International Ophthalmology Clinics最新文献

Intravitreal injections have revolutionized the treatment of retinal diseases, yet there are possible complications, such as noninfectious intraocular inflammation, a complication that may threaten vision and mimic infectious endophthalmitis. This review synthesizes current knowledge on inflammation after intravitreal therapy, with particular focus on sterile intraocular inflammation and retinal vasculitis associated with anti-VEGF agents such as brolucizumab and newer complement inhibitors like pegcetacoplan. The pathogenesis is multifactorial, involving patient-specific immune responses, drug-specific properties including aggregation or impurities, and deviations in preparation or delivery techniques. Clinical presentations range from anterior uveitis and vitritis to occlusive retinal vasculitis. Visual outcomes vary and depend on prompt recognition and appropriate management. Epidemiologic data show variable incidence across agents, with brolucizumab demonstrating higher rates of inflammation compared with ranibizumab or aflibercept. Treatment includes corticosteroids and discontinuation of the offending agent, with rare cases requiring surgical intervention. As the therapeutic landscape expands, heightened awareness and standardized evaluation of postinjection inflammation are critical to improving safety and preserving vision.

After the first successful macular hole surgery performed by Kelly and Wendel in 1990, advances in surgical techniques and instrumentation have established pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade as the gold standard for macular hole treatment. Closure rates are widely regarded as over 90% with this approach. In cases of persistent or recurrent full-thickness macular holes (FTMHs), new surgical techniques have been pioneered over the past decade for holes with worse prognosis related to size, chronicity, myopia, prior unsuccessful surgery, or other factors. This review aims to summarize the surgical developments, outcomes, and rationale for 3 techniques: the inverted ILM flap, amniotic membrane grafting, and autologous retinal transplantation.

The human retina is a multilayered tissue with diverse embryological origins and is, therefore, a window for assessment of ocular, neurological, vascular, and other systemic conditions. Innovations in big data, particularly involving large population biobanks, have enabled improved data sets that facilitate a better understanding of connections between the retina and systemic health. Retinal fundus and optical coherence tomography imaging data provide rich resources for describing interpretable imaging endophenotypes and evaluating their utility as biomarkers for future ocular and systemic conditions. Furthermore, the addition of genomic data to retinal and ophthalmic information has enabled unbiased discovery of the biological mechanisms driving changes in the retina. Assessment of inherited common and rare variants influencing ocular phenotypes through genome-wide association studies, in silico analyses for gene prioritization, pathway enrichment analysis, and experimental validation may enable the identification of biological targets for therapeutic modulation of retinal microvascular indices, neuronal health, and other imaging biomarkers. Further development of polygenic risk scores for retinal phenotypes enables a personalized medicine approach to quantifying inherited disease risk for an individual. While interpretation of causality from observational associations is difficult, Mendelian randomization (MR) analyses utilizing genomics can help improve understanding of the causal relationship between different phenotypes. Given the routine, noninvasive nature of retinal imaging, the findings from retinal cross-phenotype and genome-wide analysis have the direct potential for application clinically including in diagnosis, monitoring and prevention, and in treatment of both ocular and systemic conditions.

Age-related macular degeneration (AMD) is a common neurodegenerative disease that results in significant morbidity and economic cost to patients and society. While advances in our understanding of the mechanisms of neovascularization have led to breakthrough vision-saving treatments for "wet" AMD, the "dry" variant of AMD, geographic atrophy, still poses significant clinical and scientific challenges. Many genetic and environmental factors have been linked with AMD, providing clues for understanding the disease mechanisms driving "dry" AMD. Evidence of neuroinflammation has been found across a wide spectrum of neurodegenerative diseases including AMD and therapies targeting inflammation, including recent complement inhibitors, have been investigated as treatments for "dry" AMD. Here we survey the evidence from human patients of the potential role of inflammation in AMD and review the efforts to treat AMD with therapeutic interventions targeting mediators of inflammation.

Private equity (PE) acquisition of ophthalmology practices has grown rapidly, reflecting broader trends in the consolidation of health care services. The driving force behind these acquisitions is the potential for high returns through operational efficiencies, increased bargaining power with insurers, and access to lucrative outpatient procedures. However, PE's impact on the quality and cost of ophthalmic care remains unclear. Studies show mixed results: some report increased use of expensive treatments and higher costs, while others suggest minimal changes in patient outcomes or spending. PE's appeal to ophthalmologists includes capital infusion for practice expansion and improved risk management, though concerns exist over profit-driven incentives possibly compromising patient care. The market for ophthalmology practices remains fragmented, with PE firms capitalizing on consolidation opportunities. Despite the growth, there are challenges to assessing the full impact of PE involvement, particularly due to limited research, nondisclosure agreements, and difficulty in selecting control practices for comparison. While PE acquisitions have been accelerating, recent reports indicate a slowdown in 2024, influenced by factors such as interest rates and federal investigations into the health care sector. The future of PE in ophthalmology will likely depend on market conditions, regulatory changes, and further research into its long-term effects on care quality and physician autonomy.

Paraneoplastic syndromes are a group of nonmalignant disorders caused by immunologic or nonimmunologic reactions in response to an underlying cancer. In the orbit and ocular adnexa, paraneoplastic syndromes can affect every structure. Early recognition of paraneoplastic syndromes can expedite diagnosis and improve outcomes for patients as they are often the first sign of potentially life-threatening malignancy. The purpose of this review is to characterize the paraneoplastic syndromes as they manifest in the periorbita and orbit.

Understanding of pediatric nonanterior noninfectious uveitis (NIU), including intermediate, posterior, and panuveitis, remains limited due to its low prevalence. This review will provide an overview of the demographic characteristics, risk factors and associations, clinical manifestations, diagnostic intricacies, therapeutic considerations, as well as complications associated with pediatric nonanterior NIU.

Decades of research and innovation have led to the development of modern keratoprostheses (KPros) designed to replace the function of the native human cornea. The Boston Keratoprosthesis (B-KPro) Type I remains the most widely used KPro worldwide. Ongoing refinements and modified versions of the B-KPro, as well as novel, fully synthetic devices, aim to enhance durability and biocompatibility, reduce complications, and expand accessibility to KPros across the globe. Innovative strategies such as immunomodulatory therapies, improved biomaterials, and novel drug delivery systems have been explored to address challenges such as retroprosthetic membrane formation, glaucoma, and infectious complications. This review provides an overview of currently available and emerging KPro technology and innovative strategies for preventing and managing KPro-associated complications.

Adamantiades-Behçet disease (ABD) is a chronic inflammatory disorder manifesting as systemic vasculitis, characterized by recurrent oral and genital ulcers, skin lesions, and uveitis. Much has been elucidated regarding immunopathogenesis since the initial identification of a strong genetic susceptibility related to a HLA-B51 variant. Current understanding of the disease involves a complex interplay between defective antigen processing, environmental triggers, and an altered balance between different components of the immune system. This review aims to comprehensively synthesize the immunogenetics and immunopathology of ABD, particularly concerning ocular involvement, summarizing the current understanding of the molecular mechanisms underlying the disease.

Microbial keratitis (MK) is the leading cause of corneal blindness and can be caused by several species of bacteria, fungi, or parasites. Accurate and timely identification of the causative microbe is critical for initiating targeted antimicrobial and anti-inflammatory treatment and preventing vision loss. MK diagnosis currently relies on corneal culture or microscopy, which have suboptimal yield and can produce inconclusive results. MK requires immediate treatment with empiric antimicrobials, followed by targeted treatment after the microbe is identified. The clinical utility of anti-inflammatory therapy in MK remains controversial and likely differs due to host- and microbe-specific factors. Newer diagnostic techniques such as whole genome sequencing, metagenomic deep sequencing, transcriptomics, and proteomics have the potential to greatly improve timeliness, accuracy, and precision when diagnosing and treating MK. Metagenomic deep sequencing can identify pathogenic microbes with comparable or superior accuracy to traditional microbiology techniques, enabling faster and more accurate diagnosis and initiation of appropriate treatment. Whole genome sequencing of corneal culture isolates has the potential to provide patient-specific insights about microbial phylogenetics, antimicrobial resistance genes, and virulence factors to enable more targeted antimicrobial therapy. Characterization of the host immune response using RNA sequencing or tear proteomics could help inform the use of tailored anti-inflammatory therapies to prevent corneal damage. Although most of these precision medicine approaches are in the research phase, they show the potential to customize MK treatment based on host and microbial factors and improve clinical outcomes.