International Journal of Retina and Vitreous最新文献

Background: Swept-source OCT (SS-OCT) and OCT angiography (SS-OCTA) enable high-resolution assessment of retinal and choroidal biomarkers in diabetic macular edema (DME). However, prospective analyses of how these biomarkers correlate before and after anti-VEGF therapy in treatment-naïve eyes are limited. The aim of this study was to prospectively evaluate biomarker correlations following aflibercept treatment using state-of-the-art, high-resolution imaging with SS-OCT and SS-OCTA during 4 months of follow-up.

Methods: This was a prospective interventional case series that included 28 eyes from 25 treatment-naïve patients with DME. All eyes received three monthly intravitreal aflibercept injections. Patients were reassessed one month after the loading phase (4-month visit). The evaluated biomarkers included best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), vessel density (VD), and avascular area of the superficial plexus (AASP) and deep plexus (AADP). Pre- and posttreatment values were compared, and correlations were analyzed using Pearson's or Spearman's methods.

Results: Significant changes in BCVA (0.7250 ± 0.23 to 0.3957 ± 0.21; p < 0.000), CMT μm (339.04 ± 66.19 to 265.21 ± 55.75; p < 0.000), CCT μm (221.71 ± 69.69 to 209.07 ± 70.92; p < 0.000), VD (17.90 ± 7.82 to 15.35 ± 5.80; p < 0.038), AASP μm² (235,374 ± 91,299 to 157,326 ± 77,815; p < 0.000) and AADP μm² (1996,335 ± 1,000,047 to 362,161 ± 277,225; p < 0.000) were detected. Very high correlations were observed for the CCT pre vs CCT post (r = 0.98; p < 0.001), and AADP pre vs AADP reduction (r = -0.93; p < 0.001), high correlation: VD pre vs VD reduction (r = -0.72; p < 0.001. In total, 2 correlations were very high, 1 high, 4 moderate, and 9 were low; all the correlations were statistically significant.

Conclusions: Treatment-naïve DME eyes treated with aflibercept showed significant structural, vascular, and functional improvements, with several baseline biomarkers acting as potential predictive indicators of posttreatment outcomes. The very high correlation of CCT and AADP and the high correlation of VD suggest that SS-OCT and SS-OCTA can provide clinically useful information for identifying how patients will respond to treatment. These correlations support the role of SS-OCT and SS-OCTA not only as diagnostic tools but also as potential predictive indicators of therapeutic response, facilitating more personalized DME management in clinical practice. Notably, this is the first prospective study to evaluate correlations between SS-OCT and SS-OCTA biomarkers in naïve DME eyes treated with aflibercept.

Background: In the early1990s, neovascular age-related macular degeneration (nAMD) was the leading cause of irreversible vision loss in older adults, yet its molecular basis remained unknown. In 1992, a hypothesis was proposed in which localized hypoxia could trigger vascular endothelial growth factor (VEGF)-mediated choroidal neovascularization in nAMD. Although hypoxia was recognized in ischemic retinopathies, nAMD was not considered a hypoxia-mediated retinal vascular disease.

Main body: In 1994, this hypothesis was tested using antigen retrieval immunohistochemistry on paraffin-embedded whole human eye sections with early nAMD. The study demonstrated strong VEGF immunoreactivity in the retinal pigment epithelium in the macular area but not in normal control eyes, providing the first direct histopathologic evidence of VEGF expression at the site of disease in intact human eyes with early nAMD. Until that point, the role of VEGF in ischemic retinopathies was being uncovered, but its involvement in early-stage nAMD had not yet been demonstrated.

Conclusion: The 1992-1994 work established both the hypothesis and the first direct tissue evidence linking VEGF to early nAMD. This discovery, made just over a decade before the advent of anti-VEGF therapy, anticipated one of ophthalmology's most transformative achievements, preserving vision for millions worldwide.

Background: There is a paucity of information regarding the results of patients with uveitis and secondary epiretinal membrane (sERM) who undergo pars plana vitrectomy and membrane peeling. This study aims to analyse the functional and anatomical outcomes and possible prognostic factors of a large cohort of eyes with uveitis-associated sERM who underwent vitrectomy with epiretinal membrane peeling.

Methods: The results of 76 eyes of 76 consecutive patients with uveitis-associated sERM who underwent pars plana vitrectomy with membrane peeling were analysed. The mean follow-up duration was 42.7 ± 47.9 months. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and after intervention were measured. Furthermore, demographic data, type of uveitis according to the Standardization of Uveitis Nomenclature (SUN) classification, benefit of additional peeling of the Membrana limitans interna (ILM), activity status of the uveitis at the time of surgery, lens status and postoperative complications were evaluated. Statistical tests included paired t tests, Wilcoxon signed-rank tests, Mann‒Whitney tests, and Kruskal‒Wallis H tests. Statistical significance was defined as p < 0.05; Holm‒Bonferroni correction was employed to address the cumulative risk of false-positive outcomes (type I error).

Results: CRT improved from 421.2 ± 133.2 µm prior to surgery to 331.7±142.5 µm at the final follow-up (p = 0.069), whereas BCVA deteriorated from a mean of 0.49 ± 0.30 logMAR to 0.56 ± 0.60 logMAR in the overall cohort (p > 0.99). The rate of concomitant cystoid macular edema decreased from 42.4% to 34.3%.

Conclusions: The indications for membrane peeling in patients with a secondary epiretinal membrane and uveitis should be considered carefully. Anatomical features can be positively influenced by pars plana vitrectomy with ERM peeling, whereas BCVA may only result in beneficial changes in carefully selected patients.

Background: Diabetic macular edema (DME) is a leading cause of visual impairment in patients with diabetes. Intravitreal anti-vascular endothelial growth factor (VEGF) agents are the first-line treatment for DME, with aflibercept having demonstrated favorable outcomes in comparative studies. However, data on the efficacy of anti-VEGF therapy in vitrectomized eyes are inconclusive. Corticosteroids, specifically dexamethasone (DEX) implant, may be used for refractory cases. This study aimed to evaluate the efficacy of intravitreal aflibercept (IVA) in patients with DME with or without prior pars plana vitrectomy (PPV) and to evaluate the outcomes of DEX implantation in refractory cases.

Methods: This prospective single-center study included 46 eyes with center-involved DME. Eyes were divided into PPV and intact vitreous body (non-PPV) groups. All patients received IVA injections following the DRCR.net Protocol T. After six monthly injections, eyes refractory to IVA treatment were switched to DEX implant (refractory group). In the non-refractory group IVA injections were administered as needed (PRN) until month 12. The best-corrected visual acuity (BCVA) and central subfield thickness (CSFT) were measured at baseline; at 1 week; monthly through month 6 in all eyes; monthly through month 12 in the non-refractory group; and at 2 months after DEX implantation in the refractory group.

Results: There were 23 eyes each in the PPV and non-PPV groups. Overall, 13 (28.3%) eyes were refractory to IVA (8 PPV, 5 non-PPV; p > 0.05). The median number of IVA injections among PPV and non-PPV eyes in the non-refractory group over 12 months showed no significant difference (PPV: 10; non-PPV: 9.5; p > 0.05). Both groups showed significant improvement in BCVA (PPV: +7.0 letters; non-PPV: +11.1 letters; both p < 0.01) and CSFT (PPV: - 182.5 μm; non-PPV: - 190.4 μm; both p < 0.01) at 12 months. In refractory cases, DEX implantation resulted in a significant CSFT reduction (-259.1 μm, p < 0.01) but not BCVA improvement.

Conclusion: IVA is effective for DME regardless of vitreous status, with similar efficacy and treatment frequency in vitrectomized and non-vitrectomized eyes. DEX implantation produces anatomical benefits in IVA-refractory cases, although visual gains are limited.

Purpose: To evaluate the clinical outcomes of the switch to faricimab in a treat-and-extend (T&E) regimen patients with neovascular age-related macular degeneration (nAMD).

Methods: This prospective cohort study included consecutive patients with nAMD who had previously been treated with anti-VEGF agents in a T&E regimen, with treatment intervals (TI) that could not be extended beyond 12 weeks, and a minimum follow-up of 24 weeks. These patients were switched to faricimab therapy in a T&E regimen for at least 6 months. The primary endpoint was the TI between intravitreal injections (IVIs), and the secondary endpoint was the mean change in best-corrected visual acuity (BCVA) from baseline to the last follow-up visit (LFUV).

Results: A total of 225 eyes from 188 patients were included, with a mean age of 79.6 ± 7.4 years. Previous anti-VEGF treatments included ranibizumab (n = 34), aflibercept (n = 144), brolucizumab (n = 6), and bevacizumab (n = 41). TI1 (5.9 ± 2.0 weeks) matched the prior treatment interval. Significant increases in treatment intervals were observed at subsequent time points (TI2: 8.2 ± 3.2 weeks, TI3: 10.1 ± 3.9 weeks, TI4: 10.7 ± 4.3 weeks, TI5: 9.9 ± 4.0 weeks, and TI6: 8.5 ± 4.4 weeks; p < 0.001). BCVA remained stable, going from 0.41 ± 0.23 to 0.43 ± 0.24 (p = 0.0112). The mean number of injections was 5.9 ± 1.9, with a mean follow-up duration of 51.4 ± 11.8 weeks.

Conclusions: The switch to faricimab in a T&E regimen significantly increased treatment intervals maintaining BCVA in patients with nAMD under other anti-VEGF treatments. No serious adverse events were reported. Longer follow-up is needed to confirm these results.