Journal of VitreoRetinal Diseases最新文献

Purpose: To describe the clinical features and treatment outcomes of patients with retinal vasoproliferative tumors. Methods: This retrospective case series comprised patients diagnosed with a retinal vasoproliferative tumor. Electronic medical records were reviewed, and patients' demographic details, clinical presentation, and treatment outcomes were analyzed. Results: Nineteen eyes of 19 patients with vasoproliferative tumors were included. The mean age (±SD) at presentation was 37.0 ± 16.95 years. No eye had bilateral tumors, and 1 eye had multiple tumors. Three eyes (15%) had primary tumors, while 16 (84%) had secondary tumors. Primary tumors mainly affected the inferotemporal quadrant (n = 3). Secondary tumors involved the inferior quadrant (n = 4), inferotemporal quadrant (n = 5), and inferonasal quadrant (n = 5). Secondary tumors were associated with Coats disease (n = 6), intermediate uveitis (n = 3), traumatic chorioretinopathy (n = 2), familial exudative vitreoretinopathy (n = 2), retinal vasculitis (n = 2), and retinal vascular occlusion (n = 1). Retinochoroidal features included intraretinal and subretinal exudates, subretinal fluid, intraretinal hemorrhaging, vitreous hemorrhaging, cystoid macular edema, vitritis, preretinal fibrosis, dilated feeding vessel, epiretinal membranes, and tractional retinal detachment. Treatment modalities included cryotherapy, laser photocoagulation, and local steroids. The mean follow-up was 25.3 months, during which 18 eyes had tumor regression and 1 had a worsening condition. Conclusions: Secondary vasoproliferative tumors were more frequently observed than primary tumors, often presenting as unilateral, unifocal tumors situated posterior to the equator in the inferior fundus. Conventional treatment approaches, such as cryotherapy and laser photocoagulation, were effective at tumor regression and often required multiple sessions.

Purpose: To present the first case of macular serpiginous choroiditis after COVID-19 infection. Methods: A single case was analyzed. Results: A 28-year-old previously healthy man presented with severe unilateral vision loss in the left eye. A fundus examination showed severe atrophic pigmentary changes that corresponded with optical coherence tomography (OCT) findings of a rapidly progressing amoeboid-like lesion disrupting the ellipsoid zone and retinal pigment epithelium. Multimodal imaging, including fundus autofluorescence, OCT angiography, and indocyanine green angiography, was supportive of serpiginous choroiditis. After a comprehensive systemic workup, the diagnosis of macular serpiginous choroiditis was confirmed. No improvement was seen with high-dose steroids; therefore, an immunosuppressive regimen was initiated. Conclusions: An exaggerated choroidal inflammatory response may be triggered by a COVID-19 infection, although causation cannot be inferred. Retinal manifestations should be considered when assessing patients presenting with visual symptoms after COVID-19 infection.

Purpose: To describe a patient with bilateral ischemic retinopathy, likely attributable to vascular occlusion induced by mantle cell lymphoma. Methods: A case and its findings were analyzed. Results: A 54-year-old man presented with an 11-month history of significant vision loss in both eyes. His medical history was significant for mantle cell lymphoma with no signs of intraorbital involvement on magnetic resonance imaging. At presentation, the visual acuity was 20/400 OD and counting fingers OS, with an unremarkable anterior segment examination. On fundoscopy, optic nerve pallor, sclerotic blood vessels, and cotton-wool spots were seen. Profound retinal nonperfusion and inner retinal layer loss were confirmed with fluorescein angiography and optical coherence tomography, with no signs of macular edema at the time of presentation. Conclusions: This report represents the first instance of bilateral ischemic retinopathy, likely originating from mantle cell lymphoma, presenting predominantly with ischemic retinal features and resulting in profound vision loss. With few cases documenting retinal involvement in mantle cell lymphoma, this report provides a better understanding of this rare pathology and its effect on retinal health.

Purpose: To evaluate the use of antivascular endothelial growth factor (anti-VEGF) as treatment for tractional retinal detachments (TRDs) involving the macula. Methods: A case report was evaluated. Results: A 40-year-old man with a medical history notable for congenital heart disease and proliferative diabetic retinopathy presented with decreased vision. Surgery was not feasible for medical reasons, and panretinal photocoagulation was limited by retinal traction and hemorrhage. Despite initial progression of bilateral macula-off, foveal-on TRDs, the patient received intravitreal (IVT) bevacizumab regularly every 8 to 12 weeks. After initial improvement, both eyes remained anatomically stable with attached foveas over more than 1.5 years of follow-up. Conclusions: In cases in which surgery is not possible, macula-involving TRDs with neovascularization can be managed successfully with repeated IVT anti-VEGF injection monotherapy.

Purpose: To characterize trends in service volume and inflation-adjusted Medicare reimbursement of vitreoretinal procedures over the past 2 decades. Methods: Medicare Part B National Summary Data Files were accessed to identify the number of allowed services for vitreoretinal procedures. The Medicare Physician Fee Schedule was accessed to identify average annual national reimbursement rates. The Spearman correlation coefficient was used to evaluate time trends for each procedure. All analyses were conducted using Prism 9.5.1 software with 2-sided significance testing and statistical significance set at P ≤ .05. Results: From 2000 to 2021, the 2-tailed Spearman correlation showed that 20 of 38 procedures had statistically significant decreases in service volume over time. Intravitreal injections increased more than 1000-fold, from 2922 in 2000 to 3 444 500 injections in 2021 (ρ = 0.997; P < .001). Panretinal photocoagulation treatments declined from 104 865 to 48 533 procedures (ρ = -0.966; P = .003). Scleral buckling declined from 6502 to 587 procedures (ρ = -0.999; P < .001). Pars plana vitrectomy-associated procedures increased from 71 039 to 95 429 (ρ = 0.691; P < .001). From 2000 to 2021, the 2-tailed Spearman correlation showed that 29 of 38 procedures had statistically significant decreases in reimbursement over time. No procedure had a significant increase in payment. Conclusions: Vitreoretinal practice patterns have changed dramatically over the past 2 decades, with significant declines in inflation-adjusted Medicare reimbursement for most procedures. Awareness of service volume and reimbursement trends is vital to assessing economic viability and patient coverage under the current Medicare payment policies.

Purpose: To report a unique case of retinal exudation consistent with a Coats-like response and associated with mutations in LAMA1, confirming the diagnosis of Poretti-Boltshauser syndrome. Methods: A case and its findings were analyzed. Results: A 24-year-old woman presented with mild peripheral avascularity, circumferential membranes at the edge of the vascularized retina, exudation, numerous vessels with aneurysmal changes, and inferior retinal elevation in both eyes. Molecular Vision Laboratory panel testing (Molecular Vision Laboratory Corp) found 2 variants in the LAMA1 gene, confirming a diagnosis of Poretti-Boltshauser syndrome. Treatment with bevacizumab and sub-Tenon triamcinolone provided no improvement. Eventually, scleral buckling with pars plana vitrectomy was performed, which reattached the retina but did not improve visual acuity. Conclusions: This report shows the importance of investigating for an underlying genetic disorder in young patients with atypical exudation and abnormal vasculature and the persistent progression and challenging treatment course of patients presenting with Poretti-Boltshauser syndrome.

Purpose: To highlight the use of multimodal imaging for detecting and monitoring macular neovascularization (MNV) in the presence of focal choroidal excavation. Methods: A case and its findings were analyzed. Results: Spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA) were performed in a 30-year-old Asian woman with metamorphopsia in the left eye. Imaging showed striking MNV secondary to focal choroidal excavation, and an impressive response to antivascular endothelial growth factor therapy was seen throughout the follow-up. Conclusions: OCTA is a noninvasive, useful imaging modality for diagnosing and monitoring patients with MNV secondary to focal choroidal excavation.

Purpose: To present a case of a young adult with bilateral chronic posterior uveitis resulting from Vogt-Koyanagi-Harada (VKH) disease treated with mycophenolate mofetil who subsequently developed vitreoretinal lymphoma in the right eye. Methods: A case and its findings were analyzed. Results: A 34-year-old Hispanic woman presented with an 8-year history of chronic recurrent posterior uveitis in both eyes secondary to VKH disease. A vitreous infiltrate that was treatment resistant occurred in the right eye. Subsequently, a diagnostic vitrectomy was performed, and it was determined that the patient had developed unilateral vitreoretinal lymphoma. Conclusions: Masquerade syndromes should remain in the differential in patients with well-established uveitis who are on immunomodulatory treatment. A diagnostic vitrectomy should be considered when the treatment response is uncharacteristic. Furthermore, guidelines are lacking for central nervous system prophylaxis for isolated unilateral ocular intraocular lymphoma in young adults.

Purpose: To present a combined surgical approach for repair of a persistent full-thickness macular hole (MH) in patients with myopic traction maculopathy. Methods: Two cases were evaluated. Results: Combining a macular buckle and pars plana vitrectomy with a controlled subretinal injection of a balanced salt solution resulted in MH closure and vision improvement in both cases. Case 1 also had significant recovery of macular sensitivity on microperimetry evaluation. Conclusions: Retinal redetachment was avoided by using the buckle indentation to provide external support of the posterior pole, resulting in successful closure of the MH and improvement in functional outcomes.

Purpose: To describe a unique finding in ocular syphilis using multimodal imaging. Methods: A single case was analyzed. Results: A 52-year-old man presented with chronic syphilitic posterior uveitis and was treated with intravenous and intramuscular penicillin for systemic manifestations, topical steroids, and unilateral bevacizumab for secondary macular neovascularization. Bilateral transitory outer retinal microcysts were subsequently seen on optical coherence tomography, with an appearance distinct from outer retinal lesions found in other degenerative retinal diseases. Conclusions: Longstanding smoldering inflammation in this patient resulted in retinal pigment epithelial disruption and subsequent overlying photoreceptor rearrangement with microcyst formation. The spontaneous resolution and reappearance of these lesions elsewhere, despite previous treatment, may offer further insight into localized retinal tissue response from treponemal disease.