International Journal of Retina and Vitreous最新文献

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.

Background: As myopia reaches epidemic levels worldwide, its role in driving vision-threatening retinal complications is increasingly urgent. This study quantifies the burden of myopia by examining its association with key retinal diseases and how risk escalates with increasing severity.

Methods: We conducted a retrospective cohort study using the STARR clinical data warehouse, including all patients with ≥ 1 documented eye visit. Myopia severity was defined by spherical equivalent and axial length, classifying patients as non-myopic, myopic, highly myopic, or severely myopic. Primary outcomes included six retinal diseases associated with myopia: choroidal neovascularization (CNV), myopic macular degeneration (MMD), foveoschisis, macular hole (MH), rhegmatogenous retinal detachment (RRD), and foveal retinal detachment (FRD). Adjusted logistic regression estimated odds by myopia severity and spherical equivalent. Mean age at diagnosis was compared across groups.

Results: Retinal complications occurred at younger ages with increasing myopia severity. Compared to non-myopes, myopic, highly myopic, and severely myopic patients had 2.45 (95% CI: 2.36-2.55), 2.46 (95% CI: 2.31-2.62), and 8.15 (95% CI: 7.17-9.27) times higher odds, respectively, of developing any retinal complication. Per diopter increase in myopia, the odds of each complication increased: CNV (OR 1.11; 95% CI: 1.09-1.12), MMD (OR 1.22; 95% CI: 1.18-1.25), foveoschisis (OR 1.22; 95% CI: 1.16-1.28), MH (OR 1.06; 95% CI: 1.05-1.08), FRD (OR 1.23; 95% CI: 1.16-1.32), and RRD (OR 1.10; 95% CI: 1.10-1.11). In severe myopes, odds were markedly elevated: CNV (OR 22.90), MMD (OR 60.19), foveoschisis (OR 102.98), MH (OR 6.69), FRD (OR 22.72), and RRD (OR 6.84).

Conclusions: Myopia is independently associated with higher odds of retinal diseases, and this risk increases incrementally with severity. These findings support a dose-response relationship and highlight the importance of early risk stratification, tailored monitoring, and timely referral in patients with high and severe myopia.

Introduction: Macular edema, a major cause of vision loss in diabetic retinopathy, involves retinal fluid accumulation and retinal thickening due to vascular dysfunction and inflammation. Standard treatments include anti-VEGF agents, corticosteroids, and laser photocoagulation, but limitations such as incomplete response and adverse effects exist. Statins, known for lipid-lowering and pleiotropic anti-inflammatory effects, have emerged as a potential therapeutic option.

Methods: We conducted a systematic review and meta-analysis registered with PROSPERO (CRD420251082672) following PRISMA guidelines. Peer-reviewed studies evaluating statins' efficacy and safety in macular edema were identified via multiple databases up to May 2025. Included studies encompassed randomized controlled trials and observational studies involving patients with macular edema treated with statins versus controls. Key outcomes were hard exudate reduction, retinal thickness, visual acuity, diabetic retinopathy progression, and safety.

Results: Ten eligible studies involving atorvastatin and simvastatin showed statins significantly reduced hard exudates (risk ratio 4.42, p=0.03) and retinal thickness, with a 58% reduction in diabetic retinopathy progression. Statins also decreased the need for laser treatment by 32%. Visual acuity improvement was inconsistent, with benefits mainly in dyslipidemic patients. Safety analysis revealed no significant increase in adverse events. Statin effects were more pronounced in patients with elevated lipid levels.

Conclusion: Statins demonstrate promising anatomical and preventive benefits in diabetic macular edema, particularly in patients with dyslipidemia, by reducing lipid exudation and stabilizing retinal vasculature. Despite limited visual acuity improvement, their favorable safety profile supports considering statins as adjunctive therapy. Further large-scale, long-term trials are warranted to confirm these findings and optimize treatment protocols.

Background: Chatbots powered by large language models have shown promising results when addressing medical queries, thus transforming access to medical information. Although these chatbots produce detailed and accurate responses, it is unclear how they perform when handling real, unedited patient questions, particularly in non-English languages. This study aimed to assess the readability, accuracy, and comprehensiveness of responses to retinal disease queries provided by four chatbots (ChatGPT 4.0, ConsensusGPT, Gemini, and Claude 3) compared to responses from retina specialists.

Methods: In this cross-sectional, comparative, and blinded study, twenty unedited questions about retinal diseases were randomly selected from a popular online video channel in Portuguese. The questions were submitted to the four selected chatbots and retina specialists with fellowship training. Two independent retinal experts evaluated the responses using standardized Likert scales for accuracy and completeness. Readability was assessed using the Flesch Reading Ease Score and the Flesch-Kincaid Grade Level tests. Additional metrics, including word count and response generation time, were analyzed. Data were compared among groups using non-parametric statistical tests, including the Kruskal-Wallis test with Dunn's pairwise comparisons and chi-squared tests, with a two-sided p-value threshold of 0.05 for statistical significance.

Results: Retinal specialists and the Gemini chatbot produced responses with higher readability, indicating lower educational levels were needed for comprehension. In contrast, ChatGPT 4.0, ConsensusGPT, and Claude 3 delivered more detailed and accurate answers but required a higher reading level. ChatGPT 4.0 and ConsensusGPT achieved superior quality and comprehensiveness ratings compared to human experts and the other chatbots. Additionally, all AI systems generated responses significantly faster than the human specialists. Evaluators could correctly distinguish between human-generated and AI-generated responses in most cases.

Conclusions: Artificial intelligence chatbots demonstrate considerable promise for rapidly disseminating accurate medical information directly to the end-user, not only in English. However, optimizing the simplicity of their language is essential to ensure that detailed responses remain accessible to a broad audience. Future research should aim to replicate our findings with larger datasets of questions with the goal of refining these systems to balance comprehensive content with user-friendly language.

Background: To report the clinical course and outcomes of a surgical approach for progressive severe stellate non-hereditary idiopathic foveomacular retinoschisis (SNIFR) using pars plana vitrectomy (PPV).

Methods: Multi-center, consecutive, interventional case series. Patients with a diagnosis of SNIFR presenting with progressive loss of vision between January 1, 2017 and January 1, 2023. Evaluation of ophthalmologic findings and multimodal ocular imaging at the time of diagnosis, surgical procedure, and of visual and anatomic outcomes postoperatively. The main outcome measures evaluated include best corrected visual acuity (BCVA), central macular thickness (CMT), and findings on optical coherence tomography (OCT).

Results: Seven patients diagnosed with SNIFR were included. Median age in years at the time of diagnosis was 64 (range, 46-77). Four patients were female, and three were male. Genetic testing for mutations in retinoschisin 1 (RS1) and for other inherited conditions associated with foveomacular retinoschisis was negative. All patients demonstrated progressive and severe retinoschisis, as well as worsening vision loss and metamorphopsia when managed conservatively. PPV was performed and revealed anomalously broad and dense adherence of the posterior hyaloid in all eyes. The internal limiting membrane (ILM) was peeled in all but one case. Median BCVA at baseline measured 20/50, and declined to 20/70 at the time of surgery. Median preoperative CMT measured 561 μm, with OCT demonstrating prominent retinoschisis of the outer plexiform and outer nuclear layers. All eyes demonstrated postoperative resolution of retinoschisis and subretinal fluid, with corresponding improvements in both BCVA and subjective central visual distortion up to six months after surgery. BCVA for the entire cohort improved to a median of 20/30, and with a corresponding decrease in CMT to a median of 240 μm.

Conclusion: PPV is an effective surgical intervention resulting in anatomic resolution of retinoschisis and improved functional vision in eyes with progressive and severe SNIFR.