes in the outer retinal layers, including a higher prevalence of disrupted interdigitation zone (IZ) (29% vs. 6%, p = 0.003) and retinal pigment epithelium (RPE) disruption (12% vs. 2%, p = 0.0024). Intergrader agreement was high (Cohen's Kappa = 0.85).

Conclusion: High-Resolution OCT demonstrates promise in identifying critical biomarkers associated with CSC, particularly disruptions in the IZ and RPE. Further validation in larger cohorts is required to confirm their clinical relevance in patients with CSC.

Purpose: This study aimed to compare demographics, clinical characteristics, and post-surgical outcomes between idiopathic and secondary full-thickness macular holes (MHs).

Methods: A retrospective analysis of 348 eyes from 339 patients treated between June 2017 and December 2023 was conducted. The study included both idiopathic and secondary MHs, excluding cases where surgery was not performed or lacked sufficient follow-up. Demographic data, visual acuity (VA), ocular characteristics, and optical coherence tomography measurements were analyzed.

Results: Idiopathic MHs were identified in 308 eyes (89%), and secondary MHs in 40 eyes (11%). Idiopathic MH patients were older (mean age: 68.26 vs. 60.13 years; p = 0.001) and more commonly female (63% vs. 40%; p = 0.005). Post-surgical closure was achieved in 86% of all MHs, with a median VA improvement of 15 ETDRS letters (3 Snellen lines). However, secondary MHs had a lower closure rate (67% vs. 89%, p = 0.001) and less VA improvement (2 lines vs. 3 lines, p = 0.001) compared to idiopathic MHs. Significant differences in maximal basal diameter and diameter hole index were noted between the groups.

Conclusions: Secondary MHs, accounting for 11% of surgical cases, show poorer anatomical and visual outcomes than idiopathic MHs. Despite lower success rates, early surgical intervention in secondary MHs is recommended to enhance outcomes. Differentiating between idiopathic and secondary MHs is crucial for optimal management.

Purpose: To present a novel intraoperative application technique of basic salt solution (BSS) perfusate to address residual epiretinal perfluorocarbon liquid (PFCL) droplets.

Methods: Following standard liquid-gas exchange and aspiration of visible PFCL using a flute needle, the adjuvant drip-irrigative method is employed. A 2mL needle containing BSS is introduced and maneuvered circumferentially around the posterior pole while injecting BSS intermittently to obviate droplet presence. Subsequently, droplets lying flat to the surface drain via the flute needle, and the process if repeated until no droplets are visible.

Results: Among 112 consecutive patients diagnosed with rhegmatogenous retinal detachment (RDD) with at least 3 months follow-up, 109 patients (109 eyes, [97%]) experienced no PFCL-related complications follow pars plana vitrectomy. Among three patients with PFCL-related complications, two (2 eyes) presented with residual droplets on the retinal surface during silicone oil retrieval, and one (1 eyes) had PFCL migration to the anterior chamber. No patients experienced sub-retinal/ sub-foveal PFCL or iatrogenic injury.

Conclusion: This adjuvant drip-irrigative technique offers enhanced droplet visibility, reduced risk of iatrogenic retinal damage, and ease of application. Findings reported suggest the potential of this approach as a standard practice when using PFCL to mitigate complications.

Background: Although there has been a large increase in the number of extensive macular atrophy with pseudodrusen (EMAP) cases, the basic aspects of this disease remain unknown. Brazilian patients have a common past history of rheumatic fever (RF) and/or benzathine penicillin (BP) treatment possibly related to the disease. We analyzed how RF and BP might be correlated with EMAP in Brazilian patients.

Design: Observational, retrospective, case-control study.

Methods: The databases of three private eye clinics in Brazil were searched for patients with an EMAP-like appearance. Each patient was asked about a previous history of RF and/or long-term use of BP. Patients underwent best-corrected visual acuity (BCVA) measurement, color fundus imaging, fundus autofluorescence (FAF) imaging, optical coherence tomography (OCT) imaging, and electroretinography (ERG). The following characteristics were analyzed: subretinal drusenoid deposits (SDD), pigment mottling, retinal pigment epithelial/basement membrane (RPE/BM) separation, outer retinal or RPE atrophy, and identification of a paving stone-like appearance. The choroidal thickness was measured using enhanced depth imaging OCT. The central atrophic area was measured manually on ultra-wide-field FAF.

Results: A total of 154 eyes of 77 patients (women, 66.2%; mean age, 58.6 years) with EMAP were included; 90.9% of patients were diagnosed with RF; 94.8% had been treated with BP and treatment was started at an average age of 7.3 years (mean duration, 11.8 years). The treatment duration was significant for the area of atrophy (P = 0.027) in which each 1-year increase in treatment duration led to an average reduction of 6.91 mm² in area. The age at diagnosis of RF was significant (P = 0.026) for SDD. The increase of 1 year in the diagnosis of RF (late disease) led to a reduction of 24% in the chance of central SDD being present. On OCT, 65.5% eyes had SDD and more than 70% had a split RPE/BM and outer retinal or RPE atrophy. The choroidal thickness in patients with EMAP was significantly (P < 0.001) thinner than the control group. The ERG was abnormal in all eyes.

Conclusion: These findings may suggest a relation between RF and EMAP in Brazilian patients. Patients with EMAP should be questioned about a history of RF.

Purpose: To determine the feasibility of a prototype needle that enhances vitreous reflux (VR) to control intraocular pressure (IOP) in intravitreal injection (IVI).

Methods: We created an eye model to compare IVI using a standard 30-G needle with four different versions of a 30-G prototype needle with one to four surface grooves that enhanced VR. We injected 50, 70, and 100 µl saline through porcine sclera or 460-µm-thick rubber and measured the peak and 3-second pressure before we extracted the needle and measured the 10-second pressure.

Results: 50-µl injection through sclera with the standard needle resulted in mean (SD) pressure of 58.6 (3.8) mmHg at peak, 52.8 (4.7) mmHg at 3 s, and 39.6 (18.0) mmHg at 10 s. The prototype needle lowered the pressure; four grooves resulted in mean (SD) pressure of 29.4 (5.6) mmHg at peak, 22.0 (3.7) mmHg at 3 s, and 7.2 (6.6) mmHg at 10 s. 70-µl and 100-µl injections through sclera with the standard needle resulted in mean (SD) pressure of 68.8 (3.6) and 86.0 (6.0) mmHg at peak. Similar to 50-µl injection, the prototype needle lowered the pressure for 70-µl and 100-µl injections. At 10 s, we observed varying leakage at the injection site for sclera but not for rubber.

Conclusions: The study provides proof of concept for a needle design for which surface grooves enhance VR and counteract the effect of IVI on IOP. The safety and efficacy of the prototype needle must be studied further in a clinical trial.

Background: Pseudophakic cystoid macular edema (PCME) is a known complication of cataract surgery that contributes to decreased visual acuity. Mechanical manipulation associated with the release of inflammatory mediators is the leading hypothesis for PCME. To date, no standardized prophylactic protocol has been established to effectively reduce the incidence of PCME. This study assessed the efficacy and safety of nonsteroidal anti-inflammatory drops (NSAIDs) and corticosteroids for the prevention of PCME.

Method: We searched the following databases MEDLINE, EMBASE, and Cochrane Central. Register of Controlled Trials and included randomized controlled trials (RCTs) that studied the efficacy of NSAID vs. placebo, NSAID vs. steroid, or NSAID + steroid vs. placebo, reporting the incidence of PCME, macular thickness, and best-corrected visual acuity. The risk ratio (RR) with a 95% confidence interval (CI) and a random-effects model was used. The risk of bias was assessed using the revised Cochrane risk-of-bias tool.

Results: A total of 18 RCTs were included in this study (n = 2959). Nine RCT showed low risk of bias, 7 RCT showed unclear risk of bias, and 2 RCT had high risk of bias. The incidence of cystoid macular edema among patients treated with NSAIDs was significantly lower (RR = 0.33, P < 0.001). Subgroup analysis revealed a statistically significant low risk of edema among patients treated with NSAIDs alone (P < 0.001) compared to others. NSAIDs were associated with significantly low mean corrected visual acuity values using LogMar (P < 0.001).

Conclusion: NSAID alone or in combination with steroids showed its efficacy in reducing the incidence of PCME post-operatively. Future double-blind randomized controlled trials are required to standardize the protocol for different patient population.

Purpose: Vision-threatening diabetic retinopathy (VTDR) included severe non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR) and clinically significant diabetic macular edema (DME). To compare the axial length (AL) and assess its influence on VTDR across different ages.

Methods: A retrospective cohort study. Medical chart review was performed in 736 consecutive patients with VTDR. The patients were divided into young (≤ 45 years) and elderly group (> 45 years) based on their age at the diagnosis of VTDR. After at least one year of standardized treatments, all eligible patients were followed up. The main outcome measures included the presence of tractional retinal detachment (TRD) involving foveal, final best-corrected visual acuity (BCVA), the development of neovascular glaucoma (NVG), and recurrent vitreous hemorrhage (VH) post-vitrectomy. ALs were compared between two age groups. The impact of AL on clinical outcomes was determined by logistic analyses after controlling for systemic parameters.

Results: The study included 144 patients ≤ 45 years and 592 patients > 45 years. Young patients had significantly longer AL than elderly participants (23.9 mm vs 23.0 mm, p < 0.001). Over a median follow-up of 25.9 months, a larger proportion of young patients developed TRD (34.7% vs 16.2%, p < 0.001) and recurrent VH (18.6% vs 10.3%, p = 0.040) than elderly patients. In elderly group, longer AL is an independent protective factor in preventing TRD (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.4-0.7; P < 0.001). However, this beneficial effect was not observed in young patients.

Conclusions: Young patients with VTDR exhibited significantly longer AL but more aggressive clinical signs with compromised prognosis. In elderly group, a longer AL independently reduced the risk of TRD, while this protective effect did not exist for young patients.