International Journal of Retina and Vitreous最新文献

Background: Preoperative optical coherence tomography (OCT) biomarkers may help predict visual outcomes after idiopathic epiretinal membrane (ERM) surgery. Artificial intelligence (AI) enables automated, quantitative analysis of retinal structure, potentially improving prognostication.

Methods: In this multicenter, retrospective study, patients with idiopathic ERM who underwent pars plana vitrectomy (PPV) were included. Preoperative OCT volume scans were analyzed using an AI-based platform (Discovery OCT Biomarker Detector; RetinAI AG) to quantify retinal layer thicknesses and fluid biomarkers within the central 1 mm Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Extracted features included outer nuclear layer (ONL), combined photoreceptor and retinal pigment epithelium complex (PR + RPE), retinal nerve fiber layer (RNFL) thickness, and intraretinal fluid (IRF) volume. A random forest classifier was used to evaluate the importance of these biomarkers in predicting 12-month best-corrected visual acuity (BCVA), categorizing patients as significant improvers (≥ 0.2 logMAR gain) or minimal/non-responders.

Results: A total of 71 eyes were analyzed. Mean BCVA improved from 0.51 ± 0.41 to 0.25 ± 0.33 logMAR at 12 months postoperatively (P < 0.001). Thinner preoperative ONL thickness was strongly associated with worse final BCVA (r = - 0.54), while thicker RNFL (r = 0.28) and greater IRF volume (r = - 0.26) were also linked to poorer outcomes. The random forest model achieved an area under the curve (AUC) of 0.71 for predicting visual improvement, identifying PR + RPE thickness, RNFL thickness, and ONL thickness as the most influential predictors.

Conclusions: Preoperative AI-derived OCT biomarkers, particularly indicators of outer retinal thinning and inner retinal thickening, are associated with limited visual recovery following ERM surgery. Integration of automated biomarker analysis into preoperative assessment may help identify patients at higher risk of suboptimal postoperative vision, informing surgical decision-making and patient counseling.

Background: To evaluate postoperative outcomes, including redetachment rates, in eyes with rhegmatogenous retinal detachment (RRD) following early or late removal of silicone oil (ROSO).

Methods: This retrospective single-center study included 58 pseudophakic eyes that underwent 23-gauge pars plana vitrectomy (PPV) with silicone oil endotamponade (SOE). Patients were divided into two groups: Group I (ROSO ≤ 12 weeks) and Group II (ROSO > 12 weeks) with SOE duration of 2.3 +/- 0.7 months and 5.2 +/- 1.9 months, respectively. Clinical outcomes, including redetachment rates, best corrected visual acuity (BCVA), cystoid macular edema (CME), epiretinal membrane (ERM) formation, and intraocular pressure (IOP) changes, were analyzed. Kaplan-Meier estimation and Log-Rank tests were used to assess redetachment.

Results: Redetachment occurred in a total of 13 eyes (22% of patients) (Group I: 7 (21%), Group II: 6 (23%); p = 1.00). The cumulative incidence of redetachment was comparable between groups (Log-Rank test: p = 0.88). Final BCVA at the last follow-up showed no significant difference between Group I (0.8 ± 0.5 logMAR) and Group II (0.8 ± 0.7 logMAR; p = 0.36). Postoperative incidences of CME (Group I: 13 (41%), Group II: 9 (35%) p = 0.78), ERM (Group I: 13 (41%), Group II: 7 (27%) p = 0.40), and elevated IOP (Group I: 7 (22%), Group II: 7 (27%) p = 0.76) were also comparable between groups.

Conclusions: Early ROSO (≤ 3 months) does not appear to increase the risk of retinal redetachment or adversely affect visual and anatomical outcomes. These findings support the feasibility of earlier ROSO in selected cases, potentially reducing the risk of silicone oil-related complications.

Objective: To detect and quantify intermittent capillary perfusion using optical coherence tomography angiography (OCTA) in patients with branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), proliferative diabetic retinopathy (PDR), and healthy control eyes.

Methods: OCTA images were acquired from patients with BRVO(n = 9), CRVO(n = 8), PDR(n = 8) and healthy controls(n = 10). Five 6 × 6 mm scans were registered and averaged at baseline (T0) and thirty minutes after (T30) into single en-face images of the superficial and deep vascular complexes (SVC and DVC). Pixels were labeled as vessel or non-vessel using a previously published machine learning model. Loss of Perfusion (LoP) was defined as the percentage of vessel pixels present in T0 image that disappeared at T30, and Gain of Perfusion (GoP) was defined as the percentage of vessel pixels that appeared in T30 image. The amount of intermittent capillary perfusion was the sum of GoPLoP.

Results: Patients with PDR, CRVO and BRVO showed significantly higher GoPLoP values than controls in both the macular and temporal regions. The temporal region generally exhibited significantly greater GoPLoP values than the macular region. Layer analysis indicated a significantly higher GoPLoP within the DVC compared to the SVC. There was a significant negative correlation between perfusion density and perfusion variability.

Conclusion: Our results demonstrate higher GoPLoP in BRVO, CRVO, and PDR patients compared to controls. This measure may be utilized as a novel biomarker of tissue hypoxia. Further studies are necessary to better elucidate the role of GoPLoP in monitoring disease progression and treatment efficacy of retinal vascular diseases.

Aim: Chronic Persistent Diabetic Macular Edema can be a clinical challenge. The aim of this study is to assess the outcomes of intravitreal brolucizumab 6 mg/0.05 ml for persistent diabetic macular edema (P-DME) in a real-world clinical setting.

Methods: A prospective interventional trial of consecutive patients with P-DME was conducted at a tertiary care center in India. P-DME was defined as edema persisting despite more than three intravitreal anti-VEGF injections or despite a combination of anti-VEGFs, intravitreal steroids and/or laser photocoagulation. The change in visual acuity (VA), central retinal thickness (CRT) and any incidences of adverse effects were analyzed.

Results: 19 eyes of 13 patients received a mean of 3.3 injections at a mean interval of 11.1 weeks. The median VA improved from 0.40 logMAR (20/50) to 0.35 logMAR (20/44) after a mean period of 13 weeks after the last injection, which was statistically significant (p = 0.004). The CRT reduced from 517 microns to 237 microns (p = 0.001). One patient had an episode of intraocular inflammation, which was treated successfully with topical steroids. The same patient again received brolucizumab with no recurrent inflammation.

Conclusions: Intravitreal brolucizumab helped improve visual acuity in patients with P-DME and achieved a reduction of 54.1% in the CRT at a longer mean reinjection interval. The rate of intraocular inflammation was 5.2% without any permanent visual impairment.