International Journal of Retina and Vitreous最新文献

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.

Background: To describe a case of inadvertent methylene blue use during pars plana vitrectomy (PPV) for an epiretinal membrane (ERM).

Case: A 69-year-old man presented with 1 day of severe vision loss in his left eye. Two days prior to presentation, he had undergone PPV that was complicated by accidental methylene blue use. Visual acuity (VA) at presentation to our institution was CF from his baseline VA of 20/60. Optical coherence tomography (OCT) demonstrated diffuse hyperreflectivity and thickening of the inner retinal layers. The patient was started on oral prednisone with no improvement. On postoperative month 1, VA was HM. OCT showed disruption of the inner retinal architecture, inner retinal layer thinning and focal disruption of the outer retina layers superiorly.

Conclusion: Methylene blue may be associated with severe retinal toxicity. Given its similarity to other vital dyes in ophthalmology, care must be taken to avoid its inadvertent administration.

Background: Retinal vein occlusion (RVO) is a leading cause of vision loss, yet there are inconsistent risk estimates related to risk factors. Mendelian randomization (MR) uses genetic variants as proxies for lifelong exposure and can clarify causal pathways for RVO. We aimed to systematically review MR studies to identify causally supported systemic and ocular risk factors for RVO.

Methods: Four databases (PubMed, Embase, Scopus, and Web of Science) were searched from inception to June 2025 for peer-reviewed MR studies evaluating modifiable systemic or ocular risk factors in relation to any form of RVO utilizing GWAS data. Narrative synthesis was undertaken as methodological heterogeneity precluded meta-analysis. All effect estimates (ORs) were extracted directly from individual studies and robustness of evidence for each exposure across studies was assessed as robust, probable, suggestive, insufficient, and non-evaluable based on significance and direction of evidence.

Results: Twelve two-sample MR studies, all conducted in European cohorts, met inclusion criteria. Ocular traits showed the most consistent signals: higher intraocular pressure (RVO (OR = 1.53, 95% CI: 1.0402.26) and glaucoma liability (OR = 1.31, 95% CI: 1.18-1.45) were robustly associated with greater risk of RVO. Among cardiovascular factors, elevated blood pressure/hypertension liability demonstrated probable evidence of increased RVO risk (OR = 1.58, 95% CI: 1.34-1.85), whereas lipid profiles yielded mixed signals, with some support for higher LDL (OR = 1.23, 95% CI: 1.05-1.44) and total cholesterol (OR = 1.44, 95% CI: 1.08-1.92) effects. For metabolic factors, glycemic traits showed probable to robust evidence with fasting glucose (OR = 5.01, 95% CI: 2.00-12.55) and two-hour glucose (OR = 3.17, 95% CI: 1.63-6.18) associated with higher RVO risk. Similarly, type 2 diabetes liability showed probable evidence (OR = 2.82, 95% CI: 2.07-3.85); anthropometric measures offered probable to robust support with body mass index (OR = 1.94, 95% CI: 1.23-3.08) and waist circumference (OR = 2.40, 95% CI: 1.36-4.24) associated with RVO. In other domains, selected coagulation and platelet traits showed probable-robust signals, vitamin D evidence was insufficient, and gut microbiota instruments provided preliminary robust evidence for Bacilli and Family XIII AD3011 association with RVO.

Conclusion: Genetic evidence supports a multifactorial vascular-metabolic model for RVO in which elevated IOP, glaucoma, hypertension, adiposity, and acute hyperglycemia are genetically supported risk factors. These findings highlight blood-pressure control, weight management, and glycemic regulation as important prevention targets and underscore the need for ancestry-diverse MR studies with refined phenotyping.