International Ophthalmology Clinics最新文献

Retinoblastoma is considered a prototype pediatric malignancy as retinoblastoma research has been instrumental in advancing our knowledge of cancer genetics, tumor suppressor genes, and the development of new treatment approaches. Also, retinoblastoma boasts one of the highest survival rates among pediatric cancers, with survival rates often exceeding 90% in developed countries. The research focus is shifting towards improved globe and vision salvage. Also, there is emphasis on advancing treatments that are tailored based on individual patient characteristics, including tumor genetics and molecular markers, to improve outcomes and minimize side effects.

Introduction: In eyes with retinal hemangioblastomas (RH), vision loss may occur despite treatment due to recurrent macular edema, macular pucker, vitreous hemorrhage, and exudative, tractional, or combined retinal detachment. Pars plana vitrectomy (PPV) plays a critical role in managing these complications. This review aims to evaluate the outcomes of PPV in patients with RH.

Methodology: We searched PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Google Scholar, and Web of Science (2000 to 2025) using the keywords "retinal hemangioblastoma," "capillary hemangioblastoma," "von Hippel-Lindau retina," combined with "vitrectomy," or "pars plana vitrectomy." Given the rarity of the condition, retrospective case series were included if they had ≥4 cases. Single anecdotes and non-English articles were excluded. Two independent reviewers evaluated the studies for qualitative and quantitative synthesis.

Results: Our search yielded 120 results, of which eight studies published between 2011 and 2024 met the inclusion criteria. All were retrospective case series (level IV evidence). A total of 107 eyes from 102 patients were analyzed, with sample sizes ranging from 4 to 23 eyes. Anatomic success, defined as retinal reattachment, ranged from 70% to 100% by final follow-up. However, many eyes remained in the low vision range despite anatomic success.

Conclusions: New tumor development and proliferative vitreoretinopathy (PVR)-related complications remain key challenges in long-term management. While the evidence is limited due to study design and sample size, consistent trends across the literature suggest PPV is anatomically effective, though visual outcomes remain guarded.

Retinal imaging plays a critical role in the detection and management of proliferative diabetic retinopathy (PDR). Commonly used imaging modalities in the retina clinic include ultra-widefield fundus photography, ultra-widefield fluorescein angiography (FA), and optical coherence tomography (OCT). OCT angiography (OCTA) provides a noninvasive method to assess the retinal microvasculature and detect vascular alterations, including retinal neovascularization (NV). More recently, the emergence of expanded field swept-source OCTA (SS-OCTA) has offered faster en-face and cross-sectional imaging of the retina with a broader field of view. Prior reviews have highlighted the role of SS-OCTA in assessing associated lesions of PDR, including NV, microaneurysms, foveal avascular zone, intraretinal microvascular abnormalities, and capillary non-perfusion. In this review, we explore the clinical applications of expanded field SS-OCTA in characterizing NV morphology, comparing NV detection to FA, and offering potential imaging biomarkers associated with vision-threatening complications of PDR, including vitreous hemorrhage, neovascular glaucoma, and tractional retinal detachment.

Immunoglobulin G4-related disease (IgG4-RD) comprises a spectrum of inflammatory conditions characterized by lymphoplasmacytic infiltration by IgG4+ plasma cells, resultant tumefactive lesions at various locations in the body, storiform fibrosis, and elevated serum IgG4 levels. IgG4-related ophthalmic disease (IgG4-ROD) can occur in isolation or in conjunction with systemic findings. The most common manifestations of IgG4-ROD are dacryoadenitis and eyelid edema, though patients may also have trigeminal nerve enlargement, extraocular muscle involvement, and other orbital soft tissue lesions and inflammation. Workup is multifactorial and should include full body imaging, serum IgG4 levels, and biopsy, which must include staining for IgG4+ plasma cells and may show hallmark storiform fibrosis and/or obliterative phlebitis. IgG4-ROD can be misdiagnosed due to potential clinical, radiographic, and histopathologic overlap with other orbital inflammatory conditions; however, the presence of infraorbital or supraorbital nerve enlargement on imaging, as well as biopsy with strong levels of IgG4 histochemical staining, can be helpful in distinguishing IgG4-ROD from other orbital inflammatory pathology. Steroids are typically first-line treatment, although given high rates of recurrence, patients may require concurrent or subsequent treatment with steroid-sparing agents, most commonly rituximab.

Immune reconstitution inflammatory syndrome (IRIS) describes a hyper-inflammatory state, often manifesting as paradoxical worsening of opportunistic or latent infections, in patients with previously suppressed immune systems who undergo treatment. Ocular IRIS is known as immune recovery uveitis (IRU), a challenging complication that can occur in patients with a compromised immune system, particularly those with human immunodeficiency virus (HIV) infection who initiate highly active antiretroviral therapy (HAART). IRU primarily manifests as posterior segment inflammation with vitritis, resulting in reduced vision and floaters in the affected eye. This review article aims to provide a comprehensive overview of immune recovery uveitis, encompassing its pathophysiology, clinical manifestations, diagnostic approaches, management strategies, and future prospects. Understanding IRU is crucial for ophthalmologists, infectious disease specialists, and other health care professionals involved in the care of individuals with HIV/AIDS, as timely intervention can help prevent vision-threatening complications and improve patients' quality of life.

Laser vision correction through lamellar refractive corneal surgery, such as laser-assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE), have increased in popularity given new technologies and increased patient preference for corrective lens independence. However, these surgeries are not without potential postoperative complications. Diffuse lamellar keratitis (DLK), central toxic keratopathy (CTK), and transient light sensitivity syndrome (TLSS) comprise 3 rare, noninfectious, inflammatory complications after corneal lamellar refractive surgery that differ in their clinical presentation. DLK has the most potentially severe vision-threatening outcomes and is associated with clinical findings of white, granular cells in the stromal interface. CTK is associated with the triad of central corneal opacification, central striae, and hyperopic shift. TLSS has no findings on slit lamp examination. While both DLK and TLSS are responsive to topical steroids, CTK improves without intervention. It is important to distinguish the 3 syndromes, as proper diagnosis may provide insight into the underlying cause of the patient's symptoms and thus guide treatment.

The rise of artificial intelligence has ushered in a wave of interest and research on its potential applications in ophthalmology, including oculoplastic surgery. This review summarizes current efforts to incorporate artificial intelligence in the management of various oculoplastic conditions, including eyelid neoplasms, blepharoptosis, thyroid eye disease, orbital fractures, orbital lesions, nasolacrimal duct obstruction, as well as patient education and counseling.

Recent advances in gene therapy and salient features of the current AMD therapeutic landscape have led to increased interest in applying gene therapy approaches to AMD. This review will discuss approaches to drug administration, viral and non-viral delivery vectors, and current trials in gene therapy for both wet and dry AMD. Drug administration routes include subretinal, intravitreal, and suprachoroidal approaches. Viral vectors include adenoviral, lentiviral, and adeno-associated viral (AAV) vectors. Non-viral vectors include lipid nanoparticle (LNP) and polymer-based vectors. Current trials in wet AMD include ADVM-022 and RGX-314. Current trials in dry AMD include GT-005 and JNJ-1887.

Advances in laser-based corneal refractive surgery have allowed for a diverse array of surgical options available to patients seeking vision correction and contact lens/glasses-free independence. The most common laser-based corneal refractive surgeries include laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE). Although advancements in technology have been made, select clinical challenges such as higher-order aberrations, postoperative ectasia, diffuse lamellar keratitis (DLK)/central toxic keratopathy (CTK), and pressure-induced interlamellar stromal keratitis (PISK) remain as postrefractive issues to be addressed in laser-based corneal refractive surgery. Recent improvements in preoperative evaluation, the development of instrumentation to measure and treat higher-order optical aberrations, and new techniques for the treatment of presbyopia all serve as unique avenues for innovation in the field. Despite its many advances, laser-based corneal refractive surgery has specific clinical limitations that may be better addressed through lens-based refractive techniques.

The increasing prevalence of diabetes mellitus has emerged as a major global health concern. Persistent hyperglycemia can cause complications through vascular damage, delayed tissue healing, and immune regulatory dysfunction. There is evolving research suggesting that corneal tissue from donors with diabetes may be associated with an increased risk of graft rejection in corneal transplantation. Currently, the impact of donor diabetes status on graft survival is widely debated and the literature lacks conclusive evidence. As such, this review aims to present the current literature on the effect of diabetes on the corneal microenvironment and the impact of the donor diabetic state on corneal transplant outcomes.