International Journal of Retina and Vitreous最新文献

Purpose: To compare the long-term incidence of recurrent vitreous hemorrhage(VH) and neovascular glaucoma (NVG) in patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy (PPV) alone versus combined PPV and phacoemulsification (PPV&P).

Methods: This large, single-center, retrospective cohort study analyzed 548 eyes (137 PPV&P, 411 PPV-alone) with a minimum 12-month follow-up. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression models were used to compare outcomes and identify independent predictors for complications within a 2-year follow-up period. A supplementary propensity score-matched (PSM) analysis was also performed to confirm the findings.

Results: Over the entire follow-up, the overall incidence of recurrence and NVG did not differ significantly between the groups. However, multivariable Cox regression analysis for the first two years revealed that PPV-alone was a significant protective factor against recurrence (adjusted Hazard Ratio [aHR], 0.61; 95% CI, 0.40-0.92), while severe preoperative traction was a major risk factor (aHR, 2.24; 95% CI, 1.39-3.60). For NVG development within two years, the surgical approach was not a significant factor. Instead, severe preoperative traction (aHR, 5.88; 95% CI, 1.67-20.68) and older age (aHR, 1.06; 95% CI, 1.01-1.11) were the primary independent risk factors.These findings were confirmed in a 1:1 age-matched PSM cohort.

Conclusion: Combined PPV with phacoemulsification is associated with an increased risk of recurrence within the first two postoperative years but does not increase the risk of neovascular glaucoma. The severity of baseline proliferative disease, particularly the degree of traction, is a more critical determinant of postoperative complications than the surgical strategy regarding the lens. This supports tailoring the surgical approach based on individual patient cataract status and retinal pathology.

Background: To evaluate the accuracy and readability of answers to common retinitis pigmentosa (RP) questions from the popular generative artificial intelligence (AI) chatbots ChatGPT-4 and Gemini-2.0.

Methods: In March 2025, frequently asked questions about RP was entered to Google search tool, and the websites appearing on the first search page were selected for enrollment in the study. ChatGPT-4 and Gemini-2.0 were then prompted to generate responses about RP in both standard and simplified formats. To generate the simplified response, the following request was added to the prompt: 'Please provide a response suitable for the average American adult, at a sixth-grade comprehension level.' The AI chatbots' responses to 30 questions about RP, frequently asked by patients, were evaluated by two ophthalmologists using a five-point Likert scale, with scores ranging from 1-5. Additionally, 8 readability indices, including Average Reading Level Consensus Calculator (ARLC), Automated Readability Index (ARI), Flesch Reading Ease (FRE), Gunning Fog Index (GFOG), Flesch-Kincaid Grade Level (FKGL), Coleman-Liau Index (CL), Simple Measure of Gobbledygook (SMOG), and Forcast Readability Formula (FRF) were calculated using an online calculator, Readabilityformulas.com, to assess the ease of comprehension of each answer.

Results: No significant difference showed in accuracy both standard and simplified AI chatbot responses (p = 0.557, p = 0.090). In particular, almost all readability indices suggest that standard AI chatbot responses require a higher level of education for comprehension, whereas simplified responses require a lower level of education. Although Gemini-2.0 standard responses were more readable than ChatGPT-4 standard responses according to ARI, GFOG and FRF scores (p = 0.014, p = 0.040, and p = 0.001), Gemini-2.0 simplified responses were more readable than ChatGPT-4 simplified responses solely according to FRF scores (p = 0.016).

Conclusions: This study shows that ChatGPT-4 and Gemini-2.0 can provide patients with an avenue to access comprehensive and accurate information about, tailored RP to their educational level.

Background: We evaluated the clinical outcomes of selective retina therapy (SRT) in patients with central serous chorioretinopathy (CSC) who had nonconforming focal choroidal excavations (FCEs).

Methods: Among the 204 patients with chronic CSC who underwent SRT between June 2023 and February 2025, six patients (2.9%) with nonconforming FCEs were analyzed. Using a Q-switched Nd: YLF 527-nm laser device, SRT was applied at leaking points or in leakage areas according to the features observed on fundus fluorescein angiography. The mean best-corrected visual acuity (BCVA), central foveal thickness (CFT), subfoveal choroidal thickness height, and mean deviation (MD) of retinal sensitivity were measured during the follow-up period.

Results: Among the six patients, five patients showed complete subretinal fluid (SRF) resolution, while one patient demonstrated minimal persistent SRF during the follow-up period. Four patients showed an improvement in BCVA, while BCVA remained unchanged in the other two patients. All patients showed improvement in the MD of retinal sensitivity during the follow-up period. Among the six patients, two patients showed complete SRF resolution after a single session of SRT, while the other four patients required multiple SRT sessions. No SRT-related adverse events were observed during the follow-up period.

Conclusion: SRT produced favorable outcomes in the treatment of patients with CSC and nonconforming FCEs.

Objective or purpose: To evaluate the diagnostic performance and agreement of the EyeArt^® Artificial Intelligence (AI) system for detecting Diabetic Retinopathy (DR), comparing its results with ophthalmologists' assessments in a regional screening program.

Design: Cross-sectional observational study.

Subjects, participants, and/or controls: A total of 498 diabetic patients aged 18 years or older were enrolled between June and September 2023 through the Retisalud DR screening program in the Canary Islands. No separate control group was included.

Methods: All participants underwent non-mydriatic fundus photography using the TRC-NW400 camera. Retinal images were analyzed by the EyeArt^® AI system (version 2.1.0), and results were compared with assessments by ophthalmologists based on the International Clinical Diabetic Retinopathy scale (ICDR). Agreement was quantified using Cohen's kappa coefficient. Additionally, mixed-effects logistic regression was used to explore associations between DR and clinical risk factors.

Main outcome measures: Sensitivity, specificity, and agreement (Cohen's kappa) of the AI system compared to clinical diagnosis; predictors of DR such as age, diabetes duration, presence of Diabetic Macular Edema (DME), and central retinal thickness (CRT-OCT).

Results: The EyeArt® system achieved a binocular sensitivity of 100% (95% CI: 98.1-100) and a specificity of 93.5% (95% CI: 90.2-96.0). Agreement with ophthalmologist grading was excellent, with kappa values of 0.966 (right eye) and 0.978 (left eye). Younger age, longer diabetes duration, DME presence, and higher CRT were significantly associated with DR diagnosis.

Conclusions: The EyeArt^® AI system showed excellent diagnostic accuracy and strong agreement with clinical evaluations in DR screening. Nonetheless, its tendency to overestimate DR severity indicates the need for further refinement of its grading algorithm. These findings support the potential integration of AI systems into large-scale DR screening programs, pending further validation.

Purpose: This study assessed the short- and long-term outcomes of intravitreal (IVT) faricimab treatment in patients with neovascular age-related macular degeneration (nAMD) refractory to aflibercept. The main aim was to investigate whether faricimab might enable longer treatment intervals versus aflibercept through improved fluid control, evaluated through use of an artificial intelligence-based quantification tool to evaluate retinal fluid dynamics.

Methods: This observational cohort study involved patients with refractory nAMD who received at least three consecutive IVT aflibercept 2.0 mg injections before switching to IVT faricimab (with a four-month loading phase followed by a treat-and-extend regimen) due to persistent or recurrent disease despite 4-8-week treatment intervals. Functional and anatomical outcome measures were recorded, and fluid volume dynamics were quantified, at baseline, monthly to Month 4, and at Months 6, 9, and 12.

Results: Seventy-four eyes from 60 patients were included, with a mean ± standard deviation duration of prior aflibercept therapy of 24 ± 17 months. Fifty-two eyes completed 12-month follow-up. At Month 12, mean best-corrected visual acuity showed no significant change from baseline (+ 0.01 Early Treatment of Diabetic Retinopathy Study letters, p = 0.64). Significant reductions in mean central retinal thickness (- 80.8 μm, p = 0.0001) and maximal pigment epithelium detachment (PED) height (- 28.2 μm, p = 0.011), were observed at Month 4 and maintained to Month 12. Mean fluid volumes (intraretinal fluid [IRF], subretinal fluid [SRF]), and PED decreased significantly at Month 4 (- 26.3 nL, p = 0.007; -41.5 nL, p = 0.0001; and - 175.4 nL, p = 0.0001, respectively). At Month 12, reductions in IRF and PED volumes were sustained. The maximal fluid-free interval increased from 4.4 weeks, prior to switching to faricimab, to 6.5 weeks (p = 0.001) after switching, while mean last treatment interval improved from 5.0 ± 1.4 weeks at baseline to 7.3 ± 2.6 weeks at month 12 (p < 0.0001).

Conclusion: Faricimab may offer a valuable alternative for patients with refractory nAMD. The use of four loading injections administered monthly, followed by a treat-and-extend regimen can result in maintenance of visual acuity and improve anatomical parameters and retinal fluid activity, allowing for longer treatment intervals.